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External Transcolumellar Approach
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Chap VI - Functional Graft.

 
The Middle vault and Alar Collapse

 

FIG. 1 Although its role is essential to morphology and function The middle third of the nasal pyramid is overlooked during a routine nasal preoperative examination and during the operation.
The nasal valve is a dynamic structure of the nose located between the vestibule and the nasal fossa.
The nasal valve is the right regulator of nasal airflow ; the direction of airflow is determined by the nasal vestibule.

The dilatator muscles have an influence on the nasal valve on inspiration and prevent collapse of the valve at high inspiratory flowrates . . The valve can be manual opened by the Cottle maneuver which consists of drawing the cheek laterally away from the midline . If this relieves the nasal obstruction , this is considered as positive Cottle sign.



Before

After

Fig 1 The middle vault has been strengthened with graft placed laterally to the septum «spreader graft »



Before

After

Fig. 2 Alar pinching caused by overresection of thre alar cartilages



The doctors AIACH and DURON are both nose surgeon Paris