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).
Fraioli RE, Pearlman SJ. A Patient With Nasal Valve Compromise. JAMA Otolaryngol Head Neck Surg. 2013;139(9):947-950. doi:10.1001/jamaoto.2013.4163