Lateral wall insufficiency (LWI) is a major cause of dynamic nasal obstruction. Various techniques exist to reinforce the lateral nasal wall, but a structured, anatomy-driven surgical approach remains underreported. This retrospective case series evaluated 25 patients who underwent functional rhino-septoplasty for LWI. Inclusion criteria comprised dynamic nasal valve obstruction, defined as internal valve angle <10° or external valve collapse ≥2 mm.Pre- andpostoperative assessments included the NOSE and SCHNOS questionnaires and clinical maneuvers such as standard and modified Cottle tests.A surgical algorithm guided the tailored use of three techniques: lateral crura turned-in flap, alar batten graft,and alar rim graft. Postoperative outcomes were classified into four functional categories using combined NOSE and SCHNOS thresholds. All patients demonstrated functional improvement. Among 8 patients initially classified with "severe" impairment, all improved to "mild." Of 12 "moderate" cases, 10 reached "absent" status postoperatively. All 5 "mild" cases achieved complete resolution. Overall, 15 patients were reclassified as "absent" impairment. Mean SCHNOS scores improved from 33.2 to 11.4; NOSE scores from 72.5 to 22.1. Wilcoxon signed-rank testing confirmed statistically significant improvement (p < 0.05). No major complications were observed. Median follow-up was 14 months. An algorithm-driven surgical strategy for LWI leads to substantial improvement in nasal airflow and patient-reported outcomes. The integration of the three described techniques allows for precise, anatomy-based reinforcement of the lateral nasal wall. This approach offers a promising paradigm for functional rhinoplasty, warranting further validation through larger, multicenter studies. This study proposes a structured, algorithm-based surgical approach for the correction of Lateral Wall Insufficiency (LWI), integrating three established techniques: lateral crura turned-in flap, alar batten graft, and alar rim graft. The algorithm tailors the surgical technique to the specific anatomical and functional characteristics of each patient, enhancing precision and outcome predictability. All 25 patients in the case series showed functional improvement postoperatively, with statistically significant reductions in NOSE and SCHNOS scores (p < 0.001). The proposed strategy offers a reproducible and anatomy-driven framework that addresses both static and dynamic components of nasal valve collapse, with no major complications reported. 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 .

Nasolabial cysts (NCs) are rare, non-odontogenic developmental cysts of the soft tissue, accounting for approximately 0.7% of all non-odontogenic cysts. These lesions predominantly affect women between the fourth and fifth decades of life, with a predilection for individuals of African descent. We report a case of a 50-year-old woman presenting with swelling adjacent to the right nostril, associated numbness, and aesthetic concerns. Radiographic examination revealed a peripheral soft tissue lesion anterior to the right maxilla that had destroyed the lateral nasal wall and anterior maxillary border, with extension into and partial obstruction of the right nasal cavity. Histopathological examination of the excised specimen revealed a cyst measuring 10×20mm with a 3mm wall thickness. The cyst was lined by squamous epithelium with areas of stratified cuboidal epithelium, surrounded by fibrous connective tissue containing mild chronic inflammatory infiltrate, blood vessels, and fat cells. The lesion was successfully treated by surgical enucleation through an intraoral approach. This case highlights the importance of considering nasolabial cysts in the differential diagnosis of soft tissue swellings in the nasolabial region, despite their rarity. Accurate diagnosis requires careful clinical examination, appropriate imaging, and histopathological confirmation to distinguish these lesions from odontogenic and other non-odontogenic entities.

Objective: To compare the formation of lateral nasal synechiae after endoscopic sinus surgery with and without insertion of a silastic sheet between the middle turbinate and lateral nasal wall. Methods: This study includes 70 patients of either gender, 20-60 years of age, admitted for elective endoscopic sinus surgery for chronic rhinosinusitis. Patients were divided into two groups. In group S, a silicone sheet was placed between the middle turbinate and the lateral nasal wall. While in group-T, no silicone sheet was placed. All patients were evaluated for the development of lateral nasal synechiae up to the 6th post-operative month. Results: In group-S, 3 (8.6%) patients developed lateral nasal synechiae, while in group-T, 11 (31.4%) patients developed lateral nasal synechiae. Comparison of both groups showed a p-value of 0.017. Conclusion: Silastic sheet placement in the middle meatus significantly reduces the formation of lateral nasal synechiae after endoscopic sinus surgery.

To localise bleeding points identified in patients with intractable epistaxis. We reviewed all patients with intractable epistaxis who underwent endoscopic nasal examination under anaesthesia between 1989 and 2024 in a tertiary otolaryngology unit in Ireland. In total, 194 patients were included. Bleeding points were identified in 85 per cent of patients (165 cases). In addition, 89 patients (46 per cent) had bleeding from the septum, 70 (36 per cent) of which were high on the anterosuperior septum above the axilla of the middle turbinate. It was also found that 77 patients (40 per cent) had bleeding from the lateral nasal wall: 44 (23 per cent) at the posterior end of the middle meatus and 33 (17 per cent) at the posterior end of the inferior meatus. This study describes remarkably consistent bleeding point localisation in epistaxis failing first-line measures. We recommend detailed endoscopic examination as a first-line intervention in such instances. Direct cauterisation is the simplest method for controlling epistaxis, avoiding complex procedures such as arterial ligation or embolisation.

To investigate whether inferior turbinate position contributes to nasal obstruction in congenital nasal pyriform aperture stenosis (CNPAS) by characterizing the position of the inferior turbinates compared to healthy newborns via computed tomography (CT). In this retrospective case-control study, CT scans of 12 CNPAS newborns that were part of their diagnostic workup and the CT scans of 31 control newborns obtained for unrelated clinical reasons were analyzed. Measurements included aperture width, distance between the inferior turbinates, the anterior nasal wall as well as the mid-nasal and choanal widths. The CNPAS cases consistently showed medialized inferior turbinates in the anterior nasal cavities. The mean distance between the inferior turbinates was significantly narrower (3.98 ± 0.63 mm) than the distance between the maxillary processes of the pyriform aperture (4.94 ± 0.88 mm) in the CNPAS infants as compared to 8.48 ± 1.12 and 11.95 ± 1.13 mm respectively in the controls (P < .001 for both comparisons). The average ratio of the inferior turbinate distance to the lateral nasal cavity wall width was 0.35 ± 0.08 in the CNPAS versus 0.50 ± 0.05 in the controls (P < .001). In all the CNPAS cases, the mid-nasal width was narrower than the choanal width (P < .001), whereas in the control group, the mid-nasal width was wider (P < .001). These results indicate that the inferior turbinates tend to be medialized in newborns with CNPAS. This suggests that the inferior turbinates may be a significant factor in infants with CNPAS, thus pointing to the potential value of their surgical reduction. Therefore, measuring the inferior turbinate width can provide additional insight into the severity of nasal obstruction and assist in determining the appropriate management strategy.

Introduction The lateral nasal wall bony structures named the turbinates or concha plays an important anatomical and physiological role in the nose, also they are considered an important surgical land marks in the era of endoscopic sinus surgery. Those turbinates are prone to a variety of structural anatomical variations. Most of the studies are focusing on the middle turbinate anatomical variations with few studies that have been done on the inferior turbinate. Objective Investigate and report the incidence of inferior turbinate anatomical variations using computed tomography imaging. Methods This is a retrospective study reviewing the computed tomography imaging of 200 patients that came to our otorhinolaryngology clinic. Images were reviewed for inferior turbinate anatomical variations namely: serrated, pneumatized, paradoxical and hypoplastic. Each variation was reported regarding its presence and the site of its existence. Results our study group consisted of 103 males and 97 females aged between 18 and 60 years with mean age of 34.79±11.56. Anatomical variations of the inferior turbinate were found in 11 patients (5.5%). The observed rate of variations was as the following: serrated 2.5% (5 patients), pneumatized 1.5% (3patients), paradoxical 1% (2 patients) and hypoplastic 0.5% (1 patient). Conclusion The inferior turbinate anatomical variations seem to be more prevalent than what is known about them to be extremely rare. Identifying and reporting those variations is important from both medical and surgical point of view.

Removal of the dorsal hump in structural rhinoplasty disarticulates the upper lateral cartilages (ULCs) from the septum, resulting in a loss of control over the medial and posterior displacement of the lateral nasal walls. This consequently leads to disruption of the dorsal aesthetic lines (DALs) in oblique and frontal views. The inability to control this disadvantage has been a major factor driving the search for alternative approaches, such as dorsal preservation rhinoplasty, over the past decade. We propose a novel technique for creating a double tunnel within the mucoperichondrial-mucoperiosteal septal flap to achieve reliable control over the vertical positioning of dorsal components. This method has been applied in over 2,000 cases, demonstrating favourable outcomes in preserving mid-vault stability while allowing for precise manipulation of the hump and other dorsal characteristics in structural rhinoplasty.Level of Evidence IV 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 .

Background: Changes in the bony structures of the nose and sinuses such as the medialization of the lamina papyracea and enophthalmos have been reported after sinus surgery. Evidence for the persistence of inferior turbinate (IT) position after IT outfracture is lacking. Objectives: To evaluate for anatomical changes of the IT, lamina and the globes, after sinus surgery and the durability of inferior turbinate outfracture. Methods: A total of forty-four patients who underwent revision endoscopic sinus surgery that included complete ethmoidectomy and IT outfracture were matched. Pre- and post-operative computed tomography scans (CT) were used for evaluating and measuring the anatomical changes in different planes. The posterior globe position in the axial plane, the distance between the lamina papyracea (IODAxial, IODCoronal) in coronal and axial planes and the distance from the IT to the septum (ITM) and the lateral nasal wall (ITL) were measured. Results: There were 16 women and 28 men. Mean follow-up time (time from procedure to post-operative CT scan) was 38.9 ± 20.1 months. Statistically significant lateralization of the IT was observed with ITL (95%CI 1.1 mm to 1.5 mm p < 0.0001) and ITM (95%CI -1.5 mm to -1.1 mm; p < 0.0001). No statistically significant differences were seen in IODAxial and IODCoronal in pre-op and post-op CT scans. (p = 0.23 and p = 0.7, respectively) and no significant displacement of the globe in antero-posterior direction was seen (p = 0.915). Conclusions: IT outfracture appears to have a durable effect on IT position that lasts for several years. Ethmoidectomy did not cause the medialization of the laminae nor altered the position of the globes.

Background The study aimed to investigate the effect of customized lateral nasal wall osteotomy (LNO) on the lateral nasal wall (LNW) and pterygomaxillary junction (PMJ) separation during Le Fort I. We hypothesized that customized LNO on the LNW affect the PMJ separation type.Material and Methods This prospective, controlled, randomized study included forty-three patients were randomly assigned to either the conventional or customized (study) osteotomy groups. In the study group, LNW depth was measured before surgery in the axial section of the CT scan, and LNO was performed at a depth of 2 mm less than the measured distance. In the conventional osteotomy group, LNO was performed at 30 mm for females and 35 mm for males. Patients with cleft lip and palate, previous orthognathic surgery, or rhinoplasty were excluded. Separation types were classified as follows: LNW types; Type1-from the osteotomy line; Type2- 2-4 mm above the osteotomy line; Type3- 4 mm or more above the osteotomy line. PMJ types; Type1-including the tuber maxilla; Type2-from the pterygomaxillary junction; Type3-including the pterygoid plates. Chi-square tests were conducted to determine whether there was a significant correlation between groups and LNW separation types, groups and PMJ separation types and groups, and LNW separation type and PMJ separation type. A P value of < .05 was considered statistically significant.Results In both the conventional (P=0.052) and the study groups (p=0.828), there was no significant difference between LNW depth. Type 1 (P=0.0003) and Type 2 (P=0.0051) LNW separation types presented a significant difference between groups. A chi-square test showed a significant correlation between the surgical groups and PMJ separation patterns (P<0.05).Conclusions Customized LNO optimizes the LNW and PMJ separation. Facilitates the Le Fort I surgery and decrease unintentional fracture of the PMJ. Key words:Le Fort I, lateral nasal wall, pterygomaxillary junction, fracture type, arterial bleeding, orthognathic surgery.

Frontal view morphing is needed for better preoperative consultation and simulation process in rhinoplasty. Restoration of the correct light-shadow interactions in rhinoplasty demands a firm appreciation of the underlying nasal structures. Chiaroscuro is a painting technique of dark and light contrasts that can be utilized in the morphing process, enabling the surgeon to explain possible results. Patients undergoing surgery in 2019. Encounters were divided into three. First visit: history taking, a list of desires and physical examination, photography. Second visit: photo analysis was presented as well as the hypothesis of correction expressed by morphing (morphing with Adobe Photoshop software). We termed the differences between light and shade of the lateral nasal walls, the dorsum and the brow dome line and nose cheek line as the "Chiaroscuro of the nose." This term is significant in the process of morphing of the frontal view. We used this method of morphing in the simulation process of 126 patients. The age range was 15 to 59 years old. A total of 67% (84) were females and 33% (42) were males. A total of 43% (54) of the cases were revision cases. At the postoperative visits, all patients were more satisfied with their operative result than with their "morphed" simulation. The chiaroscuro concept of the nose is an essential step in the analysis and morphing processes of the frontal view, and a logical tool in creating a realistic surgical game plan. The morphing of the frontal view enables the surgeon and patients to discuss the possible result with more details and refinements. Morphing may be a good option to educate young surgeons in both preoperative consultation and at the operating theater.

Finite model analysis of different anchorage sites for bone-supported facemask application in unilateral cleft lip and palate.

There is a vast number of articles in the medical literature exploring the association between inverted papilloma and squamous cell carcinoma (SCC) of the nose and paranasal sinuses. However, the majority of these studies focus on papillomas originating from the epithelium of the lateral nasal wall (Schneiderian epithelium). Although the histological association of inverted papilloma and squamous cell carcinoma is uncommon, the following case presents several unique aspects. It involves a rare instance of well-differentiated, invasive squamous cell carcinoma within a squamous cell...

The objective of this study was to analyze the sensory changes reported by patients after lateral nasal wall surgery and to assess the prevalence and severity of sensory disturbances, the factors that influence their occurrence, and their impact on patients' quality of life. The methodology adopted in this study was PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), as well as the PICO (Population, Intervention, Comparison, Outcomes) strategy, which assisted in the development of the study's objectives. Based on the inclusion and exclusion criteria, among all the articles retrieved in the searched databases (PubMed and Google Scholar), we selected 15 articles, considered to be pertinent and relevant to the present investigation. The results demonstrated that there are several sensory disturbances in patients, highlighting the importance of tailoring the best surgical technique to tackle the problem and, consequently, improve patients' quality of life. Overall, all 15 articles demonstrated important outcomes for patients' health, contributing to their recovery and changing their initial status. No consensus emerges regarding the most suitable surgical technique, as has been established by previous literature. In conclusion, the revision showed that sensory changes reported by patients are congruent with the previously identified sensory disturbances. Surgical procedures must be tailored by surgeons precisely to treat the previously identified sensory disturbances, thus contributing to the increase in patients' quality of life.

Introduction: Adenoid cystic carcinoma (ACC) is an uncommon malignant tumour arising from salivary glands. It is more common in minor salivary glands, palate being the commonest site. Local recurrence, distant metastasis and perineural invasion are the common clinico-pathological features of this tumour. ACC of nasal septum and pterygo-palatine fossa is extremely rare entity with a very few reported cases in the available literature. Case Report: We report a case of ACC of nasal septum and pterygo-palatine fossa with its surgical management through endoscopic approach and follow up in the background of available literature. The article is aimed to highlight the clinical features, diagnosis, endoscopic approach for surgical management and long term post operative follow up of this rare entity. Discussion: Adenoid cystic carcinoma (ACC) itself is rare in nasal cavity; where lateral nasal wall is the commonest site of occurrence. ACC arising in the pterygo-palatine fossa is further rare entity; only 3 or 4 cases have been reported till date. ACC arising in these two sites simultaneously is a unique occurrence.

Background Endoscopic sphenopalatine artery cauterization (ESPAC) has become an important method to manage posterior epistaxis. Aims/Objectives To investigate the application of plasma knife and lateral nasal wall incision in ESPAC in the treatment of posterior epistaxis. Material and methods A retrospective study of 32 cases who underwent ESPAC for epistaxis was conducted. A vertical incision was made on the lateral nasal well to expose the sphenopalatine artery (SPA). The main branches of SPA were cauterized with a plasma knife or bipolar coagulation forceps. Cases were divided into plasma knife group (group PK) and bipolar group (group BP). The re-bleeding rates, operation time and the incidence of serious complication were compared between the two groups. Results ESPAC was successfully completed via a lateral nasal wall incision without maxillary antrostomy in all cases. All the patients were followed-up for 3 months, no serious complication was reported. There was no significant difference in re-bleeding rates and incidence of serious complication between the two groups. The operation time of group PK was shorter than group BP. Conclusions and significance Lateral nasal well incision without maxillary antrostomy is feasible for ESPAC. The application of a plasma knife may help to shorten the operation time.

Introduction The greater palatine canal (GPC) holds significant clinical importance due to its role in providing access to the branches of the maxillary division of the trigeminal nerve. Anatomical variations within this posterior maxillary region can complicate the surgical anatomy, making the identification of vital structures challenging. Therefore, a thorough understanding of both normal anatomy and common anatomical variations of the GPC is essential to minimize perioperative complications during surgical procedures.This study aims to investigate the bony architecture of the GPC in dry bones to identify anatomical variations and address significant lacunae in our current understanding of this structure. Despite its impact on the management of various dental and surgical procedures, there remains a limited and sometimes inconsistent knowledge of the normal and variant anatomy of the GPC.Existing literature often lacks comprehensive detail regarding the range of anatomical variations and their implications for surgical approaches. By systematically documenting these variations, this study aims to bridge these gaps in knowledge, justify the need for continued research in this area, and highlight its potential clinical implications. Materials and methods In total, 30 dried and intact adult skull specimens were selected, consisting of 19 males (63.3%) and 11 females (36.7%). The selection criteria included an intact hard palate with fully erupted third molars and an intact lateral nasal wall on both sides. The presence of erupted third molars was used to assess the degree of bone resorption, ensuring that only specimens with minimal bone loss were included. The exclusion criteria ruled out specimens with major craniofacial deformities, excessive bone resorption, and signs of advanced age. The bony walls of the GPC were observed by passing a black wire made of rubber material with a consistent diameter (approximately 5 mm), allowing us to qualitatively assess the bore of the canal. Results In four out of 30 specimens (13.3%), significant variations were noted in the bony medial wall of the GPC. Of these, three specimens were male (75%) and one was female (25%). These variations have been categorized into four distinct types for clarity and analysis. Type 1, in a male specimen, showed a deficiency in the lower segment of the bony medial wall of the left GPC above the greater palatine foramen. Type 2, in a male specimen, had a small bar of bone in the left GPC midway between the foramen and the pterygopalatine fossa. Type 3, in a female specimen, exhibited a small bar of bone above the greater palatine foramen on the right side, with no wall above it. Type 4, in a male specimen, displayed a bar of bone above the greater palatine foramen on the right side, with the medial wall completely absent on the left side. Conclusion The study identified anatomical variations in the bony architecture of the GPCbased on dry bone specimens. While these findings offer insights into potential variations that could affect surgical procedures, their clinical implications need validation through patient-based studies. Understanding these variations is crucial for improving preoperative planning and reducing surgical risks, but recommendations should be cautious given the limited sample size. Further research with larger samples and clinical validation is needed to fully understand the embryological basis and potential impact on surgical practice.

Quantitative measurement of the flow depending nasal valve function by elastography with electro-optical distance sensors. A pilot study

Combined Endonasal and Transseptal Approach to Achieve Binostril Access in Endoscopic Skull Base Approaches to Minimize Nasal Morbidity: A Technical Note

The largest paranasal sinus, the pyramid-shaped maxillary sinus (also known as the antrum of Highmore), is situated in the maxilla. Through the semilunar hiatus, it empties into the middle meatus of the nose [1]. It is situated inside the maxilla's body, but when it gets big, it may extend into the zygomatic and alveolar processes. It is situated to the side of the nasal cavity and below the orbit. It has a pyramidal form, with the lateral nasal wall serving as the base and the maxillary zygomatic process as the apex. [3] It has three recesses: an inferiorly orientated alveolar recess bounded by the maxilla's alveolar process; a laterally orientated zygomatic recess bounded by the zygomatic bone; and an inferiorly orientated infraorbital recess bounded by the maxilla's inferior orbital surface. Cartilage makes up the majority of the medial wall.[2] [Fig:1]

Objectives: Nasal cavity schwannomas are exceedingly rare, benign neoplasms that pose challenges in clinical differentiation from other nasal tumors. Methods: This study presents 5 cases of nasal cavity schwannoma treated surgically over a 10 year period, along with a review of the literature. Results: The most prevalent symptoms included unilateral nasal obstruction and intermittent nosebleeds. Tumors originated from various nasal sites, including the septum, middle conchae, lateral nasal wall, and alar mucosa. All surgeries were conducted transnasally, with 3 tumors excised en bloc, and the remaining two subjected to piecemeal resection. Ancient schwannoma was identified in 4 cases. No instances of recurrence were observed during the average 61 month follow-up period. Conclusions: The definitive diagnosis of schwannomas necessitates histopathological examination. An endoscopic approach to the nasal cavity, obviating the need for external intervention, proved highly effective and appropriate for both diagnosis and symptom alleviation.