A collapsed nostril, medically termed nasal valve collapse, is a structural issue that severely restricts airflow, leading to breathing difficulty. This condition occurs when the supporting cartilage and soft tissues of the nasal airway weaken or collapse inward upon inhalation, often feeling like a persistent blockage. The resulting obstruction compromises the architecture responsible for maintaining an open airway, significantly impairing quality of life.
Anatomy and Types of Nasal Valve Collapse
The nasal valve is the narrowest segment of the nasal airway, acting as the primary flow regulator for air entering the lungs. This valve is divided into two parts: the internal nasal valve and the external nasal valve.
The internal valve is the slit-like opening located approximately one and a half centimeters inside the nostril, supported mainly by the upper lateral cartilage and the nasal septum. Collapse in this area is the most common type and often appears as a pinch in the middle of the nose.
The external nasal valve forms the entrance to the nose and is supported by the lower lateral cartilage, also known as the alar cartilage. Collapse of the external valve is easier to observe, as the nostril rim visibly sucks inward during a deep breath. Physicians use the Cottle maneuver to diagnose the location of the collapse, which involves gently pulling the cheek skin outward to temporarily open the valve.
Primary Structural Causes
Nasal valve collapse stems from acute events or the natural degradation of supportive tissues over time. Direct trauma or injury to the nose can acutely damage or shift the supporting cartilages, leading to a sudden loss of structural integrity. For instance, a nasal fracture can compromise the cartilage’s ability to resist the negative pressure created during inhalation, resulting in dynamic collapse.
Aging represents a more gradual structural cause, as the cartilage naturally loses strength, elasticity, and flexibility over the lifespan. This thinning and weakening of cartilage, combined with changes in surrounding soft tissues, makes the nasal valve susceptible to inward movement. Some individuals possess a congenital weakness, being born with naturally narrower nostrils or inherently weak supporting cartilage, predisposing them to collapse. A deviated septum, where the central wall of the nose is crooked, is another structural factor that can weaken the overall framework and contribute to valve failure.
Iatrogenic and Secondary Causes
Nasal valve collapse can arise as a complication following previous medical interventions, known as iatrogenic causes. Rhinoplasty or septoplasty procedures, particularly those involving excessive removal of cartilage, can weaken the structural support of the nose. This over-resection of the upper or lower lateral cartilages destabilizes the nasal valve, sometimes resulting in a pinched appearance and impaired breathing. For example, a substantial dorsal hump reduction may necessitate additional grafting to prevent the upper lateral cartilages from collapsing inward.
Secondary causes involve chronic systemic conditions that compromise tissue health. Long-term inflammatory conditions, such as severe allergies or chronic sinusitis, can lead to changes in the soft tissue and mucosa covering the nasal valve area. This chronic inflammation and potential scar tissue formation contribute to the gradual weakening or narrowing of the airway. Furthermore, a long-standing, untreated deviated septum increases mechanical stress on the nasal valve, exacerbating pre-existing weakness until a functional collapse occurs.
Treatment and Correction Options
Initial management involves non-surgical, temporary solutions aimed at mechanically dilating the airway. External nasal strips, which are adhesive devices placed across the bridge of the nose, function by pulling the skin and underlying cartilage outward to open the valve. Internal nasal stents or cones are another temporary option, inserted directly into the nostril to provide support and prevent collapse during sleep or physical activity. These non-surgical methods offer symptomatic relief but do not address the underlying structural deficiency.
For permanent correction, surgical reconstruction is required to reinforce the weakened structures. Surgical techniques focus on using cartilage grafts to stabilize the internal or external valve area, often sourced from the nasal septum, ear, or rib. Internal valve collapse is frequently corrected using spreader grafts, which are small strips of cartilage placed between the upper lateral cartilage and the septum to push the sidewall outward. External valve collapse is addressed with alar batten grafts, placed along the side of the nose to buttress the lower lateral cartilage and prevent inward collapse. Office-based procedures using radiofrequency energy or absorbable implants are also used to tighten and reshape the weakened cartilage, providing stabilization.