Long-term effects of the titanium butterfly implant on quality of life: a prospective cohort study.

PURPOSE: Nasal valve insufficiency is known to have a negative impact on both nasal patency and quality of life. The titanium butterfly implant is a surgical treatment proven to have a positive effect on these aspects up to 6 months postoperative. This study aimed to determine the long-term effects of the titanium butterfly implant on nasal obstruction symptoms and quality of life in adult patients with nasal valve insufficiency up to 5 years after procedure. METHODS: A prospective single cohort study was performed including 29 patients that underwent the titanium butterfly implant in one tertiary medical center. Data was obtained before and at least 5 years after surgery using three questionnaires: the Nasal Obstruction and Septoplasty Effectiveness questionnaire, the Sino-Nasal Outcome Test 22 and the Glasgow Benefit Inventory questionnaire. RESULTS: A significant decrease in total NOSE score was seen compared to baseline measurements. The SNOT-22 scores also showed a significant decrease, whereas the GBI scores showed no significant changes at the late follow-up. CONCLUSION: Seven years after placement the titanium butterfly implant still has a statistically significant improvement on otorhinologic-related quality of life compared to preoperative measurements.

Evaluating post-rhinoplasty nasal obstruction treatment: The efficacy of VivAer radiofrequency ablation.

PURPOSE: Nasal obstruction is a prevalent issue affecting up to one-third of adults, often requiring surgical intervention. Low-temperature radiofrequency (RF) treatment, specifically VivAer, has emerged as a promising alternative, especially for the treatment of nasal valve collapse (NVC). However, its efficacy in patients with a history of rhinoplasty or nasal valve repair remains unexplored. METHODS: A single-center retrospective chart review was conducted on 37 patients with a history of rhinoplasty or nasal valve repair who underwent VivAer RF treatment. Treatment outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) scale. The primary outcome was defined as a decrease in NOSE score by at least one severity category or a 20 % reduction in total NOSE score. RESULTS: The study found a statistically significant average reduction in NOSE score of 22.4 points or 36.6 %. Among patients with a positive treatment response (21 patients or 56.8 %), the average NOSE score reduction was 34.7 points or 55.6 %. Repeat RF treatment in non-responders resulted in a 50 % response rate. No significant difference was observed in treatment outcomes based on the type of prior rhinoplasty or NVC. CONCLUSIONS: Temperature-controlled RF treatment with VivAer can effectively alleviate nasal obstruction in patients with a history of rhinoplasty or nasal valve repair, offering a viable alternative to revision surgery. The study also highlights the potential benefit of repeat RF treatment in non-responders. Further research, including randomized controlled trials, is needed to validate these promising results and expand the treatment options for this complex patient population.

Nasal Patency Across Seated, Supine, and Recumbent Postures in Individuals With and Without Allergic Rhinitis.

Objectives: This study aimed to investigate the effects of seated, supine, and recumbent postures on nasal resistance in individuals with allergic rhinitis (AR) and healthy controls, which has not been investigated in the past. Methods: A visual analog scale (VAS) assessed subjective nasal obstruction, while acoustic rhinometry and video endoscopy provided objective measures. Sixty participants, comprising 30 AR patients and 30 healthy controls, were evaluated across 4 postures without decongestion: seated, supine, left recumbent, and right recumbent. Results: In patients with AR, we noted no significant changes in subjective nasal blockage under various postures (all P > .18). However, significant reductions of minimal cross-sectional area (mCSA) were found (seated vs supine, P = .014; seated vs left recumbent, P = .001; seated vs right recumbent, P < .001) and significant increases in the inferior turbinate hypertrophy were observed on the dependent side of the nose when in recumbent posture (right nose: seated vs right recumbent, P = .013; left nose: seated vs left recumbent, P = .003). On the contrary, healthy controls experienced increased subjective nasal obstruction (VAS scores: seated vs supine, P < .001; seated vs left recumbent, P = .003; seated vs right recumbent, P < .001), reductions in mCSA (seated vs supine, P = .002; seated vs right or left recumbent, both P = .001), and increased inferior turbinate hypertrophy on the dependent side of the nose (right nose: seated vs right recumbent, P = .003; left nose: seated vs left recumbent, P = .006). Conclusions: Healthy controls reported better nasal patency when shifting from supine or recumbent to more upright or less gravity-dependent seated postures, which was further supported by objective examinations. On the contrary, despite patients with AR not subjectively perceiving increased nasal patency while adopting more upright postures, objective evaluations demonstrated an improvement in their nasal airflow in these less gravity-dependent postures.Level of Evidence: 4.

The Effectiveness of High-Intensity Focused Ultrasound in Treating Nasal Obstruction Caused by Inferior Turbinate Hypertrophy: A Clinical Study.

Background Nasal obstruction due to inferior turbinate hypertrophy is a common medical complaint among ENT clinic patients, which can significantly affect the patient's quality of life, and some are compelled to use topical intranasal decongestants. Conservative management is the first line of treatment; however, surgical reduction of the inferior turbinate becomes necessary if the symptoms persist after three months of treatment. The optimal surgical technique is controversial. High-intensity focused ultrasound (HIFU) is a minimally invasive surgical option that targets tissue volume precisely and minimally impacts surrounding tissue. This study aimed to assess the effectiveness and safety of HIFU in treating patients suffering from nasal obstruction due to inferior turbinate hypertrophy. Methods This prospective study was conducted from February to December 2016. The study lasted over six months. Patients with a history of allergic and non-allergic rhinitis participated in this study. It included 43 patients who had been experiencing chronic nasal obstruction due to bilateral inferior turbinate hypertrophy and had not shown improvement after three months of medical treatment. The patients underwent Ultrasound Volumetric Tissue Reduction (UVTR) surgery using the D & A Ultrasurg device (Diamant Medical Equipment Ltd., Amman, Jordan) under local anesthesia. The effectiveness, safety, and tolerance of HIFU were assessed subjectively for six months using a well-designed questionnaire utilizing a visual analog scale (VAS) and nasal endoscopy after the surgery. Results The study included 43 patients, 22 male and 21 female, aged 13 to 65 years. The study found that 40 (93%) patients showed significant improvement in nasal obstruction within a month of the surgery. However, three (7%) patients continued to experience persistent nasal obstruction even after six months of follow-up. The procedure was well-tolerated, with low rates of complications after surgery and reasonable pain control. During the surgery, 20 (46.5%) patients reported mild pain described as a pressure-like sensation, and 10 out of 43 patients (23%) required paracetamol after the procedure. Four patients (9.3%) had mild bleeding, which was treated with an ultrasound nasal probe without nasal packing. All patients experienced crusting of the nasal cavity during the first week, but no crustation was observed after the first month. There were no reported cases of synechia among the patients. Conclusion This study confirms that HIFU treatment is a reliable and effective treatment for improving short-term nasal obstruction caused by inferior turbinate hypertrophy. The procedure is easily applied and well-tolerated in outpatient clinics.

Transseptal Suturing Septoplasty in Elderly.

Objectives: Assessing the effectiveness of transseptal suturing septoplasty in elderly individuals. Methods: The method used in this study involved the prospective separation of septoplasty candidates over 65 into 2 groups. The first group underwent nasal packing, while the transseptal suture technique was used on the second group. Postoperative pain was measured using the visual analog scale, and the effectiveness of the surgery was assessed using the Standardized Cosmesis and Health Nasal Outcomes-Obstruction scale. In addition, the patients' oxygen saturation levels were monitored using a pulse oximeter, and the results of the 2groups were compared. Results: The study included 26 patients with an average age of 66 years, ranging from 65 to 74 years. Of these patients, 13 received nasal packing, and the transseptal suture technique was used on the other 13. The results showed no statistically significant difference between the Standardized Cosmesis and Health Nasal Outcomes-Obstruction scores (P > .05). However, the oxygen saturation levels in group 1 were significantly lower, and the pain scores were significantly higher (P < .05) than those recorded for the other group. Conclusions: We concluded that transseptal suturing septoplasty is an effective, safe, and more comfortable surgical option for the elderly.

Impact of posture and CPAP on nasal airflow.

Obstructive sleep apnea (OSA) patients who use continuous positive airway pressure (CPAP) often complain of nasal dryness and nasal obstruction as side effects of CPAP. The physiological mechanisms by which CPAP may cause nasal dryness and nasal obstruction remain poorly understood. It has been hypothesized that CPAP interferes with the nasal cycle, abolishing the resting phase of the cycle and leading to nasal dryness. We performed rhinomanometry measurements in 31 OSA patients sitting, laid supine, and supine after 10 min of CPAP at 10 cmH2O. A posture change from sitting to supine led to more symmetric airflow partitioning between the left and right nostrils in the supine position. CPAP did not have a significant impact on nasal resistance, unilateral airflows, or airflow partitioning. Our results suggest that airflow partitioning becomes more symmetric immediately after changing to a supine position, while CPAP had no effect on nasal airflow, thus preserving the nearly symmetric airflow partitioning achieved after the posture change.

Functional and esthetic outcomes of functional rhinoplasty for internal nasal valve dysfunction in Asian patients.

OBJECTIVE: This study aimed to use validated measures to evaluate the functional and esthetic outcomes in patients who underwent functional rhinoplasty for Internal Nasal Valve Dysfunction (INVD) in Korea. METHODS: A retrospective review of consecutive patients who underwent functional rhinoplasty for INVD confirmed by endoscopic findings and the modified Cottle test between 2016 and 2018 was performed. Nasal obstruction was assessed with the Visual Analog Scale (VAS) and nasal obstruction symptom evaluation (NOSE) scale. Acoustic rhinometry was performed pre- and post-operatively. The Minimal Cross-Sectional Area (MCA) of the nose was measured. Objective assessment of the esthetic outcomes was performed with the Objective Rhinoplasty Outcome Score (OROS), which assesses tip rotation, projection, width, dorsal height, width, length, symmetry, and the overall result. RESULTS: Fifty-seven patients (46 men and 11 women; mean age, 30.5 ±â€¯12.3 years) who underwent functional rhinoplasty were included in this study. The VAS and NOSE scores indicated functional improvement in all cases (all p < 0.001). There were no significant between-group differences (VAS score, p = 0.274; NOSE score, p = 0.952). The objective functional outcomes evaluated using MCA on the concave (p = 0.478) and convex (p = 0.631) sides did not differ significantly pre- and post-operatively. The subjective evaluation of esthetic satisfaction revealed no between-group difference. Moreover, 31 out of 44 patients (70.5%) with static INVD and nine out of 14 patients (64.3%) with dynamic or combined INVD showed excellent outcomes. Regarding objective esthetic outcomes, scores for the eight factors were >3, and there was no significant difference between the two groups (all p > 0.05). CONCLUSIONS: Functional rhinoplasty, including extracorporeal septoplasty and spreader grafting, may be a viable option for correcting INVD with functional and esthetic improvement. Dynamic INVD is less prevalent among Asians, and there was no significant difference in the surgical outcomes compared with those of static INVD. LEVEL OF EVIDENCE: Level 4.

Chief Complaint: Nasal Congestion.

Nasal obstruction is the subjective perception and objective state of insufficient airflow through the nose. Nasal congestion, conversely, describes a state of not just inadequate airflow or obstructive phenomena but also pressure- and mucus-related states to the patient. Nasal receptors belonging to the transient receptor potential (TRP) protein family mediate the sense of nasal patency via the trigeminal nerve. The transient receptor potential melastatin-8 (TRPM8) responds to temperatures around 8°C to 22°C, and is stimulated by menthol and other cooling agents. The radiant effects of airflow create heat loss to activate these receptors and humans perceive this as nasal patency rather than the direct detection of airflow. The thermovascular state of the mucosa, in conditions such as rhinitis, influence TRPM8 activation. Nasal endoscopy can show signs of rhinitis and should be considered an essential part of the workup of nasal congestion. Efforts to relieve nasal congestion need to manage the mucosal state and surgery needs to ensures that the nasal cavity mucosa is exposed to the cooling effects of airflow rather than simply creating a passage to the nasopharynx.

The Prevalence of the Nasal Vestibular Body in Patients With Nasal Obstruction.

Background and aim Nasal obstruction is one of the most common reasons for consultation addressed by otolaryngologists. There are anatomical, physiological, and pathological etiologies. Sometimes the treatment can become a challenge for the specialist, so a detailed evaluation of the etiologies must be carried out. The involvement of the nasal vestibular body (NVB) in obstructive symptoms has been described. Therefore, we must be familiar with its anatomy, presentation, and contribution to this symptomatology. This study aimed to highlight the importance of NVB in the role of nasal obstruction and know the impact that it adds to the symptoms of patients through a validated instrument on their quality of life. Material and methods A retrospective, descriptive, and analytical study was conducted on 113 patients with nasal obstruction who attended the outpatient clinic of the Otolaryngology and Head and Neck Surgery Service in a tertiary-level hospital in Monterrey, Mexico from January 2021 to January 2023. The Nasal Obstruction Symptom Evaluation (NOSE) scale was applied to assess the impact of this symptom on the quality of life of the subjects. The causes involved in the obstructive symptoms were identified by physical examination, including NVB. Two groups were made as follows: with the presence of the NVB and with the absence of the NVB, and the means of the NOSE scale were compared. Results A total of 113 patients were included, 59 male patients (52.20%) and 54 female patients (47.80%). The presence of NBV was found in 72 patients (63.70%). Other causes of nasal obstruction were found in 35 patients (31%), with chronic rhinitis being the most frequent in 27 subjects (23.90%). The mean NOSE scale score was higher in the group with the presence of the NVB than in the group with the absence of the NVB (p<0.05). The primary outcome of this study was to know the prevalence of NVB in the Hispanic population with nasal obstruction who attends the otolaryngology clinic. The secondary outcome was to know the relationship between the presence of NVB and the NOSE scores. Conclusion In this study, we observed that NVB is frequently present in patients with nasal obstruction in northeastern Mexico. There is an association between the presence of NVB and higher scores on the NOSE scale. New research will be needed to assess the effectiveness of NVB surgery in improving nasal obstruction and to determine the impact of NVB on nasal obstruction in isolation.

Prevalence of nasal obstruction and its impact on quality of life in Saudi Arabia.

Purpose/Background: Nasal obstruction is a significant issue influencing the patient's quality of life. Chronic nasal obstruction is frequently associated with other symptoms such as headache, sleep disturbance, and daytime sleepiness. This study aims to investigate the prevalence of nasal obstruction in Saudi Arabia and examine its effect on patients' quality of life. Methods: This is a cross-sectional study conducted in Saudi Arabia. Data were collected using a self-administered combination of two previously validated questionnaires (the NOSE scale and the WHOQOL-BREF) translated into Arabic. The Mann-Whitney test was used to investigate the association between nasal obstruction prevalence and the participants' QOL. Results: The study included 1039 participants from different regions of Saudi Arabia. The prevalence of nasal obstruction was 60.3% among the participants. Several factors significantly affected the prevalence of nasal obstruction, including sex, suffering from a chronic disease, having a family member with nasal obstruction, and using medications (P < 0.001 for all factors). A better score was shown in the four domains of the WHOQOL-BREF questionnaire by the participants who had no nasal obstruction: the physical health domain, psychological health, social relationships, and environment (P < 0.001 for all factors). Conclusions: Quality of life is affected by nasal obstruction. The subjective assessment is essential in evaluating the severity of nasal obstruction disease. It is recommended that healthcare providers use subjective tools combined with objective tools to assess the degree of nasal obstruction severity.

Nasal Pyriform Aperture Stenosis in a Newborn: When to Operate.

Congenital nasal pyriform aperture stenosis (CNPAS) is a very rare cause of neonatal respiratory distress and is often missed because of its rarity. It arises from the overgrowth of the nasal process of the maxilla. Maxillofacial CT scan findings of pyriform aperture width <11 mm in a full-term baby, median central incisor, triangular-shaped palate, and median palatal ridge confirm the diagnosis. We describe here a case of CNPAS admitted with respiratory distress that increased further on feeding. An infant feeding tube of size 6 was not negotiable through the nostrils. Resistance was appreciated at the inlet of the nostril. Maxillofacial CT showed pyriform aperture stenosis of 3.4 mm, suggesting CNPAS. The child could not be weaned off a high-flow nasal cannula despite conservative management with decongestants, steroids spray, dilatation, and stenting for 20 days. Subsequently, surgical widening of the nasal aperture by a sublabial approach was done. The child was discharged on the 10th postoperative day on full oral feeds. It is important to suspect CNPAS in neonates with respiratory distress where other common causes have been ruled out, as it can be treated by surgery in cases refractory to conservative management.

Enhanced revision rhinoplasty with processed costal cartilage guided by preoperative computed tomography and 3D scanning.

BACKGROUND: Revision rhinoplasty presents unique challenges, particularly in achieving structural integrity and aesthetic harmony. This study explores the efficacy of costal grafts in addressing these challenges, focusing on anatomical corrections and patient outcomes. MATERIALS AND METHODS: A prospective analysis was conducted on patients undergoing revision rhinoplasty with costal grafts. An algorithmic approach was applied to tailor the surgical technique to individual anatomical needs, documented through pre- and postoperative assessments, including CT imaging and 3D scanning. RESULTS: A total of 34 patients were included. Significant improvements were noted in nasal structure and function post-surgery. The mean NOSE score improved from 94.47 ± 5.48 preoperatively to 12.59 ± 13.43 postoperatively, and the mean ROE score increased from 18.44 ± 10.02 to 92.65 ± 13.00, indicating substantial enhancement in both nasal airway function and patient satisfaction. The use of costal grafts facilitated effective corrections for a broad spectrum of nasal deformities, with a complication rate of 2.94%. CONCLUSIONS: Costal grafts in revision rhinoplasty offer a versatile and effective solution for complex nasal deformities. The algorithmic approach used in this study enhances repeatability and outcomes, suggesting a promising avenue for achieving desired aesthetic and functional results in revision cases. Further research is warranted to optimize techniques and evaluate long-term outcomes. LEVEL OF EVIDENCE: II.

CT comparison of the nasal airway anterior and posterior to the piriform aperture in patients with and without nasal obstruction.

BACKGROUND: Nasal airway stenosis may lie anterior and/or posterior to the piriform aperture. We intended to compare the nasal airway anterior and posterior to the piriform aperture in patients with and without nasal obstruction. METHODS: Segmented computed tomography cross-sectional areas of the nasal airway anterior (CT-CSAant) and posterior to the piriform aperture (at the level of the head of the inferior turbinate; CT-CSApost) were compared between patients with nasal obstruction (cases) and trauma controls. CT-CSA were approximately perpendicular to the direction of the nasal airflow. Anterior to the piriform aperture, they were tilted about 30o, 60o and 90o to the nasal floor. Posterior to the piriform aperture, they were tilted about 50o, 80o and 100o to the nasal floor. In cases, we examined the Pearson's correlation of active anterior rhinomanometry with CT-CSAant and CT-CSApost. RESULTS: Narrow and bilateral CT-CSApost were similarly large between 56 cases and 56 controls (all p > 0.2). On the contrary, narrow and bilateral CT-CSAant were significantly smaller in cases than in controls (all p < 0.001). The ratio of the size of CT-CSAant-30 to that of CT-CSApost-80 was significantly lower in cases (median: 0.84; lower to upper quartile: 0.55-1.13) than in controls (1.0; 0.88-1.16; Mann-Whitney U test; p = 0.006). Bilateral CT-CSAant correlated significantly with total inspiratory flow (all p < 0.026) in contrast to bilateral CT-CSApost (all p > 0.056). CONCLUSIONS: The nasal airway anterior to the piriform aperture was smaller in patients with nasal obstruction due to skeletal nasal stenosis than that in controls. On the contrary, the nasal airway posterior to the piriform aperture was similarly large between patients with and without nasal obstruction. Furthermore, in patients with nasal obstruction, the anterior nasal airway was narrower compared to that located posterior to it. On the contrary, control patients' anterior nasal airway was as large as the posterior one.

Use of alloplastic implants for correction of deviated nasal septum: Systematic review and meta-analysis.

PURPOSE: To systematically reviews the safety and effectiveness of alloplastic implants (AI) in septoplasty. METHODS: We conducted a comprehensive search in Medline, EMBASE, SCOPUS, CINAHL, and Cochrane Library databases to identify articles on septoplasty using AI. We also manually searched reference lists of included articles. Inclusion criteria involved prospective or retrospective case-series studies of adults with deviated nasal septum (DNS) who underwent septoplasty with AI, with sufficient follow-up data. Two authors independently screened articles, reviewed full manuscripts, and extracted data. RESULTS: Out of 5370 articles, 16 met inclusion criteria, encompassing 884 patients from 14 eligible studies. Most studies had fair quality. AI materials included Polydioxanone (PDS), Polycaprolactone (PCL), Titanium, Macropore, and PolyMax. AI usage improved nasal obstruction in most patients, with 95.6 % (84.8 %-100 %) based on physical examination and 96.9 % (89.6 %-100 %) based on symptoms. AI-related complications occurred in 4.3 % (0 %-12.8 %) of cases, mostly non-serious. CONCLUSIONS: AI use can be considered as a useful adjunct in septoplasty, with uncommon complications similar to standard procedures. However, due to limited-quality evidence, further prospective controlled studies are needed.

Modified extracorporeal septoplasty: prospective study.

OBJECTIVES: This study aimed to evaluate quality-of-life and satisfaction outcomes in patients undergoing the MES using the Portuguese version of the Nasal Obstruction Symptom Evaluation (NOSE-p) and Rhinoplasty Outcome Evaluation (ROE), and also to evaluate the frequency of possible complications of this technique. METHODS: We conducted a single-center prospective study with patients who had the indication for MES, from May 2016 to September 2020 at the Facial Plastic Surgery Clinic of Otolaryngology Department of the Hospital de Clinicas de Porto Alegre. The primary outcome was the relative postoperative change in NOSE-p. Secondary outcome was the variation in ROE, a validated quality-of-life questionnaire for rhinoplasty patients. RESULTS: Of the 31 patients submitted to extracorporeal septorhinoplasty who were evaluated, twenty-seven patients were included. Preoperative and postoperative NOSE-p scale scores were 65.2 ±â€¯29.9 and 23.5 ±â€¯26.7, respectively (mean differences of 42.04; [95% CI 27.35-56.73]; p <  0.0001). Pre and postoperative ROE scores were 38.3 ± 24.3 vs. 67.29 ± 29.7, respectively (mean differences of -29.02; [95% CI -40.5 to -17.5]; p =  0.0001). Residual septal deviation was verified in 2 patients (7.4%). CONCLUSION: Most of the patients submitted to modified extracorporeal septoplasty had a significant improvement in quality of life scores of nasal obstruction, with good aesthetical outcomes and low indices of postoperative complications. LEVEL OF EVIDENCE: Level 3.

Reducing variability in nasal surgery outcomes through computational fluid dynamics and advanced 3D virtual surgery techniques.

Objectives: This study aims to delineate the specific impact of using computational fluid dynamics (CFD) and 3D virtual surgery techniques in otolaryngology surgery, focusing on their roles in enhancing the precision of nasal surgery and optimizing future patient outcomes. The central objective was to assess whether these advanced technologies could reduce variability in surgical approaches and decision-making among specialists, thereby improving the consistency and efficacy of patient care in cases of nasal obstruction. Methods and results: Our methodology involved a detailed analysis of pre- and post-operative scenarios using CFD feedback. Six otolaryngologists participated, employing virtual surgery techniques on two patients with diagnosed nasal obstruction. The CFD analysis focused on quantifying key airflow parameters: right nasal flow rate (QR), left nasal flow rate (QL), flow symmetry (Ф), and bilateral nasal resistance (R). These parameters were meticulously compared before and after the application of CFD feedback to evaluate changes in surgical planning and outcomes. Quantitative analysis revealed a notable decrease in the standard deviation of the measured parameters among the specialists post-CFD feedback, indicating reduced variability in surgical approaches. Specifically, for Patient #1 the standard deviation for QR values dropped from 0.694 L/min to 0.602 L/min, and for QL values from 0.676 L/min to 0.584 L/min, and for Patient #2, the standard deviation for QR values decreased from 2.204 L/min to 0.958 L/min, and for QL values from 2.295 L/min to 1.014 L/min. Moreover, the variability range, represented by the differences between the maximum and minimum values for Ф and R, diminished significantly. Post-operative average values for all parameters showed a convergence towards ideal basal levels, suggesting a more uniform and effective surgical strategy across different surgeons. Conclusions: Both integration of CFD and 3D virtual surgery techniques in otolaryngology can substantially reduce variability in surgical planning and decision-making, ultimately leading to improved patient outcomes. These advanced tools have the potential to standardize the diagnosis and treatment of nasal pathologies, contributing to more effective and consistent care. Future research in this area should focus on larger patient cohorts and further exploration of the potential benefits and applications of CFD and virtual surgery in otolaryngology.

Navigating Congenital Nasal Obstruction: A Contemporary Surgical Paradigm.

An uncommon form of nasal airway obstruction in a newborn with respiratory distress manifestations that needs prompt surgical correction when medical therapy cannot address the problem adequately. In this case study, two newborns were diagnosed with congenital nasal pyriform aperture stenosis (CNPAS) following a CT paranasal sinuses when the infant demonstrated persistent symptoms of upper airway obstruction. The narrowing of the nasal pyriform aperture, with a mean width of 0.65 cm in these newborns, was insufficient to allow breathing through the nostrils. Bedsides flexible endoscopy examinations revealed laryngomalacia in both of these infants. A supraglottoplasty, surgical nasal dilation, and stenting were performed without requiring a sublabial drill out of the pyriform aperture, allowing total resolution of the initial respiratory symptoms. Thus, a successful nasal enlargement was accomplished. During the post-operative follow-up period, no incurrences were observed. Both patients with CNPAS were successfully treated with nasal dilatation and nasal stenting instead of the traditional pyriform aperture bone removal by a sublabial approach. Despite being a small series, it demonstrates that nasal dilatation and stenting may be considered an alternate procedure in selective CNPAS cases because it lowers the risk of open surgery and presumably offers an effective management option.

Diagnostic Challenges of Sinonasal Pleomorphic Adenoma.

Pleomorphic adenomas (PAs) are benign tumors of the salivary glands. Rarely, they arise in the sinonasal cavity, presenting as well-defined, homogeneous soft tissue masses, causing expansive bony changes. The significance of PAs is the possibility of giving rise to malignant carcinoma - "carcinoma ex-pleomorphic adenoma" (CXPA).Here, we present the case of a 64-year-old female complaining of progressive unilateral congestion and external nose deformation, mostly along the left contour of the radix, with epiphora of the ipsilateral eye. Eventually, a tumor began protruding from the left naris. The computed tomography excluded osteolysis, while the surgical procedure discovered the inferior turbinate as the origin of the tumor. In addition, the ipsilateral maxillary sinus was found to have developed secondary sinusitis. After complete surgical excision, the histological result was sinonasal melanoma, but following no progression of the disease, a second pathologist with additional immunohistochemical markers (HMB-45 (human melanoma black 45) negative, Melan-A (melanoma antigen recognized by T-cells 1) negative, S100 (protein soluble in 100% ammonium sulfate at neutral pH) positive, panCK AE1/AE3 (pan cytokeratin antibodies AE1 and AE3) negative, p63 (tumor protein 63) negative, Ki-67 (marker of proliferation Kiel 67) 10%, CD68 (cluster of differentiation 68) negative, CK7 (cytokeratin 7) negative, and CDX2 (caudal-type homeobox 2) negative) placed the definitive diagnosis of PA.PA of the inferior turbinate is an extremely rare finding, with the clinical symptoms being unspecific. Sometimes, SOX-10 (SRY-box transcription factor 10) positivity can mislead to malignant melanoma, as in our case, which is why a broad panel of immunohistochemical markers is critical for the definitive diagnosis.

Polysomnographic Assessment on Osahs Outcomes in Patients with Nasal Obstruction Undergoing Septoplasty with Partial Inferior Turbinectomy.

The relationship between nasal obstruction and obstructive sleep apnea has raised interest among otolaryngologists since years. There are studies that suggest that surgical correction of nasal obstruction improves sleep quality and reduces symptoms of sleep apnea. This lead to our study to understand the effect of nasal surgery on obstructive sleep apnea hypopnea syndrome (OSAHS). AIM: To assess the effect of nasal surgery in improvement in Obstructive Sleep Apnoea Hypopnoea Syndrome in patients with nasal obstruction by Polysomnography (PSG). MATERIAL AND METHODS: This study included 30 patients with nasal obstruction who underwent septoplasty and/or turbinate reduction procedure with pre and post operative assessment of respiratory distress index (RDI) including apnoea hypopnoea index (AHI), obstructive apnoea index (OAI), Snoring Index (SI) using polysomnography (PSG). RESULT: Nasal correction surgery showed statistically significant improvement (p-value < 0.001) in RDI from 13.66 to 6.66, OAI from 6.34 to 3.18 and Snoring Index from 161.77 to 62.23 as assessed by polysomnography. There was statistically significant improvement in minimal saturation levels (during sleep) and positional sleep apnoea. CONCLUSION: Isolated nasal surgery like septoplasty and/or turbinate reduction improved sleep parameters and alleviated OSA symptoms in patients with static nasal obstruction and obstructive sleep apnoea/hypopnoea syndrome. However, patients with multilevel or dynamic airway obstruction may need further intervention.

[Subjective and objective comparative analysis of nasal ventilation function before and after nasal septoplasty].

Objective:To investigate the changes of nasal ventilation before and after septoplasty by using NOSE scoring scale and nasal function examination, and to explore the correlation between subjective nasal obstruction and nasal function examination and its clinical application value. Methods:A total of 129 cases of nasal septum deviation from December 2021 to April 2023 in our hospital were selected for study. All patients underwent septoplasty. Nasal obstruction symptom evaluation（NOSE） was performed in all patients before surgery and 3 months after surgery. nasal minimal cross-sectional area（MCA） and nasal cavity volume（NCV） were recorded by nasal acoustic reflex, nasal resistance meter and nasal respiration apparatus, nasal resistance（NR）, distance between the nostril to minimum cross-sectional area,（the distance between the nostril to minimum cross-sectional area, MD）, nasal inspiratory volume（IV）, nasal expiratory volume（EV）, the nasal partitioning ratio, NPR includes objective indicators such as inspiratory volume difference ratio（NPRi） and expiratory volume difference ratio（NPRe）. Paired test was used to compare and analyze the changes of various indicators before and after surgery, and the difference（P<0.05） was statistically significant, and Pearson correlation linear analysis was used to analyze the correlation between subjective and objective indicators. Results:There were statistically significant differences in NOSE score, NCV, NR, MD, EV, IV, NPRe and NPRi of 129 patients before and after surgery（P<0.05）, while there was no statistically significant difference between MCA before and after surgery（P>0.05）. Preoperative NOSE score was correlated with NR, NCV, EV, IV, NPRe and NPRi（P<0.05）, but not with MD and MCA（P>0.05）. There was correlation between NOSE score and NR, MCA, NCV, EV, IV, NPRe and NPRi（P<0.05）, but no correlation between nose score and MD（P>0.05）. Conclusion:The subjective NOSE scale combined with nasal function test has certain clinical reference value in evaluating the surgical effect of patients with deviated nasal septum.