Abstract

Objectives: External nasal valve stricture may result from hypertrophic scarring of the nasal wall. Many surgeons are reluctant to undertake re-canalization procedures for this condition for the fear of re-stenosis. We would like to discuss the successful treatment case of a patient with external nasal valve stricture following oral mucosal flap for columellar reconstruction. With this case, we emphasize the importance of identifying the root cause of nasal stenosis and undertaking surgical intervention whenever deemed prudent. Introduction: The direct cause of external nasal valve stenosis is debatable; some authors have attributed the phenomenon to hypertrophic scarring, while others have suggested chronic infection as the culprit. Oral mucosal flap is a long-known reconstructive method for columellar necrosis, which involves elevation of a medially based gingivolabial mucosal flap that is turned over through a subcutaneous tunnel connecting the oral cavity to the nasal area. The flap base is either cut in a secondary division procedure or left in situ along with the surgically formed oronasal fistula. Materials / method: A 50-year-old female patient presented to our department with subtotal stenosis of the right nostril. She had undergone several rhinoplasties including silicone implant insertion, rib cartilage graft and conchal cartilage graft. Following her last rhinoplasty, the patient developed columellar necrosis that was subsequently debrided and reconstructed with oral mucosal flap elevated from the right gingivolabial sulcus. The flap had been turned over through a subcutaneous tunnel and then inset to the columellar defect as a one-stage operation. She was denied surgery from another institution. Results: After two sessions of triamcinolone injection, the patient was operated for re-canalization of the nostril. Scar contracture was released and local flaps based on scar tissue were elevated for reconstruction of the nostril sill and the columellar sidewall. The existent oronasal fistula was repaired along with labial frenulotomy for tension release. Triamcinolone was injected immediately after the operation and silastic sheets were inserted for prevention of re-stenosis. Two months after the operation, the re-canalized nostril was maintained and the patient did not complain of nasal congestion. Conclusion: Surgical re-canalization can be a safe and effective option for patients with iatrogenic stenosis of the external nasal valve. In our case, the oronasal fistula that was left in situ after oral mucosal flap elevation for columellar reconstruction may had been the culprit for chronic infection and subsequent hypertrophic scarring. No re-stenosis occurred after we repaired this fistula. Therefore, surgeons are encouraged to identify the primary cause of nasal stenosis and to not hesitate to undertake surgical intervention whenever necessary.