Heated humidified high-flow nasal cannula: a new conservative approach for neonatal nasal stenosis.

PURPOSE: The aim of this study is to evaluate the efficacy of heated humidified high flow nasal cannula (HFNC) therapy as a conservative treatment option for newborns suffering from nasal stenosis, a condition that often leads to respiratory distress and feeding difficulties. Given the increasing utilization of HFNC in various upper and lower respiratory tract indications, characterized by its flow-based mechanism and minimal mucosal damage, we seek to investigate its potential benefits in this specific patient population. METHODS: A retrospective chart review of newborns with congenital nasal stenosis treated with HFNC for respiratory distress or feeding difficulties in a pediatric tertiary center between 2014 and 2022. Data were collected for demographic characteristics, clinical presentation and ventilatory requirements, pre and post HFNC application. RESULTS: Six infants with nasal stenosis were included in the study cohort. Five were diagnosed with congenital pyriform aperture stenosis, three of whom had additional midnasal stenosis. One patient had nasal synechiae. Two patients had failed surgical treatment and all patients failed conservative treatment prior to HFNC treatment. Following HFNC use, improvement was noted in oxygen saturations, heart and respiratory rates, meal volumes and weight. None of the patients required any additional sinonasal surgical treatment. No complications were observed. CONCLUSIONS: In this case series, we present the first documented use of HFNC treatment for nasal stenosis, showing favorable results. Further studies with a larger cohort, wider range of conditions and extended follow-up periods are needed to establish the risks and benefits of HFNC for neonatal nasal stenosis.

Modeling congenital nasal pyriform aperture stenosis using computational fluid dynamics.

OBJECTIVES: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of airway obstruction in the neonate. Computational airway modeling has not been done in neonates and young infants to understand the impact of stenosis on functional nasal airflow. In this study, we 1) applied computational fluid dynamics (CFD) model to the airway of a neonate with CNPAS and 2) compare airflow dynamics of a normal and CNPAS airway. METHODS: Three-dimensional models of the nasal airway of a normal neonate and a neonate with CNPAS were created using computed tomography scans of the facial bones. Measured anatomic parameters included volume, surface area, and cross-sectional area. CFD simulation was then performed. Simulated flow parameters included pressure, average velocity, and resistance. RESULTS: The neonate with CNPAS had a lesser volume (2.74 cm3 vs. 4.50 cm3) and surface area (18.8 cm2 vs. 45.5 cm2) than the normal airway. The CNPAS airway had a lesser bilateral cross-sectional area and average cross-sectional velocity throughout the length of the model. While there is a large pressure drop in the normal airway immediately after the entry point, the pressure drop in the CNPAS airway occurs more posteriorly. The total nasal resistance was approximately eight-fold greater in the CNPAS airway than the normal. CONCLUSIONS: CFD analysis can be performed on airways of neonates with nasal obstruction, such as in CNPAS. A CFD model may help characterize severity of airway obstruction as it can predict the three-dimensional pattern of airflow. Determining the role of CFD in clinical management of CNPAS requires further investigation.

CPAS: Surgical approach with combined sublabial bone resection and inferior turbinate reduction without stents.

OBJECTIVES/HYPOTHESIS: Congenital pyriform aperture stenosis (CPAS) is a form of nasal obstruction caused by congenital narrowing of the maxilla at the medial processes. Traditionally, surgical correction involves a sublabial approach with subperiosteal dissection, widening of the aperture by drilling, and the use of nasal stents postoperatively. Although this approach may lead to symptomatic improvement, it alone may fail to provide a patent airway secondary to unaddressed posterior narrowing. Additionally, the use of stents is problematic because they are prone to clogging and can cause internal nasal scarring and septal or alar necrosis. We present the surgical management of this condition in six patients using a novel approach that aims to correct these limitations by including both the traditional sublabial procedure and an endonasal reduction of the inferior turbinates, without the use of stents postoperatively. STUDY DESIGN: Retrospective chart review. METHODS: Review of the medical records of six consecutive patients aged 2 weeks to 7 months, who underwent repair of CPAS via a sublabial ostectomy and endonasal inferior turbinate reduction from 2009 to 2012. RESULTS: All six patients were clear of airway obstruction postoperatively and at follow-up. CONCLUSION: This is an alternative approach that leads to symptomatic improvement for CPAS patients without the morbidity associated with stent use. LEVEL OF EVIDENCE: 4.

Nasal cavity dimensions in congenital pyriform aperture stenosis.

OBJECTIVE: To determine the dimensions of the nasal cavity in infants with congenital pyriform aperture stenosis (CPAS). STUDY DESIGN: The nasal cavities of seven children with CPAS were identified and were compared to the nasal cavities of 13 neonates (<30 days old) who had received CT scans for other indications. METHODS: The width of the nasal cavities was measured at the pyriform aperture, choana, and at two standardized points along the lateral nasal wall (LW-1 and LW-2) between the pyriform aperture and choana. RESULTS: Comparison between neonates with and without CPAS demonstrates significant narrowing of the nasal cavity (not just the pyriform aperture) in infants with CPAS. Significantly smaller nasal width was noted at pyriform aperture, LW-1, and LW-2 (p<0.01, p<0.01, p=0.02). No significant narrowing was seen at the choana. CONCLUSION: These findings suggest that CPAS is associated with narrowing of the anterior 75% of the nasal cavity. This has implications for surgical management because simple pyriform aperture ostectomy may not be sufficient to relieve symptoms of obstruction.