[The nasal valve area: structure, function, clinical aspects and treatment. Sulsenti's technic for correction of...

The nasal valve and nasal valve area are two entities which should not be confused. The nasal valve area is the narrowest portion of the nasal passage. It is bounded: medially by the septum; superiorly and laterally by the caudal margin of the upper lateral cartilage and its fibro-adipose attachment to the pyriform aperture ('empty triangle'); inferiorly by the floor of the pyriform aperture. The nasal valve, on the other hand, is the specific slit-like segment between the caudal margin of the upper lateral cartilage and the septum. From a physiological and surgical point of view, this distinction is fundamental. The nasal valve area is the site of the highest nasal resistance. Therefore, small deformities of the valve area may severely impair the dynamics of nasal air flow. Rhinomanometry and nasal endoscopy permit the best definition of valve pathophysiology. After having discussed the various surgical techniques reported in the literature, the authors present an original technique for the surgical correction of valvular deformities. It is completely performed through Cottle's hemitransfixion incision. The technique has several advantages: a) performance of only one incision, sufficient to visualize the entire nasal valve and cartilaginous vault, thus minimizing the risk of scar tissue formation; b) through the space thus created it is possible not only to correct the entire septum, but also to inspect and easily reach the structures constituting the nasal valve area; c) it is possible to use various types of grafts to support or reconstruct the valve area; d) it is possible to reach the key area as well as to do lateral osteotomies: all variations in shape and position of the nasal pyramid may be performed in order to normalize direction and pressures of nasal air flow: e) through the retrograde undermining of the lower lateral cartilages the resistance of the cul-de-sacs may be optimally adjusted; f) it is possible to change the shape, size and position of the nostrils as well as to properly correct the columella and naso-labial angle. The technique, therefore, permits maximum correction of valvular deformities with the concomitant functional modification of any abnormalities of the nasal pyramid.