COLLAPSED ALA: Pathologic Physiology and Management

Abstract

THE PURPOSE of this paper is to discuss a type of inspiratory nasal obstruction in which the lateral cartilaginous wall is sucked against the septum, partially or completely shutting off the onward passage of air. The condition is commonly referred to as "collapsed" or "collapsing" ala. Perhaps the term "cartilaginous inspiratory obstruction" would better represent the syndrome. The clinical picture is characteristic (fig. 1). If the collapse involves both upper and lower lateral cartilages, or only the latter, the entire cartilaginous walls collapse and the nostrils appear slitlike with each inspiration. If the collapse is limited to the upper lateral cartilages, the central portion of the nose assumes a pinched appearance, the nostrils dilate markedly and the exaggerated activity of the alar muscles is clearly visible. In either case the degree of collapse is in direct proportion to the depth of the inspiratory effort. Occasionally, the closure is so abrupt