Osteotomies and Valve Area

My breathing is just normal now. By applying lateral osteotomy the base of the nasal pyramid can be narrowed. I'm concerned that initiating at the pyriform aperture will affect my internal nasal valve area. And as a result spreader grafts (which widen the nasal dorsum area) must be applied to correct this issue. Are there solutions resulting the lateral osteotomy will not affect the valve area, so that no grafts such as spreader grafts have to be applied?

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6 Doctor Answers | Asked by Ameliabeau in Bakersfield

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Osteotomies and nasal valve collapse

As mentioned by others, osteotomies if done properly should not result in nasal obstruction. The other question to ask is whether you need osteotomies in the first place - difficult to answer without photos.

Sam Naficy, MD

80 reviews

Seattle Facial Plastic Surgeon

www.seattleface.com

Osteotomies and internal nasal valve during Rhinoplasty

I have performed Rhinoplasty for over 20 years and IMHO, lateral osteotomies do not affect the internal nasal valve. I believe the most common cause of internal nasal value compromise is the non-closure of the superior aspect of the intra-cartilagenous incisions at the time of the Rhinoplasty which allows web formation at the junction of the valve and the septum. I have used lateral osteotomies on thousands of Rhinoplasty patients, over the years, and never use spreader... more

Lateral osteotomies

During lateral osteotomy a small triangle of bone is preserved at the inferior aspect of the osteotomy. This is described as Webster's triangle and preservation of this bone is thought to reduce the risk of airway compromise.

Internal valves not affected by osteotomy

The problem with much rhinoplasty teaching and belief is that surgeons may make the wrong conclusions about what they are seeing, and therefore develop the wrong rules in response. For example, the inter cartilaginous incision was condemned for years as causing airway obstruction, when in fact the obstruction was caused by resecting the hump. Dr. Johnson is exactly correct: the internal valve is supported by the intact cartilaginous roof. When the surgeon removes a bump, he... more

Spreader grafts for the nasal valve

The lateral oseotomies are not the cause of the tightness in the internal valve, and fracture through the pyriform or on the outside will make little difference. The valve collapse is caused by reduction of the hump, the cartilage portion is the support and structure of the nasal valve (upper lateral cartilage). If the hump is reduced along the valve, the spreader graft will hold the space open so the upper cartilage does not collapse against the septum and slow the air flow. There are... more

Osteotomies and Valve Area

This is a great question! The answer is that lateral osteotomies will not always require spreader grafting. I routinely perform this operation in hundreds of patient's a year who either require or don't require grafting based on the severity of the deformity. If lateral osteotomies are combined with any aggressive dorsal hump reduction you will absolutely need some form of spreader grafting to stabilize the internal valve region and prevent collapse. If only... more