Functional effects of alar cartilage malposition

Nasal airway obstruction is frequently synonymous with septal deviation or inferior turbinate hypertrophy. Less readily appreciated is the fact that the mobile lateral nasal wall caudal to the bony arch can obstruct the airway, particularly at the internal or external nasal valves. External valvular incompetence can result from postsurgical or congenital causes, among the most common of which is alar cartilage malposition. Twenty-seven patients with alar cartilage malposition in a series of 61 patients (44%) treated for airway obstruction from external nasal valvular incompetence comprise this report. Rhinomanometric data demonstrate an increase in total nasal airflow from 99 +/- 17 ml (mean +/- SEM) to 190 +/- 37 ml per 14 seconds after valvular correction. Patients in whom additional septal pathology was corrected nevertheless had no significant airflow improvement over patients with external valvular reconstruction alone. Treatment principles of valvular incompetence from alar cartilage malposition are given for primary and secondary rhinoplasty patients, among which is a composite conchal cartilage/skin graft that can reconstruct a functioning lateral crus and replace a vestibular skin deficiency. Interestingly, alar cartilage relocation to correct the malposition also narrows the alar base, even when no alar wedge resection is performed.