Treating Nasal Valve Collapse in Facial Paralysis: What I Do Differently

Patients with facial paralysis require a systematic zonal assessment. One frequently overlooked region is the effect of facial paralysis on nasal airflow. Patients with flaccid paralysis experience increased weight of the cheek and loss of muscle tone in the ala and sidewall; this significantly contributes to nasal valve narrowing and collapse. These specific findings are often not adequately corrected with traditional functional rhinoplasty-grafting techniques. Flaccid paralysis typically results in inferomedial displacement of the alar base, which must be restored with suspension techniques to fully treat the nasal obstruction. Multiple surgical options exist and are discussed in this article.