Nasal obstruction, in which resistance of nasal breathing increases, directly affects the patient’s quality of life. In some cases of anatomical deformity, the nasal airway itself should be surgically corrected. We report a case of severe nasal obstruction with traumatic saddle nose deformity and nasal valve narrowing due to scar contracture. The saddle nose deformity was compounded by bony nasal vault disruption and marked contracture of the nasal lining after major septal collapse. The nasal bony vault was adjusted and reinforced with an iliac bone graft, and bilateral nasolabial flaps were transferred to the defect after contracture release. We evaluated nasal obstruction objectively and subjectively using acoustic rhinometry and the Nasal Obstruction Symptom Evaluation Scale respectively. These scores demonstrated significant improvement after surgery and the patient was highly satisfied. Surgery for external nasal deformity with airway obstruction requires preoperative assessment of the nasal vault and valve.
