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Abello EH, Nguyen TV, Dilley KK, Hong D, Kim JS, Nair PS, Bitner BF, Jia W, Wong BJF. Temperature Profile Measurement From Radiofrequency Nasal Airway Reshaping Device. Laryngoscope 2024; 134:1063-1070. [PMID: 37594207 DOI: 10.1002/lary.30942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/17/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Nasal airway obstruction (NAO) is caused by various disorders including nasal valve collapse (NVC). A bipolar radiofrequency (RF) device (VivAer®, Aerin Medical, Sunnyvale, CA) has been used to treat NAO through RF heat generation to the upper lateral cartilage (ULC). The purpose of this study is to measure temperature elevations in nasal tissue, using infrared (IR) radiometry to map the spatial and temporal evolution of temperature. STUDY DESIGN Experimental and computational. METHODS Composite porcine nasal septum was harvested and sectioned (1 mm and 2 mm). The device was used to heat the cartilage in composite porcine septum. An IR camera (FLIR® ExaminIR, Teledyne, Wilsonville, OR) was used to image temperature on the back surface of the specimen. These data were incorporated into a heat transfer finite element model that also calculated tissue damage using Arrhenius rate process. RESULTS IR temperature imaging showed peak back surface temperatures of 49.57°C and 42.21°C in 1 and 2 mm thick septums respectively. Temperature maps were generated demonstrating the temporal and spatial evolution of temperature. A finite element model generated temperature profiles with respect to time and depth. Rate process models using Arrhenius coefficients showed 30% chondrocyte death at 1 mm depth after 18 s of RF treatment. CONCLUSION The use of this device creates a thermal profile that may result in thermal injury to cartilage. Computational modeling suggests chondrocyte death extending as deep as 1.4 mm below the treatment surface. Further studies should be performed to improve dosimetry and optimize the heating process to reduce potential injury. Laryngoscope, 134:1063-1070, 2024.
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Affiliation(s)
- Eric H Abello
- Beckman Laser Institute and Medical Clinic, Irvine, California, USA
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine Medical Center, Orange, California, USA
| | | | - Katelyn K Dilley
- Beckman Laser Institute and Medical Clinic, Irvine, California, USA
| | - Donggyoon Hong
- Beckman Laser Institute and Medical Clinic, Irvine, California, USA
| | - Justin S Kim
- Beckman Laser Institute and Medical Clinic, Irvine, California, USA
| | - Pranav S Nair
- Beckman Laser Institute and Medical Clinic, Irvine, California, USA
| | - Benjamin F Bitner
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine Medical Center, Orange, California, USA
| | - Wangcun Jia
- Beckman Laser Institute and Medical Clinic, Irvine, California, USA
| | - Brian J F Wong
- Beckman Laser Institute and Medical Clinic, Irvine, California, USA
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine Medical Center, Orange, California, USA
- Department of Biomedical Engineering, Henry Samueli School of Engineering, Irvine, California, USA
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Raithatha R, Del Signore A. Prevalence and Identification of Nasal Airway Obstruction in Patients Presenting to Otolaryngology Clinics: Results From a Large Descriptive Practice Survey. Ear Nose Throat J 2023:1455613231196670. [PMID: 37705360 DOI: 10.1177/01455613231196670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Objective: Determine the prevalence of nasal airway obstruction (NAO) in patients presenting to general otolaryngology clinics using the Nasal Obstruction Symptom Evaluation Scale (NOSE) score as a screening tool. Study Design: The clinic staff at 149 otolaryngology specialty clinics geographically distributed in the United States administered the NOSE Scale assessment to 3533 patients presenting to the clinics over a period of 1 week, regardless of the reason for the visit. All patients completed the NOSE Scale score, and additional data were collected, including the primary reason for the visit. Demographic and patient characteristics were summarized using frequencies and percentages for categorical variables. Results: The overall mean NOSE Scale score for the 3533 patients surveyed was 37.6 (SD 31.5). A total of 37.4% (1320/3533) of surveyed patients, regardless of visit reason, had severe/extreme NAO symptoms. Overall, the most common visit reason category was "Other" (61.2%, 2162/3533), followed by "NAO" (22.6%, 798/3533) and "Sinus" (16.2%, 573/3533). The mean NOSE scores for patients in each of the visit categories were 23.4 (SD 25.9), 64.7 (SD 23.3), and 53.3 (SD 28.1); for "Other," "NAO," and "Sinus," respectively. Among the patients coming in with "NAO" or "Sinus" as a primary complaint, 76.2% (608/798) and 57.2.% (328/573) had severe or extreme NOSE scores. A total of 17.8% (384/2162) of patients coming in for "Other" reasons had NOSE scores indicating severe/extreme NAO symptoms. Conclusions: The findings of this large, descriptive otolaryngology practice survey found a high prevalence of moderate to severe/extreme NAO among patients presenting to otolaryngology practices. Incorporating assessments, such as the NOSE Scale score and other diagnostic practices into the patient intake workflow and assessments, could help identify symptomatic NAO patients that might otherwise be overlooked.
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Affiliation(s)
- Roheen Raithatha
- ENT and Allergy Associates, New York, NY, USA
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony Del Signore
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Yao WC, Pritikin J, Sillers MJ, Barham HP. Two-year outcomes of temperature-controlled radiofrequency device treatment of the nasal valve for patients with nasal airway obstruction. Laryngoscope Investig Otolaryngol 2023; 8:808-815. [PMID: 37621275 PMCID: PMC10446315 DOI: 10.1002/lio2.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 08/26/2023] Open
Abstract
Background The objective of this study was to evaluate long-term symptom improvements in patients with nasal airway obstruction (NAO) secondary to nasal valve collapse (NVC) following minimally invasive temperature-controlled radiofrequency (TCRF) treatment. Methods A prospective, single-arm, multicenter study in patients >18 years with NAO due to NVC. Inclusion criteria were response to nasal valve dilation (e.g., modified Cottle maneuver) and baseline Nasal Obstruction Symptom Evaluation (NOSE) Scale score ≥60. Patients were treated in the nasal valve region with a TCRF device and followed through 2 years. A responder was ≥20% reduction NOSE Scale score or ≥1 reduction in severity class. Results A total of 122 patients were treated and 91 reached 2 years. The mean baseline NOSE Scale score was 80.3 (95% CI, 78.1-82.6). The adjusted mean change in score at 2 years was -45.8 (95% CI, -53.5 to -38.1), p < 0.001; a 57.0% improvement. The 2-year responder rate was 90.1% (95% CI, 82.3%-94.7%). Significant and sustained symptom improvement was achieved in subpopulations based on sex, age, body mass index, baseline NAO severity, nasal surgery history, NVC mechanism, septal deviation, and other anatomic contributors of NAO. No serious adverse events with a relationship to the study device and/or procedure were reported. Conclusions Minimally invasive TCRF device treatment of the internal nasal valve for NAO is well tolerated and leads to significant and sustained improvement in NAO symptom severity through 2 years, including in patients with both static and dynamic NVC, septal deviation, turbinate enlargement, or prior nasal surgery. Level of Evidence 2b.
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Affiliation(s)
- William C. Yao
- Department of Otorhinolaryngology‐Head and Neck SurgeryMcGovern Medical School at the University of Texas Health Science CenterHoustonTexasUSA
| | | | | | - Henry P. Barham
- Sinus and Nasal Specialists of LouisianaBaton RougeLouisianaUSA
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Silvers SL, Rosenthal JN, McDuffie CM, Yen DM, Han JK. Temperature-controlled radiofrequency device treatment of the nasal valve for nasal airway obstruction: A randomized controlled trial. Int Forum Allergy Rhinol 2021; 11:1676-1684. [PMID: 34240571 PMCID: PMC9292281 DOI: 10.1002/alr.22861] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/13/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
Background Nasal valve collapse is one of several causes of nasal obstruction. The safety and efficacy of a temperature‐controlled radiofrequency (RF) device for the treatment of the nasal valve for nasal airway obstruction (NAO) has been established in single‐arm studies. The objective of this trial was to compare active device treatment against a sham procedure (control). Methods In a prospective, multicenter, single‐blinded, randomized controlled trial (RCT), patients were assigned to bilateral temperature‐controlled RF treatment of the nasal valve (n = 77) or a sham procedure (n = 41), in which no RF energy was transferred to the device/treatment area. The device was applied to the mucosa over the lower lateral cartilage on the lateral nasal wall. The primary endpoint was responder rate at 3 months, defined as a ≥20% reduction in Nasal Obstruction Symptom Evaluation (NOSE)‐scale score or ≥1 reduction in clinical severity category. Results At baseline, patients had a mean NOSE‐scale score of 76.7 (95% confidence interval [CI], 73.8 to 79.5) and 78.8 (95% CI, 74.2 to 83.3) (p = 0.424) in the active treatment and sham‐control arms, respectively. At 3 months, the responder rate was significantly higher in the active treatment arm (88.3% [95% CI, 79.2%‐93.7%] vs 42.5% [95% CI, 28.5%‐57.8%]; p < 0.001). The active treatment arm had a significantly greater decrease in NOSE‐scale score (mean, −42.3 [95% CI, −47.6 to −37.1] vs −16.8 [95% CI, −26.3 to −7.2]; p < 0.001). Three adverse events at least possibly related to the device and/or procedure were reported, and all resolved. Conclusion This RCT shows temperature‐controlled RF treatment of the nasal valve is safe and effective in reducing symptoms of NAO in short‐term follow‐up.
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Affiliation(s)
| | | | | | - David M Yen
- Specialty Physician Associates, Bethlehem, PA
| | - Joseph K Han
- Department of Otolaryngology-Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
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San Nicoló M, Berghaus A. Two-Year Sustained Benefit of an Absorbable Implant for the Treatment of NVC. OTO Open 2017; 1:2473974X17722982. [PMID: 30480191 PMCID: PMC6239033 DOI: 10.1177/2473974x17722982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/21/2017] [Accepted: 07/07/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Marion San Nicoló
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Alexander Berghaus
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University of Munich, Munich, Germany
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Ceccarelli G, Gentile P, Marcarelli M, Balli M, Ronzoni FL, Benedetti L, Cusella De Angelis MG. In Vitro and In Vivo Studies of Alar-Nasal Cartilage Using Autologous Micro-Grafts: The Use of the Rigenera ® Protocol in the Treatment of an Osteochondral Lesion of the Nose. Pharmaceuticals (Basel) 2017; 10:E53. [PMID: 28608799 PMCID: PMC5490410 DOI: 10.3390/ph10020053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 12/26/2022] Open
Abstract
Cartilage defects represent a serious problem due to the poor regenerative properties of this tissue. Regarding the nose, nasal valve collapse is associated with nasal blockage and persistent airway obstruction associated with a significant drop in the quality of life for patients. In addition to surgical techniques, several cell-based tissue-engineering strategies are studied to improve cartilage support in the nasal wall, that is, to ameliorate wall insufficiency. Nevertheless, there are no congruent data available on the benefit for patients during the follow-up time. In this manuscript, we propose an innovative approach in the treatment of cartilage defects in the nose (nasal valve collapse) based on autologous micro-grafts obtained by mechanical disaggregation of a small portion of cartilage tissue (Rigenera® protocol). In particular, we first analyzed in vitro murine and human cartilage micro-grafts; secondly, we analyzed the clinical results of a patient with pinched nose deformity treated with autologous micro-grafts of chondrocytes obtained by Rigenera® protocol. The use of autologous micro-graft produced promising results in surgery treatment of cartilage injuries and could be safely and easily administrated to patients with cartilage tissue defects.
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Affiliation(s)
- Gabriele Ceccarelli
- Department of Public Health, Experimental Medicine and Forensic, Human Anatomy Unit, University of Pavia, Pavia 27100, Italy.
- Center for Health Technologies, University of Pavia, Pavia 27100, Italy.
| | - Pietro Gentile
- Chief of Plastic and Reconstructive Surgery, Catholic University, Tirana 1005, Albania.
- Plastic and Reconstructive Surgery Department, University of Rome "Tor Vergata", Rome 00173, Italy.
| | - Marco Marcarelli
- Santa Croce Hospital, Unit of Orthopedics and Traumatology of Chieri and Moncalieri, Turin 10024, Italy.
| | - Martina Balli
- Department of Public Health, Experimental Medicine and Forensic, Human Anatomy Unit, University of Pavia, Pavia 27100, Italy.
- Center for Health Technologies, University of Pavia, Pavia 27100, Italy.
| | - Flavio Lorenzo Ronzoni
- Department of Public Health, Experimental Medicine and Forensic, Human Anatomy Unit, University of Pavia, Pavia 27100, Italy.
- Center for Health Technologies, University of Pavia, Pavia 27100, Italy.
| | - Laura Benedetti
- Department of Public Health, Experimental Medicine and Forensic, Human Anatomy Unit, University of Pavia, Pavia 27100, Italy.
- Center for Health Technologies, University of Pavia, Pavia 27100, Italy.
| | - Maria Gabriella Cusella De Angelis
- Department of Public Health, Experimental Medicine and Forensic, Human Anatomy Unit, University of Pavia, Pavia 27100, Italy.
- Center for Health Technologies, University of Pavia, Pavia 27100, Italy.
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Goldman ND, Alexander R, Sandoval LF, Feldman SR. Nasal Valve Reconstruction Using a Titanium Implant: An Outcomes Study. Craniomaxillofac Trauma Reconstr 2017; 10:175-182. [PMID: 28751940 DOI: 10.1055/s-0037-1600900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 10/17/2016] [Indexed: 10/19/2022] Open
Abstract
Septoplasty alone is not always sufficient to correct nasal obstruction. Various techniques have been employed to repair nasal valve collapse and improve airflow. This article aimed to evaluate outcomes and quality of life following nasal valve reconstruction using a titanium implant in patients with nasal valve collapse. This is a single-center retrospective study that consisted of a telephone questionnaire of 37 quality-of-life measures and questions related to the surgical procedure and recovery process to evaluate postsurgical outcomes. Fifteen patients completed the survey. There was a significant improvement in nasal blockage/obstruction, breathing through the nose, sleeping, breathing through nose during exercise, the need to blow nose, sneezing, facial pain/pressure, fatigue, productivity, and restlessness/irritability after surgery. Overall, 100% of patients were satisfied with the results and would recommend this procedure. The most common postoperative complaints were pain (33%) and difficulty breathing (33%). Patients noticed no increase (20%) or a slight increase (73%) in the size of their nose. Sixty percent of patients cannot see the implant and 13% report the implant is barely noticeable. Nasal valve repair with a titanium implant was successful at improving symptoms of nasal obstruction and other quality-of-life issues. Satisfaction was high among all patients. The implants are palpable, thought to be visible by some patients, yet accepted by the majority of patients. This approach may be especially important in patients with prior nasal surgery but continue to experience refractory symptoms.
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Affiliation(s)
- Neal D Goldman
- The Goldman Center for Facial Plastic Surgery, Boone, North Carolina
| | - Richard Alexander
- Department of Otolaryngology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Laura F Sandoval
- Department of Dermatology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston Salem, North Carolina
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Maalouf R, Bequignon E, Devars du Mayne M, Zerah-Lancner F, Isabey D, Coste A, Louis B, Papon JF. A functional tool to differentiate nasal valve collapse from other causes of nasal obstruction: the FRIED test. J Appl Physiol (1985) 2016; 121:343-7. [PMID: 27283916 DOI: 10.1152/japplphysiol.00779.2015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 06/06/2016] [Indexed: 11/22/2022] Open
Abstract
Nasal valve collapse is a dynamic abnormality that is currently diagnosed purely on the basis of clinical features and thus subject to certain interpretation. The aim of this study was to develop a new and reliable functional test to objectively characterize nasal valve collapse. This was an observational prospective study including consecutive patients referred to our center for exploration of chronic nasal congestion. The patients were classified into two groups according to their symptoms and clinical abnormalities: the nasal valve collapse (NV+) group when nasal valve collapse was clinically detected during moderate forced inspiration and/or when the feeling of nasal congestion improved during passive nasal lateral cartilage abduction (n = 32); and the no-nasal valve collapse (NV-) group for the others (n = 23). All patients underwent nasal functional tests (posterior rhinomanometry and acoustic rhinometry) before and after topical nasal decongestion. We compared the difference between the pressure flow of the inspiratory and expiratory phases during posterior rhinomanometry [flow rate inspiratory-expiratory difference (FRIED) test] between the two groups. The difference between the absolute value of inspiratory and expiratory flow was significantly higher in the NV+ group than in the NV- group both before and after topical decongestion. The cutoff value for the FRIED test was -0.008 l/s with a good sensitivity (82%) and a specificity of 59%. We suggest that the FRIED test constitutes an objective and easy-to-apply technique to diagnose nasal valve collapse in daily practice.
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Affiliation(s)
- Ramzi Maalouf
- Assistance publique-Hôpitaux de Paris, Hôpital Henri-Mondor-A-Chenevier et Hôpital intercommunal, service d'ORL et de chirurgie cervico-faciale, Créteil, France
| | - Emilie Bequignon
- Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France; Université Paris-Est, Faculté de Médecine, Créteil, France; Centre National de la Recherche Scientifique, ERL 7240, Créteil, France; Assistance publique-Hôpitaux de Paris, Hôpital Henri-Mondor-A-Chenevier et Hôpital intercommunal, service d'ORL et de chirurgie cervico-faciale, Créteil, France
| | - Marie Devars du Mayne
- Assistance publique-Hôpitaux de Paris, Hôpital Henri-Mondor-A-Chenevier et Hôpital intercommunal, service d'ORL et de chirurgie cervico-faciale, Créteil, France
| | - Françoise Zerah-Lancner
- Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France; Université Paris-Est, Faculté de Médecine, Créteil, France; Centre National de la Recherche Scientifique, ERL 7240, Créteil, France; Assistance publique-Hôpitaux de Paris, Hôpital Henri-Mondor-A-Chenevier, service de physiologie et d'explorations fonctionnelles, Créteil, France
| | - Daniel Isabey
- Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France; Université Paris-Est, Faculté de Médecine, Créteil, France; Centre National de la Recherche Scientifique, ERL 7240, Créteil, France
| | - Andre Coste
- Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France; Université Paris-Est, Faculté de Médecine, Créteil, France; Centre National de la Recherche Scientifique, ERL 7240, Créteil, France; Assistance publique-Hôpitaux de Paris, Hôpital Henri-Mondor-A-Chenevier et Hôpital intercommunal, service d'ORL et de chirurgie cervico-faciale, Créteil, France
| | - Bruno Louis
- Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France; Université Paris-Est, Faculté de Médecine, Créteil, France; Centre National de la Recherche Scientifique, ERL 7240, Créteil, France;
| | - Jean-François Papon
- Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France; Université Paris-Est, Faculté de Médecine, Créteil, France; Centre National de la Recherche Scientifique, ERL 7240, Créteil, France; Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, service d'ORL et de chirurgie cervico-faciale, Le Kremlin-Bicêtre, France; and Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
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Bloching MB. Disorders of the nasal valve area. GMS Curr Top Otorhinolaryngol Head Neck Surg 2007; 6:Doc07. [PMID: 22073083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The nasal valve area is not a singular structure, but a complex three-dimensional construct consisting of several morphological structures. From the physiologic point of view, it is the place of maximum nasal flow resistance ("flow limiting segment"). Therefore, according to Poiseuille's law, even minor constrictions of this area result in a clinically relevant impairment of nasal breathing for the patient. This narrow passage, also called "ostium internum nasi", is formed by the mobile lateral nasal wall, the anterior septum with the swell body, the head of the inferior turbinate and the osseous piriform aperture. Within the framework of aetiology, static and dynamic disorders of the nasal valve area have to be distinguished since they result in different therapeutic measures. In the context of diagnosis, the exploration of the case history for assessing the patient's extent of suffering and the clinical examination are very important. In addition to the presentation of the basics of disorders of the nasal valves, this paper focuses on the treatment of dynamic disorders that mainly constitute the more important therapeutic issue. In this context, we distinguish between stabilisation techniques through grafts or implants and stabilising suture techniques. Following a thorough analysis, the correction of static nasal valve disorders requires various plastic-reconstructive measures using transposition grafting and skin or composite grafts.
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