The nostril, although often overlooked, plays very important aesthetic and functional roles in the nose. Beside being the obvious and only inlet for airway passage through the nose, its shape and opening help form the tip of the nose in both height and width. While nostril morphologies are as variable as the rest of the nose, significant changes in their shape affect the nose adversely.
Nostril stenosis, or collapse of the side of the nostril, is a well known nasal problem. It can be caused by differing reasons (e.g, lacerations, burns, birth defects) but they all create the same fundamental problem, loss of nostril tissue and contracture. This creates the pinched nostril look with its shape being a more narrower vertical slit. Such a change limits the amount of airflow due to both internal and external valve collapse. The nasal tip also becomes narrower and in some cases may deviate away or toward the collapsed nostril side.
Correction of nostril stenosis is a difficult problem. In the early phase after the injury, many different types of stents have been described and their use is needed for up to a year after placement. The use of stents in established stenosis is not a primary treatment but a potential postoperative management strategy.
Surgical correction of nostril stenosis involves the addition of tissue. Tissue is usually lacking in both cartilage support and in lining inside the nose. The concept is to build up or support the hypotenuse of a triangle. Cartilage batten grafts, usually harvested from the ear, can be used on top of or underneath the overlying lower alar cartilage. Alar expansion grafts can also be placed between the upper and lower alar cartilages. Nasal lining can be replaced by chondrocutaneous grafts from the ear. It is important to have some cartilage in these skin grafts otherwise their small size will shrink almost to nothing. Their use is of particular value at the inside of the nostril base. They can help open up the nostril base-sill angle which is the opposite mate to the external and internal nasal valve angles.
In my Indianapolis plastic surgery experience, I have found it takes a multitude of rhinoplasty techniques to help re-expand the stenotic nostril. No single one of the above techniques will be sufficient. Nostril stenosis is a difficult problem and should not be confused with its more common nasal valve collapse cousin. Nostril stenosis always has valve collapse but that is a secondary effect from constriction of the alar sidewall.
Postoperative stenting of the surgically expanded nostril is certainly helpful and does no harm. Whether the patient can tolerate wearing a stent for an extended period of time is often another story. I plan the way the nasal reconstruction is done not counting on a stent for success.
Dr. Barry Eppley
Indianapolis, Indianapolis