[Aging nose (presbinasalis) in the practice of an otorhinolaryngologist.]

Population aging, increasing in duration of active life dictate to keep the level of health and create conditions for prolongation and preservation of ability to work. An otorhinolaryngologist often has to deal with age-related changes occurring in the nasal cavity and paranasal sinuses. The study of age-related features occurring in the nasal cavity and paranasal sinuses at the level of not only function, but also structures providing maintenance of mucous membrane protective mechanisms, preserving nasal architectonics, becomes a topical issue. Detailed consideration can be the key to understanding what is a natural process over time, and what should be viewed as pathology. These processes are often interrelated. For example, cartilage aging and nasal tip ptosis may trigger pathophysiologic mechanisms that create an obstacle to normal nasal breathing in older patients. Nasal aging accompanied by increasing dryness, rhinorrhea in some cases, postnasal drip in others, decreased sense of smell, reduces the quality of life, which will also need the involvement of an otorhinolaryngologist. In otorhinolaryngology, some of the terms used to describe age-related changes in the ent organs have been known and used since ancient times - presbyacusis (decreased hearing), presbyosmia (decreased sense of smell), presbyathacsia (ability to maintain equilibrium). Others are relatively recent, such as presbynasalis - an aging nose.

Disorders of the nasal valve area

The nasal valve area is not a singular structure, but a complex three-dimensional construct consisting of several morphological structures. From the physiologic point of view, it is the place of maximum nasal flow resistance ("flow limiting segment"). Therefore, according to Poiseuille's law, even minor constrictions of this area result in a clinically relevant impairment of nasal breathing for the patient. This narrow passage, also called "ostium internum nasi", is formed by the mobile lateral nasal wall, the anterior septum with the swell body, the head of the inferior turbinate and the osseous piriform aperture. Within the framework of aetiology, static and dynamic disorders of the nasal valve area have to be distinguished since they result in different therapeutic measures. In the context of diagnosis, the exploration of the case history for assessing the patient's extent of suffering and the clinical examination are very important. In addition to the presentation of the basics of disorders of the nasal valves, this paper focuses on the treatment of dynamic disorders that mainly constitute the more important therapeutic issue. In this context, we distinguish between stabilisation techniques through grafts or implants and stabilising suture techniques. Following a thorough analysis, the correction of static nasal valve disorders requires various plastic-reconstructive measures using transposition grafting and skin or composite grafts.