1
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Vo R, Barhoush Y, Batchu L, Adams S, Setzen G. All-cause claims analysis of the LATERA absorbable nasal implant vs surgical repair in patients with nasal valve collapse. J Med Econ 2024; 27:1099-1107. [PMID: 39138885 DOI: 10.1080/13696998.2024.2362046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 08/15/2024]
Abstract
AIMS To compare all-cause claims associated with the LATERA Absorbable Nasal Implant and surgical repair of nasal vestibular stenosis in patients with nasal valve collapse. METHODS This retrospective cohort study utilized data from STATinMED RWD Insights. A defined set of HCPCS, ICD-10-CM and CPT codes were used to identify patients with ≥1 claim for a LATERA procedure, and patients with ≥1 claim for surgical repair between June 1, 2015- March 31, 2023. Patients with continuous capture for at least 12 months before and at least 6 months after the index date were selected. The index date was defined as earliest date of encounter for a LATERA or surgical repair procedure. Inverse probability of treatment weighting (IPTW) was used to ensure balance between cohorts. Descriptive analyses were provided for all claims data using standard summary statistics. All-cause claims were assessed during the baseline, index date, and follow-up period. Chi-squared tests and independent sample t-tests were used to assess differences in cohorts for categorical and continuous variables, respectively. RESULTS The study population included 5,032 LATERA patients and 26,553 surgical repair patients. During the baseline and follow-up periods, the matched cohorts exhibited similar all-cause claims. On the index date, LATERA patients incurred lower claims vs. surgical repair, likely due to LATERA's ability to be implanted in the physician office setting. LATERA patients and surgical repair patients mean (SD) total costs were $9,612 [$14,930] vs $11,846 [$17,037] (p ≤ 0.0001), respectively. CONCLUSIONS Treatment with the LATERA Absorbable Nasal Implant is a potentially cost saving option for payers on the index date compared to traditional surgical repair in patients with nasal valve collapse due to the ability to be performed in the office. All-cause claims were similar in the baseline and follow-up periods. When performed with concomitant procedures, all-cause claims during follow-up were similar between groups.
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Affiliation(s)
- Ricky Vo
- Medical Affairs, Stryker ENT, Plymouth, Minnesota, USA
| | | | | | | | - Gavin Setzen
- Albany ENT and Allergy Services, Albany, New York, USA
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2
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Liu SW, Lyford-Pike S. Management of Lateral Wall Insufficiency. Facial Plast Surg 2023; 39:616-620. [PMID: 37709288 DOI: 10.1055/s-0043-1773767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Lateral wall insufficiency is a commonly encountered etiology of nasal obstruction, resulting from dynamic collapse at the level of the internal or external nasal valve. Various management strategies exist to strengthen the lateral wall or stent the nasal valves to relieve nasal obstruction, and range from noninvasive devices, minimally invasive implants, or surgical reconstructive techniques. Surgical options to address the nasal valves are selected based on each patient's anatomic findings, aesthetic and functional goals, and surgeon preference. This article describes the anatomy and physiology of the nasal sidewall and nasal valves and diagnosis of lateral wall insufficiency, and provides a framework for treatment options.
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Affiliation(s)
- Sara W Liu
- Head and Neck Institute, Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sofia Lyford-Pike
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota
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3
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Razavi CR, Byrne PJ. Intellectual Property in Facial Plastic and Reconstructive Surgery: The Importance and Process of Obtaining Intellectual Property Rights. Facial Plast Surg 2023; 39:460-465. [PMID: 37196666 DOI: 10.1055/a-2095-6367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
Understanding the purpose and process of obtaining intellectual property rights (IPR) is fundamental to health care innovation. Facial plastic and reconstructive surgeons are natural innovators; however, knowledge deficit in this space may hinder the ability to move ideas from the "bench to bedside." Here we provide an overview of IPR, outlining the steps necessary to obtain intellectual property protection in an academic setting while highlighting recent U.S. Food and Drug Administration (FDA) approvals pertaining to facial plastic and reconstructive surgery.
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Affiliation(s)
- Christopher R Razavi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Patrick J Byrne
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio
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4
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Wilkins SG, Sheth AH, Kayastha D, Abdou H, Salehi PP, Citardi MJ, Peter Manes R. Adverse Events Associated With Bioabsorbable Nasal Implants: A MAUDE Database Analysis. Otolaryngol Head Neck Surg 2023; 168:1253-1257. [PMID: 36939542 DOI: 10.1002/ohn.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 01/29/2023]
Abstract
Bioabsorbable implants (eg, Latera) have recently been approved for addressing nasal valve collapse. The purpose of this study is to summarize adverse events and treatment sequelae associated with bioabsorbable nasal implants queried in the Manufacturer and User Facility Device Experience (MAUDE) database. Of the 26 device reports entered between March 2017 and April 2022, the most frequently reported complications included abscess (n = 13) and implant protrusion (n = 5). Other common symptoms reported greater than 1-year postimplantation included facial pain/discomfort (n = 3) and failure to absorb (n = 3). Management of adverse events included treatment with antibiotics (n = 9), steroid injections (n = 4), and explantation (n = 20). In 3 reports, adverse reactions required a biopsy of adjacent tissue for pathologic analysis. These findings suggest that further research is required to assess the potential long-term complications and optimize the management of bioabsorbable nasal implants. Furthermore, standardized reporting templates may improve the utility of the MAUDE database.
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Affiliation(s)
- Sarah G Wilkins
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amar H Sheth
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Darpan Kayastha
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hisham Abdou
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Parsa P Salehi
- Nassif MD Plastic Surgery, Beverly Hills, California, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - R Peter Manes
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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5
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Winkler AA, Pham TT. Promising Implants in Rhinoplasty. Facial Plast Surg 2022; 38:455-460. [DOI: 10.1055/s-0042-1748766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AbstractMany dilemmas in rhinoplasty tempt surgeons to use exogenous materials. We have long looked toward implants to decrease operative time, to achieve a more reliable result, or when there is a paucity of autologous material. More than ever, the innovative and highly lucrative field of nasal implantology is developing technologically advanced products. This article looks at some popular nasal implant choices with a look toward what might be on the horizon.
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Affiliation(s)
- Andrew A. Winkler
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Tiffany T. Pham
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado
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6
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Clark CM, Hakimi AA, Parsa KM, Tanenbaum Z, Wang H, Chu E, Reilly MJ. Comparison of Nasal Obstruction Symptom Evaluation Score Outcomes After Autologous Cartilage Grafts and Latera Nasal Implants. Ann Otol Rhinol Laryngol 2022:34894221121405. [DOI: 10.1177/00034894221121405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare quantitative Nasal Obstruction Symptom Evaluation (NOSE) scores for ACG and Latera implants for nasal valve repair. Methods: Retrospective chart review of patients who underwent ACG or Latera placement between January 2016 through May 2019 by a single surgeon. Patients who had completed NOSE surveys pre- and post-operatively were identified and eligible for inclusion. Data regarding baseline demographic characteristics, adjunctive surgical procedures, NOSE scores at 1, 3, and 6-month post-operative visits, complications, and total operative time were collected. Unpaired t-tests and linear mixed models were performed to analyze differences between study groups. Results: There were 24 and 39 patients who underwent ACG and Latera, respectively, who met eligibility criteria. There were no differences in demographic characteristics or pre-operative baseline NOSE scores (ACG: 65.1 and Latera: 64.4; P = .92) between groups. Mean operative times were not significantly different between groups (ACG: 113 minutes and Latera: 102 minutes; P = .76). Within each group, NOSE scores were significantly improved at each post-operative visit compared to pre-operative baselines. Between groups, mean NOSE scores were lower at each post-operative visit for ACG compared to Latera (1-month ACG: 21.7 and Latera: 45.9, P = .002 ; 3-month ACG: 14.5 and Latera: 39.9, P = .034; 6-month ACG: 8.4 and Latera: 44.2, P = .003). Conclusions: Both ACG and Latera offer significant improvements in patient-reported nasal obstruction severity; however, ACG may yield more favorable subjective symptom scores.
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Affiliation(s)
- Christine M. Clark
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Amir A. Hakimi
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Keon M. Parsa
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Haijun Wang
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Washington, DC, USA
| | - Eugenia Chu
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Michael J. Reilly
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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7
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Moazzami C, Sédillot-Daniel È, Gagnon C, Voizard B, Martineau S, Moubayed SP. A Randomized Controlled Trial on Facial Muscle Therapy in Nasal Obstruction. Facial Plast Surg Aesthet Med 2022; 24:460-464. [DOI: 10.1089/fpsam.2021.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chloé Moazzami
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Ève Sédillot-Daniel
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Canada
| | - Carolanne Gagnon
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Canada
| | - Béatrice Voizard
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Canada
| | - Sarah Martineau
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Department of Speech Therapy, Hôpital Sacré-Coeur de Montréal (HSCM), Montreal, Canada
| | - Sami P. Moubayed
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Canada
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8
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Update on the Evaluation and Management of Nasal Valve Collapse. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Neffe AT, Izraylit V, Hommes-Schattmann PJ, Lendlein A. Soft, Formstable (Co)Polyester Blend Elastomers. NANOMATERIALS 2021; 11:nano11061472. [PMID: 34206137 PMCID: PMC8230036 DOI: 10.3390/nano11061472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 11/20/2022]
Abstract
High crystallization rate and thermomechanical stability make polylactide stereocomplexes effective nanosized physical netpoints. Here, we address the need for soft, form-stable degradable elastomers for medical applications by designing such blends from (co)polyesters, whose mechanical properties are ruled by their nanodimensional architecture and which are applied as single components in implants. By careful controlling of the copolymer composition and sequence structure of poly[(L-lactide)-co-(ε-caprolactone)], it is possible to prepare hyperelastic polymer blends formed through stereocomplexation by adding poly(D-lactide) (PDLA). Low glass transition temperature Tg ≤ 0 °C of the mixed amorphous phase contributes to the low Young’s modulus E. The formation of stereocomplexes is shown in DSC by melting transitions Tm > 190 °C and in WAXS by distinct scattering maxima at 2θ = 12° and 21°. Tensile testing demonstrated that the blends are soft (E = 12–80 MPa) and show an excellent hyperelastic recovery Rrec = 66–85% while having high elongation at break εb up to >1000%. These properties of the blends are attained only when the copolymer has 56–62 wt% lactide content, a weight average molar mass >140 kg·mol−1, and number average lactide sequence length ≥4.8, while the blend is formed with a content of 5–10 wt% of PDLA. The devised strategy to identify a suitable copolymer for stereocomplexation and blend formation is transferable to further polymer systems and will support the development of thermoplastic elastomers suitable for medical applications.
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Affiliation(s)
- Axel T. Neffe
- Institute of Active Polymers, Helmholtz-Zentrum Hereon, 14513 Teltow, Germany; (A.T.N.); (V.I.); (P.J.H.-S.)
| | - Victor Izraylit
- Institute of Active Polymers, Helmholtz-Zentrum Hereon, 14513 Teltow, Germany; (A.T.N.); (V.I.); (P.J.H.-S.)
- Institute of Chemistry, University of Potsdam, 14469 Potsdam, Germany
| | - Paul J. Hommes-Schattmann
- Institute of Active Polymers, Helmholtz-Zentrum Hereon, 14513 Teltow, Germany; (A.T.N.); (V.I.); (P.J.H.-S.)
| | - Andreas Lendlein
- Institute of Active Polymers, Helmholtz-Zentrum Hereon, 14513 Teltow, Germany; (A.T.N.); (V.I.); (P.J.H.-S.)
- Institute of Chemistry, University of Potsdam, 14469 Potsdam, Germany
- Correspondence:
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10
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Sidle DM, Stolovitzky P, O'Malley EM, Ow RA, Nachlas NE, Silvers S. Bioabsorbable Implant for Treatment of Nasal Valve Collapse with or without Concomitant Procedures. Facial Plast Surg 2021; 37:673-680. [PMID: 33853139 PMCID: PMC8492107 DOI: 10.1055/s-0041-1726464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of the study is to report outcomes after treatment of nasal valve collapse with a bioabsorbable nasal implant. It involves two prospective, multicenter, post-market studies evaluating long-term effectiveness of the LATERA implant for severe to extreme nasal obstruction. Participants underwent implant alone or with concomitant inferior turbinate reduction (ITR) and/or septoplasty. Outcome measures included the change from baseline Nasal Obstruction Symptom Evaluation (NOSE) scores, NOSE responder rates, visual analog scale (VAS) scores, and adverse events. A total cohort of 277 participants (109 implants only, 67 implants + ITR, 101 implants + septoplasty + ITR) enrolled at 19 U.S. centers was available for analysis with 177 participants (69 implants only, 39 implants + ITR, 69 implants + septoplasty + ITR) available at 2 years. The mean changes from baseline in NOSE scores and VAS scores were statistically significant (
p
< 0.001) at all follow-up periods. The baseline NOSE score of 77.8 ± 13.6 was improved to 24.2 ± 23.6 at 24 months. Greater than 90% of participants were NOSE responders across all follow-up periods, 6.1% withdrew for lack of treatment effect. The baseline VAS score of 66.7 ± 18.8 was improved to 21.1 ± 23.9 at 24 months. There were no serious adverse events related to the device or implant procedure. Implant retrieval rate was 4.0% (22/543 implants). Nonserious adverse events were mild to moderate in severity, typically occurred within 6 months of implant, and resolved or were stable. Significant reductions in NOSE and VAS scores and high responder rates from our large population of patients with nasal obstruction who had nasal valve implants confirm sustained effectiveness at 24 months after treatment. The studies are registered on
www.clinicaltrials.gov
(NCT02952313 and NCT02964312).
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Affiliation(s)
- Douglas M Sidle
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pablo Stolovitzky
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, California
| | - Nathan E Nachlas
- Ear, Nose, Throat, and Allergy Associates of Florida, Boca Raton, Florida
| | - Stacey Silvers
- Madison ENT and Facial Plastic Surgery, New York, New York
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11
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Geelan-Hansen K, Were V, Miller M, Heckman WW. Use of Functional Rhinoplasty in the Aging Nose: Medicare Database Analysis. Facial Plast Surg Aesthet Med 2021; 24:271-275. [PMID: 33847511 DOI: 10.1089/fpsam.2020.0536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Nasal obstruction is a common clinical problem. It has become more recognized that the internal and external nasal valves are the areas of greatest resistance. There are changes with aging that can contribute to nasal valve compromise. This study sought to evaluate the utilization of functional rhinoplasty, septoplasty, and inferior turbinate reduction procedures in the Medicare population. Methods: The annual procedure data were obtained from the Part B National Summary Data File from 2000 to 2019. Functional rhinoplasty procedures using current procedural terminology (CPT) for rhinoplasty (30400, 30410, 30420, 30465), septoplasty (30520), and inferior turbinate reduction (30801, 30802, 30130, 30140, 30930) procedures were analyzed. Results: There was increased use of CPT codes 30465, 30410, and 30420 with a decrease in 30400. There was an overall increase in codes 30520 and 30140. When adjusting for the Medicare population per 100,000 enrollees, there was increased use of 30465 and 30140 and decrease in 30520. The charges and payment trends were similar to the overall use of CPT codes. Discussion: There is an overall increase in use of nasal airway procedures including functional rhinoplasty in the aging population.
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Affiliation(s)
- Katie Geelan-Hansen
- Department of Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Vega Were
- Department of Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mark Miller
- Department of Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - William Wes Heckman
- Department of Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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12
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Treating Symptomatic Midvault Soft Tissue Collapse in Revision Rhinoplasty with a Nasal Wall Implant. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2887. [PMID: 32766052 PMCID: PMC7339293 DOI: 10.1097/gox.0000000000002887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 01/09/2023]
Abstract
Persistent nasal airway obstruction (NAO) due to midvault soft tissue collapse in patients following rhinoplasty or nasal surgery is a clinical challenge for surgeons. An absorbable lateral nasal wall implant is one option available to help treat midvault soft tissue collapse and to improve NAO symptoms. Previous studies have not investigated its use in complex revision functional rhinoplasty with respect to patient-reported outcomes. Data were collected on all patients with a history of previous nasal procedures who underwent Latera implant placement in conjunction with functional rhinoplasty from January to December 2018. The Nasal Obstructive Symptom Evaluation and Visual Analogue Scale were used to evaluate functional outcomes. Eight implants were placed in 6 revision functional rhinoplasty patients with midvault collapse. All patients responded to the survey. Mean follow-up was 16 ± 4 months. There were no implant-related adverse events. Mean Nasal Obstructive Symptom Evaluation score was 33 ± 33, and mean Visual Analogue Scale score was 20 ± 9. In total, 1 patient reported complete resolution of NAO, whereas 2 patients reported mild, 1 reported moderate, 1 reported severe, and 1 reported extreme symptoms. Four of the 6 patients reported nasal obstruction improvement, with all reporting improvement in midvault soft tissue collapse. Apart from being used in nasal valve collapse treatment, a lateral nasal wall implant is a potentially useful solution that may help surgeons improve patients’ NAO symptoms in complex functional rhinoplasty cases. However, in certain cases, a patient’s nasal obstructive symptoms may continue to be multifactorial.
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13
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Brandon BM, Stepp WH, Basu S, Kimbell JS, Senior BA, Shockley WW, Madison Clark J. Nasal Airflow Changes With Bioabsorbable Implant, Butterfly, and Spreader Grafts. Laryngoscope 2020; 130:E817-E823. [PMID: 32364619 DOI: 10.1002/lary.28691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Internal nasal valve compromise is a major cause of nasal obstruction, with a growing number of ways to treat this condition. In this study, we compared the effects of butterfly graft, spreader graft, and the bioabsorbable nasal implant on nasal airflow resistance. STUDY DESIGN Cadaver study. METHODS Computational fluid dynamics (CFD) simulations were completed from nine preoperative and postoperative cadaveric subjects. Each cadaveric head underwent placement of a bioabsorbable nasal implant (BNI) (Spirox Latera; Stryker ENT, Plymouth, MN), butterfly graft, or spreader graft. Pre- and postoperative computed tomography (CT) scans were used to generate three-dimensional models of the nasal airway used in steady-state CFD simulations of airflow and heat transfer during inspiration. RESULTS Butterfly graft placement resulted in a mean improvement in nasal airway resistance of 24.9% (±7.3), whereas BNI placement resulted in a 6.7% (±1.2) improvement, and spreader graft placement also resulted in a consistent improvement of 2.6% (±13.5). Pressure within the main nasal cavity was consistently lower following butterfly graft placement versus a spreader graft or BNI. Butterfly and spreader graft placement also resulted in modest improvements in airflow allocation, whereas BNI demonstrated more variation (-1% to 12%). Heat flux was not significantly different; however, a small improvement in total heat flux was seen with all three interventions. CONCLUSIONS The results of this study demonstrate reduction in nasal airway resistance in all three surgical interventions, with the butterfly graft demonstrating superiority to the other two techniques. However, these data only reflect a static environment and not dynamic changes in airflow seen during respiration. LEVEL OF EVIDENCE NA Laryngoscope, 130:E817-E823, 2020.
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Affiliation(s)
- Bryan M Brandon
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Wesley H Stepp
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Saikat Basu
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.,Department of Mechanical Engineering, South Dakota State University, Brookings, South Dakota, U.S.A
| | - Julia S Kimbell
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Brent A Senior
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - William W Shockley
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - J Madison Clark
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
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14
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Kim DH, Lee HH, Kim SH, Hwang SH. Effectiveness of using a bioabsorbable implant (Latera) to treat nasal valve collapse in patients with nasal obstruction: systemic review and meta-analysis. Int Forum Allergy Rhinol 2020; 10:719-725. [PMID: 32282129 DOI: 10.1002/alr.22543] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/20/2020] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nasal obstruction is a common cause of breathing problems with lateral wall insufficiency (LWI) a key anatomic contributor. Recently, a bioabsorbable nasal implant was introduced to correct LWI and treat nasal obstruction. The goal of this study was to perform a systematic review with meta-analysis to determine the efficacy of the bioabsorbable nasal implant for treating nasal obstruction caused by LWI. METHODS Five databases (PubMed, SCOPUS, EMBASE, Web of Science, and the Cochrane Database) were independently reviewed by 2 researchers, starting at the earliest time point recorded in the database to September 2019. Studies that scored endoscopic lateral wall movement and nasal obstruction related to quality of life (QOL) postoperatively before and after bioabsorbable nasal implants and those that compared the outcomes of nasal implants (treatment group) with outcomes of sham surgery (control group) were included in the analysis. RESULTS Five studies (396 patients) met the inclusion criteria. Bioabsorbable nasal implants significantly reduced endoscopic lateral wall motion compared to pretreatment values and also improved QOL at 12 months postoperatively. Most adverse effects following the nasal implant, such as skin or mucosal reaction, infection, or implant retrieval, were reported with a 5% incidence rate. All adverse outcomes were resolved without significant sequelae. Compared with sham surgery, bioabsorbable nasal implants significantly improved disease-specific QOL. CONCLUSION Bioabsorbable nasal implants may reduce nasal wall movement and subjective symptom scores compared to preoperative status. More randomized clinical trials must be conducted to further verify the effectiveness of bioabsorbable nasal implants.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Ho Lee
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Hong Kim
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Rameau A, Hong RS, Djalilian H, Erbele ID, Phillips KM, Capasso R, Rose AS, Brenner MJ, Santa Maria PL. New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2019. OTO Open 2020; 4:2473974X20932506. [PMID: 32537556 PMCID: PMC7268138 DOI: 10.1177/2473974x20932506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To review new devices and drugs relevant to otolaryngology-head and neck surgery that were approved by the US Food and Drug Administration (FDA) in 2019. DATA SOURCES Approval notifications for 2019 were extracted from the ENT (ear, nose, and throat) and general and plastic surgery sections of the FDA's medical devices and therapeutics listings. REVIEW METHODS New therapeutics and medical devices identified from the query were analyzed by members of the American Academy of Otolaryngology-Head and Neck Surgery's Medical Devices and Drugs Committee. Technologies were assessed by 2 independent reviewers to ascertain relevance to otolaryngology, prioritized, and classified to subspecialty field with critical review based on extant scientific literature. CONCLUSIONS Query of the FDA drug and device database returned 105 ENT devices (50 cleared, 55 with premarket approval, and 0 de novo), 543 general and plastic surgery devices (372 cleared, 170 with premarket approval, and 1 de novo), and 46 new otolaryngology-relevant drug approvals that occurred in 2019. Advances spanned all subspecialty areas with otology predominating, primarily due to hearing-related technologies. While scientific evidence was available for all new devices, there was significant heterogeneity in rigor of supporting scientific data. IMPLICATIONS FOR PRACTICE Technological and pharmaceutical innovation is an important catalyst for advances in the surgical specialties. Familiarity with new devices and therapeutics in otolaryngology-head and neck surgery ensures that clinicians keep abreast of developments with potential to improve prevailing standards of care.
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Affiliation(s)
- Anais Rameau
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, New York, USA
| | - Robert Stephen Hong
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Hamid Djalilian
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, University of California–Irvine, Irvine, California, USA
| | - Isaac David Erbele
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology, Louisiana State University of the Health Sciences, Baton Rouge, Louisiana, USA
| | - Katie M. Phillips
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Robson Capasso
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Austin S. Rose
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael Joel Brenner
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Peter Luke Santa Maria
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California, USA
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