Functional Nasal Surgery Research Articles

Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience.

The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP- therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and January 2017. All patients were subjected to the following s iter: anamnesis with Epworth Sleepiness Scale, NOSE scale, evaluation of "CPAP usage data." Upper airway optical fiber endoscopy with Müller's maneuver. We performed various type of nasal surgery (septoplasty, decongestion of the lower turbinates and FESS) 6months after the surgery, CPAP usage was evaluated and the NOSE scale has been reapplied. All patients had a subjective degree of obstruction classified in severe or extreme by the NOSE scale before surgery. Almost all patients reported a mild degree of obstruction after the surgery. About CPAP usage, the average usage has passed by 2, 3h at night to 6, 8h after the surgery. The result is significant because it shows how the nasal functional surgery can make selected patients suitable to ventilation therapy. As our work shows, a better nasal function allows to reduce the CPAP pressure, Therefore, we believe that all patients with medium to severe obstructive apnea syndrome and for whom night-time ventilation therapy (CPAP) is advised should be evaluated with endoscopy and anamnesis oriented to evaluate nasal obstructive pathologies that may reduce effectiveness of CPAP.

Simultaneous Rhinoseptoplasty and Orthognathic Surgery: Outcome Analysis of 250 Consecutive Patients Using a Modified Le Fort I Osteotomy.

The purpose of the present study was to assess the safety and efficacy of both functional intranasal procedures and cosmetic rhinoplasty combined with bimaxillary surgery. The author executed a retrospective cohort study derived from patients who underwent combined rhinoseptoplasty and bimaxillary surgery at a private practice setting (Face Surgery Center, Parma, Italy) between April 2006 and 2015 by a single surgeon. The minimum follow-up was 12months. Patients underwent bimaxillary orthognathic surgery, functional nasal surgery and cosmetic rhinoplasty. Two-hundred and fifty (250) consecutive, non-randomized patients met the inclusion criteria to enter the study. The overall complication rate was 5%, whereas the revision rate was 9%, showing an overall low rate, comparable to that of primary rhinoplasty (control group). About 94% of the patients polled after this procedure asserted they definitely accepted to have rhinoplasty only because it was included in one single surgical act together with orthognathic surgery. Cosmetic rhinoplasty shows great potentials to change our patients' appearance, whereas orthognathic surgery corrects jaw skeletal deformities and builds the right foundation for facial harmony. The combination of both procedures magnifies the single results reciprocally and significantly enhances the final outcomes. The quality of the overall aesthetic results, the scarcity of complications and the low percentage of defects that require revisions lead to the conclusion that when alterations to both the jaws and the nose are detected, a single intervention can grant great benefit to the patients in terms of morbidity and costs. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Percepción profesional y pública del campo de acción de la Otorrinolaringología y Cirugía de Cabeza y Cuello en un hospital de tercer nivel

Introduction: There are currently several medical specialties; this creates confusion about the fi eld of action of each of them. The work of an otolaryngologist and head and neck surgeon is wrongly limited to diseases of the ears, nose, and throat. Objective: To examine the perception that general practitioners, medical specialists and the general population have of the diseases that a certain specialist solves. Materials and methods: This is a descriptive study in which a survey was applied to general practitioners, residents and to the general population of the Hospital Español de México. Results: A total of 146 surveys was obtained. All the respondents—except general surgery residents—, 106 (72.6%), consider otolaryngologists and head and neck surgeons experts only in functional nasal and aesthetic surgery. Conclusions: The opinions obtained from the surveyed population differ greatly from each other and evidently show that, in general, there is no clear knowledge of the fi eld of action of our specialty, which results in a delay in effective medical care and patient protection.

Corrective Nasal Surgery after Maxillomandibular Advancement for Obstructive Sleep Apnea: Experience from 379 Cases.

Objective Efficacy of maxillomandibular advancement (MMA) in the treatment of obstructive sleep apnea (OSA) is associated with degree of maxillary advancement. Large maxillary advancement leads to profound changes of the nasolabial region. We present the incidence and indications of post-MMA corrective nasal surgery in a large cohort. Study Design Case series with chart review. Setting University medical center. Subjects and Methods A total of 379 subjects with OSA underwent MMA at Stanford Hospital (surgeons: S.Y.L., R.W.R.) from August 1992 to December 2015. Data were collected on age, sex, American Society of Anesthesiologists score, polysomnography parameters, and history of nasal surgery. Primary outcome parameters were the incidence and indications of post-MMA corrective nasal surgery. Results Of 379 subjects, the surgical success rate was 76.3% based on the change in respiratory disturbance index. Seventy-one subjects (18.7%) underwent corrective nasal surgery after MMA, whereas 48 underwent functional nasal surgery and 23 underwent both functional and aesthetic nasal surgery. Lower oxygen saturation nadir and higher baseline respiratory disturbance index were associated with increased likelihood of post-MMA corrective nasal surgery. Conclusion MMA surgical success is associated with degree of maxillary advancement, which is especially significant in patients with severe OSA. Patients must be counseled on its impact in nasal function and aesthetics. Our series, the largest to date to address this question, suggests that the incidence of post-MMA corrective nasal surgery is at least 18.7%. Prospectively, refinement in MMA techniques is needed to minimize postoperative compromise in nasal form and function.

Principles of computer planning in the functional nasal surgery

Principles of computer planning in the functional nasal surgery

Cytofunctional changes in nasal ciliated cells in patients treated with hyaluronate after nasal surgery.

Hyaluronic acid (HA) plays a significant role in tissue repair of mucosal surfaces and, consequently, in surgical injury remodelling of nasal mucosa. To assess the effect of high-molecular-weight HA administered by aerosol on the morphofunctional recovery of ciliated cells damaged by surgical trauma. A single-blind, prospective, randomized trial was carried out with 94 patients who were randomly assigned, after endoscopic turbinoplasty, either to treatment with nasal saline solution irrigation (control group, n = 47) or to treatment with nasal douches based on high concentration (9 mg) and high-molecular-weight sodium hyaluronate (active treatment group, n = 47). All the patients were evaluated by using nasal fiberendoscopy, mucociliary transport time, nasal cytologic test, and a visual analog scale in terms of symptoms before and at 2 and 4 weeks after surgery. Visual analog scale values were significantly lower in the active treatment (AT) group at week 2 regarding each individual symptom. Mucociliary transport time was significantly reduced in patients in the AT group but only 1 month after surgery. Both the percentage of cellular impairments and the number of cells with hyperchromatic supranuclear stria showed significant improvements in the AT group in all postsurgery evaluations (p < 0.05). Intranasal use of sodium hyaluronate in patients who underwent functional nasal surgery improved both mucociliary clearance and nasal mucosa regeneration due to a faster recovery of the impaired ciliated cells.

Does the Nose Have a Function Beyond Breathing?

This article examines how functional nasal surgery can result in aesthetic improvement to the nose. We performed a literature search examining functional rhinoplasty with resultant aesthetic benefits. We also conducted a review of various techniques that can be used to correct functional nasal obstruction that also achieve aesthetic improvement(s).Although there are data demonstrating improvements to quality of life after functional and aesthetic nasal surgery, there is limited work linking the close relationship between functional nasal surgery with resultant aesthetic improvements.Functional rhinoplasty to correct nasal obstruction can also result in aesthetic improvements. Perhaps reconsideration of separating these closely tied issues is needed. A formal study looking at the degree of worsened, unchanged, and improved nasal aesthetics that occurs after true functional rhinoplasty, from both objective and subjective viewpoints, should be considered.

The Nasal Airway: A Critical Review.

Functional nasal surgery is frequently performed and deeply embedded in otolaryngology. However, unequivocal proof of its efficacy is still pending, leading some health authorities toward restrictive policies. In this article, we review the evidence and suggest that reexamining the paradigm of functional nasal surgery may be appropriate.

Book Review: Functional Reconstructive Nasal Surgery

Book Review: <i>Functional Reconstructive Nasal Surgery</i>

Safety and Efficacy of Expanded Polytetrafluoroethylene Implants in the Surgical Management of Traumatic Nasal Deformity.

The ideal alloplastic implant for correction of traumatic nasal deformity has not been adequately examined. To evaluate the safety profile and postoperative results of expanded polytetrafluoroethylene (ePTFE) implants used in functional nasal surgery (FNS) in the setting of traumatic nasal deformity. We conducted a 13-year retrospective medical chart review for patients treated at a tertiary academic facial plastic and reconstructive surgery practice between July 1999 and July 2012. A total of 404 FNS procedures were performed by a single surgeon during this period, 255 to repair traumatic deformities, 35 of these involving ePTFE implants. Patient demographics, medical comorbidities, operative and technical considerations, functional and aesthetic results, complications, and postoperative course findings were collected from patient records. In addition, preoperative and postoperative photographic documents were examined. Functional nasal surgery. Postoperative complications or presentations necessitating revision. A total of 404 patients (197 male, 207 female) underwent FNS. Of those, 255 procedures were to treat traumatic deformities. Forty patients altogether required the use of an ePTFE implant, 35 of those 40 deformities being associated with a traumatic injury. One of the 35 patients in the ePTFE-repaired traumatic deformities group experienced postoperative infection. This patient ultimately developed exposure after the infection failed to resolve with oral antibiotics, and the implant was removed. An additional patient in the ePTFE group required revision of the implant owing to contour irregularity and aesthetic concerns. No infections or other complications occurred among the 220 patients with traumatic deformity treated with autologous grafts. Analysis of other variables including sex, tobacco use, diabetes, immunosuppression, implant thickness, suture material, and prior septorhinoplasty were not associated with increased rate of infection (P > .05 for all). In the setting of traumatic nasal deformities requiring FNS, ePTFE implants can be used at the level of the nasal dorsum, where soft tissue coverage is often adequate, with a low risk of complications.

Functional Rhinoplasty: Short Review

Examination of anatomical structures including the septum, internal and external nasal valve regions is essential in planning for functional rhinoplasty. In modern rhinoplasty procedures nasal functions (breathing and olfaction) beside its cosmetic role; should not be ignored for a successful operation. We should respect supportive structures of the nose in cosmetic rhinoplasty and also augment the weaker regions of the nose that are limiting nasal breathing during functional nasal surgery.

Pathological review of turbinate tissue from functional nasal surgery: incurring costs without adding quality.

Inferior turbinate surgery for nasal obstruction can be performed in a variety of ways. Only a few of these methods produce tissue that can be sent for pathologic analysis. According to the College of American Pathologists, turbinate tissues are not exempt from requisite pathologic evaluation. Our objectives were to evaluate the clinical value and cost implications of routine pathological examination of turbinate specimens. Case series with chart review. Academic tertiary care medical center. Charts of patients who underwent an inferior turbinate procedure for nasal obstruction between January 2008 and August 2011 were reviewed. Thirteen hundred consecutive cases from 17 surgeons were identified. Among these patients, 223 (17%) underwent an isolated turbinate reduction procedure and 779 (59%) underwent a reduction procedure in conjunction with a septoplasty. The remaining patients had a turbinate procedure in addition to another head and neck procedure. Only 591 (45%) turbinate reduction procedures were performed by methods that were tissue producing, and of these, 137 (23%) were sent for pathologic analysis. All submitted specimens received a gross examination and 123 (90%) also underwent histologic analysis. No abnormalities were reported. At our institution, most surgeons did not submit turbinate tissues for pathologic examination even when a specimen was produced. Of the specimens sent, no abnormal pathologic results were identified. Our results suggest that routine pathologic evaluation of inferior turbinate specimens may not contribute to patient care and perhaps represents an unnecessary cost.

Validation of the Rhinoplasty Outcomes Evaluation (ROE) questionnaire adapted to Brazilian Portuguese

The aim of this study was to validate the Rhinoplasty Outcomes Evaluation (ROE) questionnaire adapted to the Brazilian Portuguese. A prospective study was conducted with ROE administration to 56 patients submitted to rhinoplasty (preoperatively, and then 15-day and 90-day postoperatively) and 100 volunteers without the need or desire of cosmetic or functional nasal surgery. Reliability (internal consistency and test-retest reproducibility), validity, responsiveness and clinical interpretability were assessed. Rhinoplasty patients' mean preoperative score was 7.14, 15days post-op 17.73 and 90days post-op 20.50, while controls presented 17.94 points (p<0.0001), showing the questionnaire's validity and responsiveness. Internal consistency was 0.86. Inter- and intra-examiner test-retest reproducibility was 0.90 and 0.94, respectively. The effect size caused by the surgery was considered large (15days post-op compared to the preoperative score: effect size=3.22; 90days post-op compared to preoperative score: effect size=4.06). The minimally important difference was 8.67 points, so changes smaller than 9 points in ROE might not be perceived by the patient as an improvement or worsening. The Brazilian Portuguese version of ROE is a valid instrument to assess results in rhinoplasty patients.

Prospective Outcomes Study of the Impact of Nasal Surgery on Sleep Quality

Objectives: Evaluate the impact of functional nasal airway surgery on the quality of sleep in patients using validated outcomes measurements. Study Design: Prospective, single center, outcome study of sleep quality before and after functional nasal surgery in patients with nasal airway obstruction treated from August 1, 2011, to August 1, 2013. Patients &gt;18 years old with symptomatic structural nasal airway obstruction treated surgically at an academic otolaryngology practice. Intervention: Primary septoplasty, revision septoplasty, functional septorhinoplasty. Methods: Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale (0-100 scale), Epworth Sleepiness Scale (ESS) (0-21 scale), the Pittsburgh Sleep Quality index (PSQI) (0-21 scale), and Likert scales pre-operatively and at 3 months post-operatively. The impact of nasal surgery outcome on sleep quality was analyzed. Linear regression analyses were carried out to identify independent variables affecting sleep outcomes in nasal surgery patients. Results: 48 patients enrolled, and 7 were lost to follow-up. 41 patients for preliminary analysis: 19 septoplasty, 4 revision, and 18 functional septorhinoplasty. Mean NOSE scores decreased from 67 pre-op to 17 at 3 month follow-up. ESS scores decreased from 7.8 to 5.8. PSQI decreased from 7.9 pre-op to 5.0 post-op. Additional analyses are ongoing. Conclusions: Nasal airway surgery does have an effect on sleep quality when evaluated using validated outcomes measurements. The NOSE score showed the most significant improvement in symptomatology. The ESS and PSQI also showed improved sleep quality after nasal surgery.

Highlights of Archives of Facial Plastic Surgery

Archives of Facial Plastic SurgeryVol. 14, No. 5 Free AccessHighlights of Archives of Facial Plastic SurgeryPublished Online:3 Sep 2012AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Split Hump Technique for Reduction of the Overprojected Nasal DorsumPeter J. F. M. Lohuis, MD, PhD, and colleagues describe their results using the split hump technique (SHT) in aesthetic rhinoplasty while emphasizing the additional advantage of this approach. The SHT allows for a more controlled reduction of the nasal dorsum with preservation of the entire upper lateral cartilage (ULC) during deprojection. This, in turn, enables more precise resection of the ULCs and less destabilizing of the key area. Ninety-seven patients who underwent rhinoplasty for aesthetic reasons using the SHT were evaluated for aesthetic contentment and functional satisfaction recorded by a questionnaire. Results demonstrate a significant subjective increase in both aesthetic and functional outcomes. The authors strongly recommend the use of the SHT to rhinoplasty surgeons.See page 346Reconstruction of Nasal Alar Defects in Asian PatientsDoo Hee Han, MD, PhD, and colleagues present a retrospective review regarding functional and aesthetic outcomes of methods used for nasal alar reconstruction in Asian patients while stating the criteria for selection of these methods. Although outcomes and criteria have been studied in Western populations, this is the first study in Asian people. The study consists of 17 patients, of whom 2 are described as representative cases. Objective and subjective aesthetic outcomes are evaluated along with subjective functional findings. Results show that the size and depth of the defect primarily affects the choice of reconstruction in Asian patients. The authors propose a working algorithm for reconstruction of nasal alar defects with respect to these 2 components.See page 312Impact of Cleft Width in Clefts of Secondary Palate on the Risk of Velopharyngeal InsufficiencyDerek J. Lam, MD, MPH, and colleagues question the relationship between cleft width and other risk factors with occurrence of velopharyngeal insufficiency (VPI). A total of 61 patients with isolated cleft palates (Veau type 2) are retrospectively surveyed for the presence of VPI, and the correlation with various parameters, including width and length of cleft, type of surgery, and age at which the operation was performed, are analyzed. Results show a significantly higher overall rate of VPI in subjects with a cleft width greater than 10 mm. The authors conclude that cleft width should be considered as a prognostic indicator of postoperative VPI, regardless of the Veau type.See page 360Role of Virtual Surgery in Preoperative Planning: Assessing the Individual Components of Functional Nasal Airway SurgeryJohn S. Rhee, MD, MPH, and colleagues demonstrate the use of computational fluid dynamics (CFD)-aided virtual surgery planning in evaluating the effects of individual components of functional nasal airway surgery. They accomplish this by evaluating nasal airway resistance and airflow allocation in preoperative and postoperative 3-dimensional digital nasal models created from computed tomographic images. Results prove that septoplasty and inferior turbinate reduction have the highest impact on reduction of nasal resistance, but the authors also state that contribution from nasal valve repair surgery is significant. They conclude with the proposition that CFD-aided surgery may be used for preoperative planning for a more successful outcome in patients with multifactorial anatomic nasal airway obstruction.See page 354Portrait of a Man Holding a Book, by Titian (Tiziano Vecellio) (about 1488 to 1576).See page 376This issue's Highlights were written by Ismet Emrah Emre, MD.FiguresReferencesRelatedDetails Volume 14Issue 5Sep 2012 InformationCopyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Highlights of Archives of Facial Plastic Surgery.Archives of Facial Plastic Surgery.Sep 2012.311-311.http://doi.org/10.1001/archfaci.2012.1014Published in Volume: 14 Issue 5: September 3, 2012PDF download

Role of Virtual Surgery in Preoperative Planning

Objectives To demonstrate the effect of individual components of functional nasal airway surgery in a patient with multifactorial obstruction and to discuss the potential benefit of computational f...

Nasal Tip Complications

As cosmetic nasal surgery becomes increasingly more popular worldwide, postoperative nasal tip deformities have also become far more prevalent. Owing to the cosmetic prominence of the nose and to the functional importance of the nasal airway, postsurgical nasal tip deformities often result in debilitating emotional and physiological consequences. However, contemporary principles of cosmetic and functional nasal surgery, when applied expertly, will typically prevent such complications and will simultaneously permit a natural, attractive, and well-functioning nose. This article explores the mechanisms leading to common iatrogenic deformities of the nasal tip and provides alternative techniques for the safe and effective modification of nasal tip contour.

Computed nasal resistance compared with patient-reported symptoms in surgically treated nasal airway passages: A preliminary report.

Nasal airway obstruction (NAO) is a common health condition impacting mood, energy, recreation, sleep, and overall quality of life. Nasal surgery often addresses NAO but the results are sometimes unsatisfactory. Evaluating surgical treatment efficacy could be improved if objective tests were available that correlated with patient-reported measures of symptoms. The goal of this study was to develop methods for comparing nasal resistance computed by computational fluid dynamics (CFD) models with patient-reported symptoms of NAO using early data from a 4-year prospective study. Computed tomography (CT) scans and patient-reported scores from the Nasal Obstruction Symptom Evaluation (NOSE) scale and a visual analog scale (VAS) measuring unilateral airflow sensation were obtained pre- and postoperatively in two NAO patients showing no significant mucosal asymmetry who were successfully treated with functional nasal surgery, including septoplasty. Pre- and postsurgery CFD models were created from the CT scans. Numerical simulation of steady-state inspiratory airflow was used to calculate bilateral and unilateral CFD-derived nasal resistance (CFD-NR). In both subjects, NOSE and VAS scores improved after surgery, bilateral CFD-NR decreased, and unilateral CFD-NR decreased on the affected side. In addition, NOSE and VAS scores tracked with unilateral CFD-NR on the affected side. These preliminary results suggest a possible correlation between unilateral NR and patient-reported symptoms and imply that analysis of unilateral obstruction should focus on the affected side. A formal investigation of unilateral CFD-NR and patient-reported symptoms in a series of NAO patients is needed to determine if these variables are correlated.

Role of Virtual Surgery in Preoperative Planning: Assessing the Individual Components of Functional Nasal Airway Surgery

Role of Virtual Surgery in Preoperative Planning: Assessing the Individual Components of Functional Nasal Airway Surgery

Video-Rhino-Hygrometer: A New Method for Evaluation of Nasal Breathing after Nasal Surgery

Nasal obstruction is one of the most frequent symptoms in the ear, nose, and throat (ENT) setting. It can be evaluated either subjectively or objectively. In a subjective way, a visual analog scale (VAS) and the Sino-Nasal Outcome Test 20 (SNOT 20) can rapidly quantify the degree of obstruction, whereas the most commonly used objective methods are nasal endoscopy and active anterior rhinomanometry (AAR). It is still a matter of controversy to what extent the sense of nasal obstruction is associated with objective measures for nasal space and airflow. The aim of the study was to evaluate nasal breathing before and after functional nasal surgery by video-rhino-hygrometer (VRH) comparing the results with widely accepted methods. Twenty patient candidates for septoplasty and inferior turbinate reduction were included in the study. SNOT-20, VAS, nasal endoscopy, and AAR were analyzed and compared with VRH values. Before surgery VRH showed variability of nasal respiratory flow between individuals and between nostrils. After surgery we had an increase (p < 0.05) of airflow in both nostrils. VRH data were found to be correlated with VAS and SNOT-20 values (p < 0.05) both pre- and postoperatively. Despite the statistically significant correlation of AAR with SNOT-20 and VAS, no statistically significant correlation between AAR and VRH was found. VRH provides an immediate, easy, and noninvasive assessment of nasal respiration. For these reasons it can be used, in association with rhinoscopic data and other instrumental tests, to evaluate nasal breathing in daily ENT practice.