Nasal valve dysfunction after Mohs surgery for skin cancer of the nose

The nasal valve is the narrowest part of the nasal vestibule and is an important regulator of airflow. Nasal valve insufficiency (NVI), which can be caused by nasal surgery, results in nasal stuffiness, or resistance to airflow on inspiration. This entity has not been well described in the dermatologic surgery literature.

To study nasal valve insufficiency in 100 consecutive patients who had Mohs surgery for skin cancer of the nose, review the literature, and report methods for prevention of this complication.

One hundred consecutive nasal Mohs surgery cases were studied retrospectively. Symptomatic patients were evaluated based on several parameters to determine causative and exacerbating factors, and possible methods of prevention. The pertinent literature was reviewed.

Out of 100 patients, 92 responded--38 (41.3%) of whom were determined to be "at risk" for NVI based on the anatomic location of their defects. Out of those 38, five (13.2%) had new onset nasal stuffiness. An additional three of the 38 (7.9%) reported an exacerbation of prior nasal obstructive symptoms. Healing by secondary intention, bulky flaps, inadequate cartilaginous support, inappropriate choice of flap, mucosal scarring, and sacrifice of nasalis and levator labii superioris alaeque nasi fibers were identified as contributors to postoperative NVI.

NVI is a relatively common complication of Mohs surgery and reconstruction of the lower third of the nose. Treatment is difficult, but prevention is possible in many instances. Therefore, surgeons should be well aware of this entity and techniques that may aid in its prevention.