Nasal Valve Collapse

Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon, specialist registration in Otorhinolaryngology, Head & Neck Surgery.

Nasal valve collapse is one of the most common structural causes of nasal airflow obstruction. It is frequently missed or undertreated, and can occur either as a primary condition or as a complication of previous rhinoplasty. Accurate diagnosis and appropriate surgical technique are essential to addressing it effectively.

All surgery carries risks — read the full rhinoplasty risks page →

What is the Nasal Valve?

The nasal valve is the narrowest segment of the nasal airway — the point of greatest resistance to airflow between the nostrils and the trachea. It is divided into two anatomically distinct regions:

External Nasal Valve

The nostril opening on each side at the entrance to the nose. It is supported by the alar cartilage, skin, and subcutaneous tissue. The external valve is prone to collapse on inspiration in patients with weak or malpositioned alar cartilages, long and narrow nostrils, or following rhinoplasty that has reduced alar cartilage support.

Internal Nasal Valve

Situated just deep to the external valve, the internal nasal valve is bounded by the nasal septum, the lower edge of the upper lateral cartilage, and the head of the inferior turbinate. It is the narrowest point of the airway and is a common site of obstruction in patients with a deviated septum, large turbinates, or a nose that has been narrowed by previous rhinoplasty.

External nasal valve anatomy

Internal nasal valve anatomy

How Do I Know if I Have Nasal Valve Collapse?

A simple self-assessment test — called the Cottle test — can help identify nasal valve collapse:

Breathe in and out normally through the nose
Place a finger on the cheek beside the nose and gently pull the cheek skin outward — this opens the nasal valve area
Breathe in again. If breathing is noticeably easier with the cheek held out, a degree of nasal valve collapse is likely contributing to your obstruction

You may also be able to see external valve collapse by watching yourself in a mirror during inspiration — visible inward collapse of the nostril wall on breathing in indicates external valve insufficiency.

Cottle test — cheek held out improves breathing if nasal valve collapse is present

Surgical Treatment

Nasal valve collapse typically requires rhinoplasty — with or without septoplasty and turbinoplasty — to address the underlying structural cause. Several techniques are available depending on whether the problem involves the internal valve, external valve, or both:

Spreader grafts	Cartilage grafts placed between the nasal septum and upper lateral cartilages to widen the internal nasal valve and prevent collapse. Particularly useful after dorsal reduction or where the middle vault has weakened. Learn more →
Alar batten grafts	Cartilage grafts placed over the nasal sidewall to support the external valve and prevent inspiratory collapse. Learn more →
Lateral crural strut grafts	Grafts placed beneath the lower lateral cartilages to stiffen and reposition them, addressing both external valve collapse and internal recurvature. Learn more →
Septoplasty & turbinoplasty	Where a deviated septum or enlarged turbinates are contributing to internal valve obstruction, these are addressed at the same time. An ENT specialist can perform all three procedures in a single operation.

Dr Jason Roth | MBBS, FRACS (ORL-HNS) | MED0001185485
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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