Treating Nasal Valve Collapse in Facial Paralysis: What I Do Differently

Management of the Nasal Valve in Facial Paralysis

Facial paralysis significantly impacts the form and function of patients. Assessment of the face in zones is important to ensure no functional area of the face is neglected. Nasal valve compromise in patients with facial paralysis, for example, is often overlooked yet should be addressed to correct nasal obstruction. In flaccid facial paralysis, inferomedial displacement of the alar base and lateral nasal sidewall insufficiency contribute to nasal valve compromise. For surgical candidates, static suspension of the nasal valve in a superolateral vector is an ideal technique to address the etiology of nasal obstruction in patients with facial paralysis.

Rhinoplasty: Considerations for Patients with Facial Paralysis

Nasal obstruction is a common sequela of flaccid facial paralysis but one that is often underaddressed surgically. Weakness of nasal musculature on the paralyzed side of the face leads to nasal valve narrowing through loss of static and dynamic nasal side wall tone as well as inferomedial displacement of the alar base. Standard rhinoplasty techniques such as alar batten grafts or flaring sutures may be used to support the nasal side wall in facial paralysis. However, to address the inferomedial alar displacement, suspension techniques are often required. Suture resuspension and fascia lata resuspension techniques are described, with modifications to each to improve longevity of the suspension.