The effect of rhytidectomy on the nasal valve

Bilateral congenital aplasia of nasal lower lateral cartilage: a rare anomaly

Congenital nasal anomalies are rare and occur in 1/20 000-1/40 000 newborns. An 8-year-old boy presented with developmental aplasia of bilateral nasal lower lateral cartilages, with excessive wrinkled and loose skin on the dorsum of the nose and with difficulty breathing through the nose. This is probably the first such case to be reported in the literature. The defect was reconstructed using conchal and septal cartilage grafting through an external rhinoplasty approach. At the end of the 12-month follow-up period, the patient was found to be satisfied with the functional and aesthetic results of the operation. Bilateral congenital aplasia of nasal lower lateral cartilages is extremely rare. Paediatric rhinoplasty is imperative in such cases.

Secondary Improvement in Static Facial Reanimation Surgeries: Increase of Nasal Function

OBJECTIVE

The aim of this study was to measure the effect of the static reanimation operation administered to patients with facial paralysis on nasal function area by comparing patients' preoperative and postoperative subjective perception of the nasal airflow.

MATERIALS AND METHOD

We applied the Nasal Obstruction Symptom Evaluation (NOSE) scale to 13 patients who underwent static reanimation because of facial palsies, both preoperatively and postoperatively, and results were compared statistically. The changes in nasal base angulation were recorded and compared based on the photographs of patients taken before and after the surgery.

RESULTS

Following the static reanimation operation, 76% (10/13) of the patients reported a subjective improvement in the nasal airflow, whereas 24% (3/13) did not report any change. Mean preoperative and postoperative NOSE scale scores were 66.92 ± 9.90 and 36.15 ± 9.61, respectively. The change in mean NOSE scale score was statistically significant (P < 0.001). In the preoperative and postoperative comparison of the photographs taken from the front view of the patients, a decreased nasal base angulation compared with preoperative period was detected in 8 (61.6%) patients.

CONCLUSIONS

A statistically significant increase in subjective perception about nasal function was observed after the static facial reanimation; however, it is not certain whether this effect can be considered persistent. Long-term studies conducted on a larger patient population will provide beneficial results.

Facial nerve trauma: evaluation and considerations in management

The management of facial paralysis continues to evolve. Understanding the facial nerve anatomy and the different methods of evaluating the degree of facial nerve injury are crucial for successful management. When the facial nerve is transected, direct coaptation leads to the best outcome, followed by interpositional nerve grafting. In cases where motor end plates are still intact but a primary repair or graft is not feasible, a nerve transfer should be employed. When complete muscle atrophy has occurred, regional muscle transfer or free flap reconstruction is an option. When dynamic reanimation cannot be undertaken, static procedures offer some benefit. Adjunctive tools such as botulinum toxin injection and biofeedback can be helpful. Several new treatment modalities lie on the horizon which hold potential to alter the current treatment algorithm.

Effect of an intra-oral nasal dilation appliance on 3-D nasal airway morphology in adults

To determine the effects of a nasal dilation appliance on 3-D nasopharyngeal airway patency. The sample comprised 187 adults (98 males, 89 females) with a history of sleep-disordered breathing. Acoustic rhinometry readings were taken from all patients before and after the intra-oral placement of a nasal dilation appliance (OASYS). The mean left and right nasopharyngeal airways were reconstructed in 3-D, and the data from the right and left nostrils were subjected to principal components analysis (PCA) and finite-element scaling analysis (FESA). Comparing the pre- and post-treatment 3-D mean, left nasopharyngeal airways using PCA, the first two eigenvalues accounted for 96% of the total shape change, and statistical differences were found (p < 0.01). Similarly, for the right side, significant differences were detected between the mean pre- and post-treatment 3-D nasopharyngeal airways (p < 0.01) using PCA. Using FESA to quantify and localize changes after the placement of the nasal dilation appliance, the 3-D mean, normalized, left nasopharyngeal airway was found to be 14% wider in the anterior nasal valve region and 28% wider in the distal regions, while the 3-D mean, normalized, right nasopharyngeal airway was 13% wider in the anterior nasal valve region and 27% wider further distally. The use of an intra-oral nasal dilation appliance may be useful in the management of nasopharyngeal conditions, such as snoring, upper airway resistance syndrome, sleep-disordered breathing, and obstructive sleep apnea, especially in cases where nasal obstruction is demonstrable.

Acoustic rhinometry in the practice of allergy

OBJECTIVE

To provide a comprehensive practical overview of the use of acoustic rhinometry in the practice of allergy.

DATA SOURCES

An all-inclusive PubMed search was conducted for articles on acoustic rhinometry that were published in peer-reviewed journals, between 1989 and 2006, using the keywords acoustic rhinometry, allergic rhinitis, and nasal provocation testing.

STUDY SELECTION

The expert opinion of the authors was used to select studies for inclusion in this review.

RESULTS

Acoustic rhinometry is a sound-based technique used to measure nasal cavity area and volume. It has been validated by comparison to measurements with computed tomography and magnetic resonance imaging. Acoustic rhinometry requires minimal patient cooperation and may be used in adults, children, and infants. It is used by medical practitioners to diagnose and evaluate therapeutic responses in conditions such as rhinitis and to measure nasal dimensions during allergen provocation testing. Acoustic rhinometry also provides a visual reflection of the nasal response to therapy, which may be useful in increasing compliance to prescribed medications.

CONCLUSIONS

Acoustic rhinometry is a safe, noninvasive, objective, and validated measure of nasal obstruction that appears to be of practical use in the diagnosis and management of inflammatory diseases of the upper airways.

Correlation between fiberoptic nasal endoscopy and acoustic rhinometry in adults without nasal complaints

BACKGROUND

Acoustic rhinometry indirectly calculates cross-sectional areas of the nose at various locations from the nostrils and the total volume of the nasal cavity. These parameters are calculated from an area-distance curve displayed by the device.

METHODS

Seventy-seven adults between the ages of 20 and 40 years who had no nasal complaints were examined by acoustic rhinometry and fiberoptic nasal endoscopy in an attempt to compare and correlate areas of nasal narrowing detected by these two methods.

RESULTS

The comparison between the distances to the various narrowed areas revealed a statistically significant correlation between the first three constrictions detected by acoustic rhinometry and the first three areas of anatomic narrowing measured by fiberoptic nasal endoscopy in both nares but no correlation between the fourth constriction and the fourth measurement on either side.

CONCLUSION

The results confirm an anatomic correlation between the two examination methods, identifying the first constriction as the nasal valve, the second constriction as the head of the inferior nasal turbinate, and the third constriction as the head of the middle turbinate. The fourth constriction did not correspond to the choanal region.

Advances in facial reanimation

PURPOSE OF REVIEW

Facial paralysis often has a significant emotional impact on patients. Along with the myriad of new surgical techniques in managing facial paralysis comes the challenge of selecting the most effective procedure for the patient. This review delineates common surgical techniques and reviews state-of-the-art techniques.

RECENT FINDINGS

The options for dynamic reanimation of the paralyzed face must be examined in the context of several patient factors, including age, overall health, and patient desires. The best functional results are obtained with direct facial nerve anastomosis and interpositional nerve grafts. In long-standing facial paralysis, temporalis muscle transfer gives a dependable and quick result. Microvascular free tissue transfer is a reliable technique with reanimation potential whose results continue to improve as microsurgical expertise increases. Postoperative results can be improved with ancillary soft tissue procedures, as well as botulinum toxin.

SUMMARY

The paper provides an overview of recent advances in facial reanimation, including preoperative assessment, surgical reconstruction options, and postoperative management.