The problem of the collapsing upper lateral cartilage.

The collapsing upper lateral cartilage is an airway problem that admits to no ready solution, such as the deviated nasal septum or deflected columella. It is my understanding from experienced nasal surgeons that an attack directly on the upper lateral cartilage has not provided a solution, but in general makes the problem worse. A look at the nasal septal base by simultaneous viewing of both nasal chambers may reveal a dimenionsal of 1 cm or more. In that event, a fairly radical narrowing of the septal base in the plane of the pyriform crest by a subperiosteal and subperichondrial approach with well-placed transfixion sutures can increase the air-flow across that plane. It has done so in eight patients. This operation is for the experienced nasal surgeon, or the otolaryngologist who has prepared himself by careful cadaver preexperience.