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Continued Learning
September 2013

A Patient With Nasal Valve Compromise

Author Affiliations
  • 1Department of Otorhinolaryngology, Albert Einstein College of Medicine, Bronx, New York, New York
  • 2Montefiore Medical Center, Bronx, New York, New York
  • 3Department of Otolaryngology, Columbia College of Physicians and Surgeons, St Luke’s Roosevelt Hospital, New York, New York
JAMA Otolaryngol Head Neck Surg. 2013;139(9):947-950. doi:10.1001/jamaoto.2013.4163

A 45-year-old woman presented with a complaint of nasal airway obstruction and a history of aesthetic rhinoplasty at age 20 years. She had been initially happy with the appearance of her nose, but over time, she felt that her nose had adopted a narrow, “pinched” appearance. She also noted gradually worsening nasal airway obstruction. After a 3-month trial of medical therapy failed, the patient was referred for further evaluation. Physical examination revealed a narrow middle one-third of her nose and deep alar grooves (Figure 1). Anterior rhinoscopy showed a severe S-shaped septal deviation, worse on the left side. Rigid nasal endoscopy revealed narrowing of the internal nasal valves (INVs) bilaterally, with severe collapse on the right side (Figure 2).

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