Collapse Repair

• Collapsed Air Sac
• Collapse Airways

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Nasal valve repairs may be required because of a number of factors. Inside the nose nostrils, the nasal valves keep the front air passages open. When nasal valves collapse, the nasal passages are pinched shut, just like pinching your nose with your fingers. When there is permanent nasal valve collapse or damage, the nasal passages may be obstructed. Dr. Gary Linkov is a top-rated plastic surgeon at City Facial Plastics in New York who offers nasal valve repairs, which are often included during a rhinoplasty revision or functional rhinoplasty.

Collapsed Pipe Repair Collapsed pipes are a common and frustrating problem to have. A collapsed pipe can prevent you from doing simple tasks such as showering and cleaning dishes, but what is more troubling is the risk it causes for your entire plumbing system. After the partially collapsed arch is repaired, it is almost certain that some of the upper layers of stonework will need rebuilt, and the fill and roadway reinstated. Even though it is certainly not the easiest repair to be made on a stone bridge, a partially collapsed arch can, happily, be repaired. The major reason for building collapse is the change in the direction/path of load path building without consulting the structural engineer. Removing RCC column or load bearing wall, repairing of old and damaged column without adequate propping, increasing size/strengthening of RCC elements, addition of stories on old building, or when. It’s important to be aware of how to prevent a septic tank collapse. Not only is the dirt that covers the tank extremely heavy, be sure that you don’t drive any vehicles or heavy equipment over the surrounding area of the yard where the septic tank is located. Another concern is an aging tank.

What Is the Nasal Valve?

The nasal valve consists of internal and external components that constitute the greatest amount of nasal airflow resistance in the nose. The external nasal valve can be thought of as the nostril opening and its boundaries are the nasal ala, alar rim, septum, medial crura, and nasal sill. The internal nasal valve is located further inside the nose and its boundaries are the septum, head of the inferior turbinate, and the upper lateral cartilage. Conditions that narrow either the internal or external nasal valve lead to nasal obstruction or blockage.

What Is Nasal Valve Repair?

Correcting faulty nasal valves has the potential to improve nasal obstruction, which in turn improves nasal breathing. Internal and external nasal valve collapse involves different repair strategies. Most repair techniques involve adding stronger structural support, in the form of cartilage in the majority of cases, to promote valve patency. The internal and external nasal valves are often addressed during the same nasal valve collapse surgery.

Who Is a Good Candidate for Nasal Valve Repair?

A good candidate for nasal valve repair has one or more of the following conditions, including:

• Static internal nasal valve collapse
• Dynamic internal nasal valve collapse
• Static external nasal valve collapse
• Dynamic external nasal valve collapse

What Is the Relevant Anatomy for Nasal Valve Repair?

In order to adequately prepare for a nasal valves collapse treatment, the following structures need to be carefully assessed:

• Septum – A deviated septum can adversely affect the internal and external valve.
• Medial crura of the lower lateral cartilage – Short medial crura create a widened columella, which narrows the nostrils and can lead to nasal obstruction.
• Shape of the lower lateral cartilage – The paired lower lateral cartilages are the primary structural component of the external nasal valve.
• Nasal midvault – This region is defined by the attachment of the upper lateral cartilages to the nasal bones and the cartilaginous septum. Collapse or a weakened midvault can contribute to internal nasal valve insufficiency.
• Inferior turbinates – As part of the internal nasal valve, the inferior turbinate size and position are important. An overly hypertrophied inferior turbinate will reduce the internal nasal valve aperture and would need to be addressed at the time of the nasal valve collapse repair.

What Are the Types of Nasal Valve Repair?

Surgical nasal valve repair options

The main types of surgery that address internal and external nasal valve collapse repair include:

• Septoplasty
• Inferior turbinate reduction
• Spreader graft
• Alar rim graft
• Lateral crural strut graft
• Batten graft
• Tip ptosis repair
• Lower lateral cartilage repositioning
• Suspension sutures

Non-surgical nasal valve repair options

• Breathe Right nasal strips – Worn on the outside of the nose to stent the external nasal valve in patients who are poor surgical candidates. Wearing these with good effect can be useful information if one becomes a candidate for nose surgery.
• Internal nasal dilators – Such as Airmax, can also be effective in some patients.
• Trimming of nasal hair – Studies have found that trimming the hairs in patients many nasal hairs is a low-risk, inexpensive way to improve nasal breathing
• Physical therapy – EMG biofeedback is helpful to improve the muscular stenting of the valve.

How Is Nasal Valve Repair Done?

A detailed review of the various types of nasal valve repair surgeries is provided, including:

• Septoplasty
  • Using an open or closed approach, the septum is accessed and deviated areas are removed or repurposed to create a straighter septum. Sometimes the septum is too tall in the vertical dimension and needs to be shortened to be straighter. A straighter septum will improve both the internal and external nasal valves.
• Inferior turbinate reduction
  • As part of the internal nasal valve, reducing the inferior turbinate can help improve nasal airflow. This is done by either out fracturing it with an instrument, doing a submucous resection and burning or chewing up the deeper tissue on the bone, or removing part of the turbinate bone.
• Spreader graft
  • A spreader graft is made of cartilage and is inserted between the dorsal (upper) septum and the upper lateral cartilage to widen the internal nasal valve. This can be placed using a closed or open approach, though an open septoplasty approach affords improved access and better confirmation of placement.
• Alar rim graft
  • An alar rim grafts help reinforce the nostril margin and improve the external nasal valve. It may not be enough to fully support a collapsing ala, as much of that has to do with the lower lateral cartilage, but an alar rim graft can help.
• Lateral crural strut graft
  • A stronger correction than an alar rim graft, a lateral crural strut graft supports most of the length of the lateral crura of the lower lateral cartilage. This provides shape and resilience to the ala to improve the external nasal valve.
• Batten graft
  • A batten graft is typically inserted through a closed approach and can be placed free-floating to reinforce the lateral nasal wall. The exact placement of the batten graft can be modulated to improve either the internal or external nasal valve, or both.
• Tip ptosis repair
  • A weak tip that collapses on gentle palpation or one that droops, may be a reason for external valve collapse. It can be improved with cartilage grafting to better support the nasal tip cartilages and to maintain a more open nasal airway.
• Lower lateral cartilage repositioning
  • Cephalically-malpositioned lateral crura are a significant contributor to external nasal valve incompetence. They can be dissected and reoriented to open the external nasal valve.
• Suspension sutures
  • A minimally invasive way to support the lateral nasal wall. It is used in facial paralysis patients and many others with valve collapse.

How to Prepare for Nasal Valve Repair?

Once you have decided to undergo nasal valve collapse surgery, Dr. Linkov will discuss in detail how to prepare for your surgery.

There are a few steps you should take before your nasal collapse surgery to get the best results. These steps include:

• Avoiding certain medications and supplements that may thin the blood, such as:
  • NSAIDS – ibuprofen (Motrin) and naproxen
  • Aspirin
  • Vitamin E
  • Garlic, Ginger, Ginseng, St. John’s Wort, Ginkgo, Black Cohosh
• Stop smoking at least 2 weeks before surgery, as tobacco products can decrease blood flow to the skin and compromise the healing of the surgical site
• Stop all nasal sprays 2 weeks before surgery, with the exception of saline which you can continue
• Pick up medications at the pharmacy, as you will be prescribed certain medications to take after surgery, such as:
  • An antibiotic
  • Pain medication
• Identify an escort home, as you will need someone to accompany you home and stay with you at least the first night

What to Expect on the Day of the Procedure?

On the day of your nasal valve repair surgery in Midtown, Manhattan, it is important not to eat or drink 6 hours before your nasal valve repair surgery. Most nasal valve repair surgery is performed under general anesthesia with an anesthesiologist, so there will be no pain during the surgery and you will have no recollection of the procedure.

You will be asked to change into a surgical gown and women of child-bearing age will need to take a pregnancy test. The intake process can take about an hour, the surgery usually takes 2-4 hours, and recovery will be about another hour.

What Is the Recovery From Nasal Valve Repair?

Recovery from nasal valve repair can be divided into time from surgery, such as:

• First 48 hours – Oozing from the nose is possible. Wear a drip pad under the nose to catch the spots of blood. Pain is usually mild to moderate and can usually be managed without narcotics.
• 1-2 weeks – Primary swelling and most bruising resolve in the first two weeks. Splints, casts, and sutures are removed typically at one week. Nasal stuffiness slowly improves.
• 8-12 weeks – The redness of the external incision, if used, diminishes. Tip swelling improves and can be aided by steroid injections.
• 3mo – 1 yr – Tip swelling continues to improve and eventually resolves leaving you with a final revision rhinoplasty result.

It is important to avoid strenuous activity such as exercise or heavy lifting for at least 1 week. Avoid contact sports for at least 6 weeks.

Nasal Valve Repair With Latera

Latera is a bioabsorbable lateral nasal wall stent, made of 70:30 copolymer of poly(l‐lactide) and poly(d‐lactide), that can be placed in the office or the operating room. The implant absorbs over the course of 18-24 months. The efficacy of the implant has been demonstrated for at least one year after placement. It is unclear exactly how long the results of Latera last.

Rhinoplasty for Nasal Valve Collapse

The nasal valve is comprised of two parts, one at the tip of the nose and the other farther back in the internal portion. Depending on the extent of the damage to the nasal valves, rhinoplasty is used to repair either one or both portions. Often, cartilage grafting is needed to reconstruct the nose structure to support the nasal valve.

This offers relief from breathing and sinus issues, as well as snoring and unhealthy mouth breathing. Internal nose valve collapse can accompany other unfortunate issues from a poor nose job. Dr. Linkov will perform nasal valve repair and a revision rhinoplasty during the same procedure, giving you the function and form you desire.

What Are the Risks and Complications of Nasal Valve Repair?

The risks and complications of nasal valve repair surgery include:

• Bleeding
• Infection
• Poor scarring
• Undesirable aesthetic result
• Upper dental numbness
• Asymmetry
• Bossae (tip irregularities)
• Overrotated tip
• Alar retraction
• Septal perforation
• Saddle nose (bridge collapse)
• Persistent nasal valve collapse
• Deviated nose

Are Patients Satisfied After Nasal Valve Repair?

Nasal breathing is an important quality of life factor for many people. If the nasal valves are found to be a contributor to nasal valve collapse and nasal breathing, then repair is recommended. In the well-selected patient who undergoes a nasal valve repair, the satisfaction is high. Attention must be paid to not significantly altering the cosmetic appearance of the nose. Dr. Linkov at City Facial Plastics in UES, Manhattan also performs many cosmetic rhinoplasty procedures and always factors in the aesthetics when offering functional nose surgery for nasal valve repair.

Who Is the Best Nasal Valve Repair Surgeon in NYC?

Collapsed Air Sac

Patients often search for the best, top-rated doctor for nasal valve repair. Dr. Gary Linkov is a board-certified facial plastic surgeon in Manhattan, NY specializing in nasal surgery. Dr. Linkov is a specialist with extensive experience treating all conditions of the nose, especially those that have been previously operated.

He is the Chief of Otolaryngology and Facial Plastic Surgery for the Veterans Hospital in Brooklyn, NY, where he operates on complex nasal deformities on our country’s veterans. Dr. Linkov’s private practice in Manhattan’s Upper East Side focuses on cosmetic and functional rhinoplasty and other nasal procedures.

If you have collapsed nasal valves, contact City Facial Plastics, located in Manhattan, NYC. We will schedule your consultation with the facial plastic surgeon in New York City, Dr. Linkov to discuss options to give you relief and possibly improve the aesthetics of your nose.

City Facial Plastics: Dr. Gary Linkov
635 Madison Ave #1402E
New York NY 10022
(212) 439-5177

Can a partially collapsed stone arch be repaired? While presenting a somewhat of a challenge, this sort of damage to a stone bridge is, nevertheless, reparable, as proved by the case of Ireland’s Avoca Village Bridge.¹

The Avoca Village Bridge consists of several true semi-elliptical arches built with precision-cut stones. In August 1986, a series of floods caused scouring of one of the piers of the Avoca Village Bridge, causing the collapse of part of the pier and part of the arches. When rebuilding, the original stones were used as much as possible; however, one hundred stones were either lost or damaged. Replacements had to be precision cut at the significant expense of 50,000 pounds. Although the total cost of reinstating the Avoca Village Bridge was 135,000 pounds, the repair was significantly cheaper than simply replacing the bridge. When combined with the fact that a piece of history was saved, repairing the partially collapsed arches and pier proved to be a win-win.

A partially collapsed arch needs to receive fairly prompt attention, as the remaining portion of the arch is often made vulnerable to further damage. Therefore, when repairing a partially collapsed arch, the cause of the collapse should be ascertained, and remedied.

When the collapse is caused by scour, therefore, it is apparent that the first act towards restoring the bridge would consist of stabilizing the remaining foundations and then rebuilding the scoured foundation so that it can accept the arch.

An arch can also collapse due to other factors, such as the deterioration and falling out of stones. High velocity debris can also damage an arch by knocking out stones all on its own. Making sure the mortar joints in a mortared bridge are in good condition might help prevent this, at least to some degree.

To repair a partially collapsed arch proper, a formwork will very likely be required. This temporary form will need to be shaped to fit the correct curve of the arch to allow for proper rebuilding of the arch. After placing the form flush against the remaining portion of the arch, stones in the arch that are loose or otherwise placed in a distorted position by the partial collapse will then need to be removed. It may also be necessary to remove some of the fill above the arch as well as spandrel walls holding the fill. Where possible, the original arch stones should be used and replaced to match the original construction of the bridge.

The repair should be made to bond well with the intact portion of the arch. Typically arches fail in a corbelled fashion (something like a staircase in shape), which makes bonding to the remaining arch easier. Once the repair is complete, the formwork can be removed.

After the partially collapsed arch is repaired, it is almost certain that some of the upper layers of stonework will need rebuilt, and the fill and roadway reinstated.

Even though it is certainly not the easiest repair to be made on a stone bridge, a partially collapsed arch can, happily, be repaired. Besides preserving a piece of history, may very well be less expensive than replacing the bridge, as was the case with Ireland’s Avoca Bridge.

Collapse Airways

¹This story is recounted with excellent before-and-after pictures in latest edition of Irish Stone Bridges: History and Heritage by Peter O’Keeffe and Tom Simington, revised by Rob Goodbody.