The internal nasal valve is narrowest part of the entire upper airway (from the nostrils all the way down to the trachea or windpipe). It is located in the nasal middle third where the upper lateral cartilage attaches to the septum. If you were to grab the middle of your nose with your thumb and index finger and wiggle it back and forth you will basically be holding the “internal nasal valve” between your thumb and index finger.

This cross sectional schematic shows an even better view of how this valve forms where the upper lateral cartilage meets the septum. The upper lateral cartilages are shown in green and the blue line down the middle represents the nasal septum- the structure that separates your right and left nasal passage.

In some people the upper lateral cartilage is relatively weak and ends up becoming narrowed or pinched in this area. As a result, the airflow through the internal nasal valve inside the nose is restricted.

Internally, the effect on the internal nasal valve can be seen in this schematic simulation of right internal nasal valve narrowing:

Sometimes this narrowing of the internal nasal valve can only be diagnosed with a detailed nasal exam while in other patients there is a more visible “indentation” in the middle third of the nose- directly correlating to the area of the internal nasal valve.

Symptoms of Internal Valve Collapse:

Most patients with internal valve collapse describe their nose is just constantly not moving air optimally. Athletes can be particularly bothered by internal valve collapse, as they can perceive their nasal passages collapsing under the stresses of vigorous nasal respiration. Many, but not all, patients with internal nasal valve collapse will notice their breathing improve with the use of over the counter “Breathe Right™ “ nasal strips.

Aging weakens the nasal sidewalls and causes the sides of the nose to collapse in more easily. Also, previous nasal surgery or previous nasal trauma can weaken the upper lateral cartilages thus leading to internal nasal valve collapse. This are some scenarios that can be corrected with Nasal Valve Collapse Repair surgery.


A detailed history and complete nasal exam are critical to diagnosing internal nasal valve collapse. Each year, Dr. Mobley sees many patients who have undergone previous nasal surgery by other surgeons but still do not have optimized nasal breathing. While each revision case has its own details, this fact underscores the importance of having your initial nasal surgery by someone dedicated fully to functional nasal surgery. It is optimal (obviously) to have all areas of nasal compromise diagnosed by a thorough evaluation, and then; if surgery is needed- have everything taken care of in just one operation.

During your consultation Dr. Mobley will perform a “Cottle maneuver”. This is an invaluable tool for diagnosing nasal valve collapse. The nose’s internal and external valves are elevated outward and the improvement in breathing is scored on a 10 point scale. Dr. Mobley will also perform an intranasal exam and will “scope” the nose endoscopically in certain cases. In addition to valve collapse, a complete intranasal exam should look for indications of a deviated nasal septum, inferior turbinate swelling, sinus infection or polyps, or adenoid enlargement. A Sinus CT scan may be required for some patients.

Medical Treatment

Short of committing to wear Breath Right nasal strips daily there are not many excellent non-surgical treatments for internal valve collapse. Some patients find relief with prescription nasal sprays. However, since Utah is one of the driest states in the nation, the long-term use of these sprays can lead to nasal drying, irritation, and recurrent nosebleeds.

Surgical Treatment

The best surgical treatment for internal nasal valve collapse is to open up the restricted nasal valve by placing a graft (of your own cartilage) called a “spreader” or “spacer” graft.

How a spreader graft can widen a collapsed internal nasal valve

A spreader graft is a cartilage graft that is insert between the septum and upper lateral cartilage, thereby widening the area of narrowing and opening up the internal nasal valve. The cartilage is usually carved from septal cartilage that is removed during a concurrent septoplasty.

You can also see how lateralizing the narrowed upper lateral cartilage can also create improved nasal symmetry.

Enough with the schematics. Let’s look at a real-life example of how a spreader graft can improve collapse of the middle third of the nose. I’ve previously discussed how we used rhinoplasty techniques to treat this patient’s bulbous nasal tip. You can see how this patient has significant narrowing of the middle third of her nose. The collapse was worse on her left than right so a thicker graft was carved for her left side.

Recovery Time

Recovery from nasal valve surgery can be very quick. Most patients will want 2-4 days simply to recover from having had general anesthesia. Dr. Mobley rarely packs noses after surgery and so most people experience improved nasal breathing as soon as they awake in the surgical facility. The nose will appear somewhat swollen for 2-8 weeks based on how quickly you heal in general. Vigorous physical activity can be fully resumed in 2 weeks and contact sports engaged in after 6-8 weeks of recovery.

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Murray, UT 84123
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