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David R. Edelstein, Thorough Examination Is the Key to Diagnosing Postrhinoplasty Airway Problems, Aesthetic Surgery Journal, Volume 18, Issue 1, January 1998, Pages 59–60, https://doi.org/10.1016/S1090-820X(98)80031-9
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In my experience, there are many causes of postrhinoplasty airway problems that do not involve valvular obstruction. For example, there may be mucosal problems. In fact, if you examine a patient within the first year after rhinoplasty, I believe most of the problems are mucosal. After a year, the problem is more likely to be structural support, of which the valve is a part.
Remember that the valve is a three-dimensional space, so the septum is actually part of what I call the valve area, as well as the interior part of the inferior turbinate. The floor of the nose is prone to scarring and manipulation, both of which can decrease the size of the anterior space. Again, three-dimensionally, there are multiple airflow patterns for lamina flow through the nose. If the surgeon doesn't look closely, it's easy to overlook areas of obstruction.
When examining a patient complaining of postrhinoplasty obstruction, I want to look three-dimensionally at the internal space. For this, I need to use an endoscope. I first go along the floor of the nose, then the mid portion, which is another major part of the airway, and then superiorly into the nasal pharynx. I look for possible infection or a posterior septal deflection. I determine the status of the turbinates, particularly the inferior and middle turbinates and their relationship to the other internal structures of the nose. Frequently, there may be scarring in the posterior portion of the nose. Webs and synechia can be seen with a nasal speculum. I examine the septum along the floor, in the inferior turbinate, and its intersection with the upper lateral cartilage.
