Management of the Keel Nose and Associated Valve Collapse
Fred J. Stucker, MD;
Timothy Lian, MD;
Matthew Karen, MD
Arch Otolaryngol Head Neck Surg. 2002;128:842-846.
Objectives To analyze the anatomical abnormality of the keel nose and correlate
the findings with etiologic maneuvers of a routine rhinoplasty procedure;
to identify the contributing factors and offer suggestions to avoid or decrease
the severity of these surgical complications; and to present an effective
revisional procedure to correct the functional and cosmetic consequences of
this deformity.
Patients and Methods A total of 47 patients (31 women and 16 men; age range, 18-71 years)
with a keel-appearing nose presented for revision rhinoplasty. All had undergone
at least 1 rhinoplasty procedure, and 39 had undergone 2 or more previous
nasal procedures. All patients had bilateral lateral nasal wall collapse and
an associated severely compromised internal nasal valve. All patients underwent
reconstruction with a conchal cartilage overlay graft.
Results All patients had a moderate to excellent cosmetic improvement; the subjective
improvement in nasal airway was more dramatic. Since patients with a keel
nose have an associated internal valve collapse, both abnormalities are addressed
simultaneously with the conchal cartilage overlay repair, which results in
minimal morbidity with no major complications.
Conclusions Conchal cartilage overlay repair uses a cartilage graft from the auricle
with a recommended external rhinoplasty for placement. Appropriate sizing
and fashioning precede the precise placement and suture fixation. This technique
addresses both functional and cosmetic abnormalities.
From the Department of Otolaryngology–Head and Neck Surgery,
Louisiana State University Health Sciences Center, Shreveport.
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Khosh et al.
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