Nasal Air Research Articles

Cleft Palatal Fistula: Perspectives on Management With Review of Literature

The goals of cleft palate surgery are an effective barrier between the nasal and oral air passages leading to functional outcomes in terms of speech, feeding and hearing for the affected child. But unfortunately, these goals are sometimes not easily attained and complicated by Cleft Palate Fistulas (CPFs), which adversely affects not only the child but also the parents. The principles of cleft palate surgery include a two-layer, tension-free, watertight closure with preservation of the greater palatine neurovascular pedicle. This article aims to give a broad review of the current perspectives in the management of this distressing complication.

At “half mask” or “nose commando:” A note demonstrating nasal breaths can spread microorganisms when improperly wearing a mask during COVID-19

Many individuals are wearing face masks improperly at ‘half mask’ and potentially breathing out microbes that can contaminate the air as well as anything below the nose. This note provides the first report that bacteria and fungi breathed out during nasal air exhalation are able to be cultured after landing on blood agar plates. The CFU’s are higher after both 10 breaths and extremely significant for 20 breaths compared to the control plates exposed to the air. Implications of this finding are that going ‘nose commando’ may be able to continue the spread of respiratory diseases such as COVID-19. Minute bioaerosols carrying bacteria may be designated as microsnot.

Nasal air conditioning following total inferior turbinectomy compared to inferior turbinoplasty – A computational fluid dynamics study

BackgroundThe aim of this study was to use computational fluid dynamics (CFD) to investigate the effects on nasal heat exchange and humidification of two different surgical techniques for reducing the inferior turbinate under different environmental conditions. MethodsVirtual surgery using two techniques of turbinate reduction was performed in eight nasal airway obstruction patients. Bilateral nasal airway models for each patient were compared: 1) Pre-operative 2) Post inferior turbinoplasty 3) Post total inferior turbinate resection (ITR). Two representative healthy models were included. Three different environmental conditions were investigated 1) ambient air 2) cold, dry air 3) hot, humid air. CFD modelling of airflow and conditioning was performed under steady-state, laminar, inspiratory conditions. FindingsNasal conditioning is significantly altered following inferior turbinate reduction surgery, particularly with ITR under cold, dry inspired air (CDA). The degree of impairment is minor under the simulated range of environmental conditions (temperature = 12–40 °C; relative humidity = 13–80%). Streams of significantly colder air are found in the nasopharynx and more prevalent under CDA in ITR. These are related to high velocity flow streams, which remain cool in their centre throughout the widened inferior nasal cavity. InterpretationReduced air-mucosal heat exchange and moisture carrying capacity occurs under cooler temperatures in patients following inferior turbinate surgery. The clinical impact in extremely cold and dry conditions in groups with poor baseline respiratory function, respiratory illness, or endurance athletes is of special interest.

New Concepts in Nasal Tip Rhinoplasty.

Cosmetic rhinoplasty involves surgical manipulation of the nasal cartilages, nasal bones, lining mucosa and extracartilaginous soft. The nasal tip is a complex composite arrangement of tissues. These structures are responsible for creating individuality and asymmetries and for controlling nasal air entry and valving. Medical aesthetics involves filling relevant areas of the tip with hyaluronic acid to disguise grooves or soft defect contour defects. Standard tip surgery involves an open or closed approach. Manipulation of the flexible alar cartilage using intracartilaginous and interartilaginous sutures is preferable to resection, and alar base reduction is becoming more prevalent.

Velopharyngeal Insufficiency in Craniofacial Microsomia: Prevalence, Diagnosis, and Treatment

BACKGROUND: Craniofacial microsomia (CFM) is characterized by malformations of facial structures that are derived from the first and second brachial arches. Although hearing, occlusion, and facial paralysis are the most typical functional considerations for CFM, abnormalities in speech, including velopharyngeal insufficiency (VPI), have also been sparingly reported in several studies. As a result, the purpose of this multicenter study was to analyze the prevalence and management of VPI in patients with CFM. Furthermore, this study sought to investigate the effects of concomitant cleft lip and/or palate (CL/P) on VPI in CFM patients. METHODS: A retrospective chart review of patients from the University of California, Los Angeles Craniofacial Clinic and the Orthopaedic Institute for Children in Los Angeles was conducted. Inclusion criteria included patients who were diagnosed with CFM, first and second brachial arch syndrome, oculo-auriculo-vertebral sequence, facio-auriculo-vertebral syndrome, or Goldenhar syndrome. Patients with isolated microtia were excluded from this study. Included CFM patients were stratified based on the presence or absence of CL/P, and all patients were evaluated for VPI, methods of diagnosis, speech therapy, and surgery. All patients received at least 1 thorough evaluation by a speech pathologist and were diagnosed clinically with VPI if they were noted to have any hypernasal speech, nasal air emission, or nasal turbulence. Chi-square tests and Levene’s test (P ≤ 0.05) were used for analysis. RESULTS: Overall, 78 patients with CFM (48 males, 61.5%) were assessed for VPI, aged 4–34 years old at time of review. In the entire cohort, 22 (28.2%) patients were found to be diagnosed with VPI. Of the 78 patients, 8 (10.3%) patients had concomitant CL/P. Of the 70 CFM patients without CL/P, 14 (20.0%) had VPI. Eight (57.1%) of these patients were recommended for nasoendoscopy, whereas none of these patients required any corrective VPI surgery. Comparatively, all 8 CFM with CL/P patients were diagnosed with VPI and recommended for nasoendoscopy, significantly higher rates than those without CL/P. Furthermore, 6 (75.0%) of these patients eventually underwent VPI surgery, significantly more than those without CL/P. CONCLUSIONS: This study establishes an overall rate of VPI in CFM at 28.2%, with the largest cohort of CFM looking into VPI in the literature. All of the CFM patients with CL/P had VPI, with a majority requiring surgery, compared with only a fifth of CFM patients without CL/P having VPI and none needing surgery. Findings from this study highlight VPI as a common problem in CFM patients who should be diagnosed and managed early on. In addition, this study displays CL/P as a risk and severity factor for VPI.

Washing hands and the face may reduce COVID-19 infection

The contribution of various modes of transmission of SARS-CoV-2 has been the subject of recent intensive debate. The predominant route of the viral transmission is via exhaled droplets of different sizes which can be inhaled by nearby exposed individuals or deposited on peoples and surfaces. Touching contaminated surfaces followed by hand to facial transfer has been identified as a potential infection route. As humans involuntarily touch their faces over 20 times per hour a hand washing with soap and water is recommended to avoid hands to face transmission. To date however, there is no clear explanation how the viruses arrive form the face into the nose and the lung. Our hypothesis is that during the physiological nasal air inspiration the virion particles attached on the face close to the nose are resuspended in the air and then are inhaled into the nose. Our preliminary fluid dynamics simulations confirm our hypothesis. Further experimental and computational studies are warranted.

Endoscopic soft palate augmentation using injectable materials in dogs to ameliorate velopharyngeal insufficiency.

BackgroundVelopharyngeal structure augmentation methods are used as alternatives to pharyngeal flap operations. Recently, we investigated the sites of velopharyngeal structure augmentation in dogs and reported that the most effective injection location is the soft palate. However, there have been no reports regarding the optimal materials for implantation or injection. In this study, we aimed to investigate the injectable materials used in soft palate augmentation in dogs to ameliorate velopharyngeal insufficiency (VPI).MethodsEndoscopic soft palate augmentation (ESPA) was performed in dogs using purified sodium hyaluronate, atelocollagen, or autogenic fat tissue. ESPA is an original technique developed by our group, and this is the first report of its performance. Moreover, we assessed the amount of nasal air leakage during inspiration at rest and during expiration under the rebreathing system at 1, 2, 3, 4, 5, and 6 months after injection of these materials.ResultsThe amount of nasal air leakage during expiration under the rebreathing system was significantly decreased in all dogs injected with the ESPA materials, but neither apnea nor hypopnea was observed.ConclusionsWe investigated the optimal materials for use in ESPA, such as purified sodium hyaluronate, atelocollagen, or autogenic fat tissue. We found that all of them reduced nasal air leakage and only autogenic fat tissue showed significant histologic differences in dogs at 6 months. This technique may also be useful for the treatment of patients with VPI.

Stabilizing Effect of Yawning on Nasal Cycle

The dominant passability of the left or right nostril in terms of nasal air resistance can be classified into 4 main modes. In the first mode, both nostrils are closed and have equal and low air passability. In the second mode, the passability of the right nostril is higher than the left. In the third mode, the passability of the left nostril is higher than the right. In the fourth mode, both nostrils are open and passability of nostrils is equal and high. The first and fourth modes are unstable (with duration- minutes). The second and third modes are stable (with duration-hours). Author presents a yawning as physiological reflex leading to transition from unstable to stable modes.

Crowdsourcing to Assess Speech Quality Associated With Velopharyngeal Dysfunction.

To assess crowdsourced responses in the evaluation of speech outcomes in children with velopharyngeal dysfunction (VPD). Fifty deidentified speech samples were compiled. Multiple pairwise comparisons obtained by crowdsourcing were used to produce a rank order of speech quality. Ratings of overall and specific speech characteristics were also collected. Twelve speech-language pathologists (SLPs) who specialize in VPD were asked to complete the same tasks. Crowds and experts completed each task on 2 separate occasions at least 1 week apart. On-line crowdsourcing platform. Crowdsource raters were anonymous and at least 18 years of age, North American English speakers with self-reported normal hearing. Speech-language pathologists were recruited from multiple cleft/craniofacial teams. None. Correlation of repeated assessments and comparison of crowd and SLP assessments. We obtained 6331 lay person assessments that met inclusion criteria via crowdsourcing within 8 hours. The crowds provided reproducible Elo rankings of speech quality, ρ(48) = .89; P <.0001, and consistent ratings of intelligibility and acceptability (intraclass correlation coefficient [ICC] = .87 and .92) on repeated assessments. There was a significant correlation of those crowd rankings, ρ(10) = .86; P = .0003, and ratings (ICC = .75 and .79) with those of SLPs. The correlation of more specific speech characteristics by the crowds and SLPs was moderate to weak (ICC < 0.65). Crowdsourcing shows promise as a rapid way to obtain large numbers of speech assessments. Reliability of repeated assessments was acceptable. Large groups of naive raters yield comparable evaluations of overall speech acceptability, intelligibility, and quality, but are not consistent with expert raters for specific speech characteristics such as resonance and nasal air emission.

Protocol for the development of a core outcome set for reporting outcomes of management of velopharyngeal dysfunction

IntroductionVelopharyngeal dysfunction (VPD) is present in up to 40% of patients following cleft palate repair. Children with VPD display hypernasal speech, nasal air emission and are at a high risk...

The Effectiveness of the Buccal Myomucosal Flap on Speech and Surgical Outcomes in Cleft Palate: A Systematic Review

Purpose: A systematic review was conducted to assess speech and velopharyngeal competence outcomes following the buccal myomucosal flap surgical approach used for primary palatoplasty and secondary surgery for velopharyngeal insufficiency (VPI) in individuals with cleft palate. Methods: A systematic review was guided by the PRISMA guidelines. Articles were included if the patients received the surgical technique for primary cleft palate repair or secondary surgery for VPI and if the study provided detailed methods on the perceptual speech assessment or visualization of postoperative velopharyngeal anatomy. Results: A total of 1013 patients were included from 11 studies. Post-surgery, normal resonance was achieved in 77.4% of patients and no nasal air emission was reported in 54.7% of patients. An improvement in velopharyngeal closure was reported in 81.8% of patients. A variety of perceptual speech assessment scales and methods for assessing velopharyngeal competence were used in the studies. Conclusions: The review suggests that the buccal myomucosal flap procedure results in improved velopharyngeal closure as evidenced by physiologic observation and reported perceptual changes in speech intelligibility, resonance balance, and reduced nasal air emission. The development of an international, standardized method for assessing and reporting speech outcomes and velopharyngeal competency is recommended to ensure accurate comparisons between surgical techniques. Keywords: Buccal flap, systematic review, perceptual speech assessment, speech outcomes, surgical outcomes. Read more →

1264 Innovation and Ingenuity to Improve Treatment Efficacy of Non-Invasive Positive Pressure Ventilation

Abstract Introduction Use of chronic non-invasive-positive-pressure ventilation (NIPPV) in individuals with neuromuscular disease allows for increased independence and mobility in this population. Optimal mask fit is imperative due to the chronic and extensive device use. Commonly cited side effects of improper mask fit include air leak, dermatitis, skin breakdown, nasal discomfort, and claustrophobia. Report of Case This is a case report of a 46-year-old female with rigid spine muscular dystrophy leading to chronic hypercarbic respiratory failure secondary to neuromuscular weakness and thoracic cage abnormalities. The patient is dependent on continuous use of NIPPV with a PLV 100 device (Philips Respironics; discontinued model). The patient prefers this model because of its unique ventilation delivery mode, which allows her to pause breaths to speak. The patient developed a significant air leak with her nasal mask and was unable to be fitted properly with commercially available nasal masks. In order to minimize her air leak her husband used an innovative approach using 3D printing technology. He created a 3D print of her facial and nose features and then used this to print a 3D mask. Additionally he 3D printed silicone nose clips, that reinforced the seal on the outside of her nose. The patient had a significant decrease in her air leak and subjectively reported improved comfort with use of the 3D printed mask. Conclusion This represents a case where application of ingenuity and innovative technology improved treatment efficacy and compliance with NIPPV. The combination of 3D custom fit mask (currently available from a limited number of vendors), with custom fit nasal clips may possibly be applied to a wider category of patients with similar complaints of nasal discomfort and frequent air leaks.

Late Primary Palatoplasty in Skeletally Mature Patients: Obstacles and Outcomes

As the performance of late primary palatoplasty for skeletally mature patients remains controversial, there is little data available regarding speech outcomes for this patient population. The purpose of this study therefore is to identify and evaluate the impact of speech outcomes following late palate repair on skeletally mature patients. A retrospective study was performed on 19 consecutive skeletally mature patients who underwent late primary palate repair between 2010 and 2018. Speech assessment was performed preoperatively, between 3 and 6 months postoperatively, and then after 6 months postoperatively. Levels for hypernasality, oral pressure, and audible nasal air emission were scored and recorded.Patients were stratified by age, gender, presence of postoperative fistula, and Veau cleft type, in order to determine the impact of each variable on final speech outcomes. The Kruskal-Wallis test was used to compare the preoperative speech assessment with the postoperative speech outcomes, and the Mann-Whitney test was used to analyze the impact of the above variables on final speech outcomes. Our data showed overall postoperative speech improvement for all tested variables. Patients without postoperative fistula presented better results in oral pressure than those patients with postoperative fistula (P < 0.05). None of the other tested variables presented a significant negative impact on speech outcomes. Late primary palatoplasty significantly improves speech outcomes for skeletally mature patients. Fistula has a negative impact on oral pressure.

The Role of the Depressor Nasi Septi Muscle in Nasal Air Flow

BackgroundMusculus depressor septi nasi and its tendon, the dermocartilaginous ligament, play an important role in external nasal valve and nasal respiration. If the ligament is cut during septorhinoplasty operations, nasal functions of the nose and facial expressions are affected. Therefore, the aim of this study was to investigate the role of M. depressor septi nasi in nasal respiration at open rhinoplasty operations using rhinomanometry and electromyography.MethodsThe study included 29 patients who had only external nasal deformity (nasal hump deformity). All patients underwent open rhinoplasty. The dermocartilaginous ligament of the patients in the study group (DCL + group) was repaired but not in the control group (DCL − group). Rhinomanometry and electromyography were applied to all patients preoperatively and postoperatively.ResultsIn the DCL − group, right and left nasal airflow values were significantly lower in post-op (562.92 cm3/s and 548.57 cm3/s), whereas right, left, and total nasal resistances were significantly lower in pre-op (0.28 Pa/cm3/s, 0.22 Pa/cm3/s, and 0.11 Pa/cm3/s). Statistically significant differences were not found between rhinomanometric measurements in pre-op and post-op values of the DCL + group. Post-op right, left and mean values of M. depressor septi nasi amplitude in the DCL + group (2.05 mV, 2.0 mV, 2.02 mV) were significantly higher than those in the DCL − group (1.52 mV, 1.61 mV, 1.57 mV).ConclusionRepair of the dermocartilaginous ligament during open rhinoplasty operations enhances nasal respiratory functions by expanding the external nasal valve through M. depressor septi nasi and allows the nose to participate in mimic movements.Level of Evidence IVThis 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.

Nasal swell body: a literature review

Abstract The nasal swell body (NSB) is considered to be an enlarged region of the nasal septum, which is located superiorly to the inferior nasal turbinate and anteriorly to the middle nasal turbinate, with a potential effect upon the airflow nasal valve. The histological studies of the NSB demonstrated that it is a glandular formation, not a venous structure, and it is formed by septal cartilage and bone, as well as a thick mucosa. Recent studies emphasized the functional role of the nasal swell body and it is thought to interfere with the nasal airflow and air humidification, due to its proximity to the internal nasal valve and its histological characteristics (venous sinusoids and seromucinous glands). The nasal swell body is strongly related to the presence of rhinosinusal chronic inflammations (allergic rhinitis and chronic rhinosinusitis) and the septal deviation. In case of the presence of the nasal swell body, surgical treatment is not commonly done, due to the absence of a consensus between the ENT practitioners. Most of them consider surgery as being too aggressive because of the presence of seromucinous glands, with slight impact upon the nasal obstruction. Most probably, the lack of consensus is determined by inconsistent anatomical and histological study results.

Detection of Influenza Infection by IMS of Nasal Air Sampling

Detection of Influenza Infection by IMS of Nasal Air Sampling

The Effectiveness of Palate Re-Repair for Treating Velopharyngeal Insufficiency: A Systematic Review and Meta-Analysis.

Palate re-repair has been proposed as an effective treatment for velopharyngeal insufficiency (VPI) with a low risk of obstructive sleep apnea (OSA). The authors conducted a systematic review and meta-analysis to determine the proportion of patients achieving normal speech resonance following palate re-repair for VPI, the proportion developing OSA, and the criteria for patient selection that are associated with increased effectiveness. PubMed, Embase, and Scopus were searched from inception through April 2018 for English language articles evaluating palate re-repair for the treatment of VPI in patients with a repaired cleft palate. Inclusion criteria included reporting of hypernasality, nasal air emission, nasometry, additional VPI surgery, and/or OSA outcomes. Meta-analysis was conducted using random effects models. Risk of bias was assessed regarding criteria for patient selection, blinding of outcome assessors, and validity of speech assessment scale. Eighteen studies met inclusion criteria. The incidence of achieving no consistent hypernasality follow palate re-repair was 61% (95% confidence interval [CI]: 44%-75%). The incidence of additional surgery for persistent VPI symptoms was 21% (95% CI: 12%-33%). The incidence of OSA was 28% (95% CI: 13%-49%). Criteria for selecting patients to undergo re-repair varied, with anterior/sagittal position of palatal muscles (33%) and small velopharyngeal gap (22%) being the most common. No specific patient selection criteria led to superior speech outcomes (P = .6572). Palate re-repair achieves normal speech resonance in many but not all patients with VPI. Further research is needed to identify the specific examination and imaging findings that predict successful correction of VPI with re-repair.

Partial Preservation of the Inferior Turbinate in Endoscopic Medial Maxillectomy: A Computational Fluid Dynamics Study.

BackgroundEndoscopic medial maxillectomy (EMM) is a workhorse for multiple sinonasal conditions. To reduce its burden on the sinonasal physiology, several modified EMM (M-EMM) have been proposed. Objective: In order to provide a theoretical basis for EMM and its modifications, this study introduces a computational fluid dynamics (CFD) model, based on a time-resolved direct numerical simulation, describing EMM and assessing the role of the M-EMM in preserving the overall fluid dynamics of the sinonasal cavities.MethodsA normal sinonasal CT scan was converted into a geometrical model and used as a reference; 2 anatomies were then created by virtual surgery, mimicking EMM and M-EMM, with the latter sparing the anterior portion of inferior turbinate and medial maxillary sinus wall. The airflow was simulated in the models via the OpenFOAM CFD software and compared in terms of flow rate, mean and fluctuating velocity, vorticity, and turbulent structures.ResultsThe analysis shows that EMM induces a massive flow rate increase in the operated side, which becomes less obvious in the M-EMM model. In contrast to M-EMM, EMM induces higher velocity fields that reach the maxillary sinus. Velocity and vorticity fluctuations are negligible in the baseline model, but become increasingly evident and widespread in the M-EMM and EMM models.ConclusionsA significant disruption of the nasal fluid dynamics is observed in EMM, while M-EMM minimizes variations and reduces interference with nasal air conditioning. Our analysis provides insights into the pathophysiology of radical sinus surgery and provides a theoretical basis for the ability of M-EMM to reduce the temporary surgery-related changes on both healthy and operated sides.

Comparison between sphincter pharyngoplasty and a rolled pharyngeal myomucosal flap surgery for management of velopharyngeal incompetence

Background Surgical techniques for velopharyngeal incompetence are directed at creating more favorable structure or function of the velopharyngeal mechanism to achieve an appropriate blend of oronasal resonance and eliminate nasal air emission. Purpose This study aimed to compare the functional outcome of sphincter pharyngoplasty and a rolled superiorly based myomucosal pharyngeal flap for surgical treatment of velopharyngeal incompetence. Patients and methods This study was conducted on a total number of 20 patients (11 male and nine9 female) with velopharyngeal insufficiency (VPI) with age ranging between 8 and 20 years. Patients were divided into two equal random groups according to the surgical technique used for correction of VPI. Group 1 comprised 10 patients with VPI were managed by sphincter pharyngoplasty and; group 2 comprised 10 patients with VPI were managed by a rolled superiorly based pharyngeal myomucosal flap. Perceptual evaluation of voice and nasopharyngoscopy were used for preoperative and postoperative assessment of velopharyngeal adequacy. Results Postoperative clinical evaluation for hypernasality revealed improvement of hypernasility in both patients group. Mean nasalance scores obtained in the postoperative evaluation revealed that both groups presented mean nasalance scores significantly lower than those obtained before surgery. Conclusion Sphincter pharyngoplasty and a rolled pharyngeal flap surgery were efficient in reducing hypernasality for treatment of VPI.

Extracorporeal Septoplasty-A Well Proven Technique for Treatment of Crooked Noses.

Crooked noses (noses with complex septal and pyramidal deviations) are an important challenge for both plastic surgeons and otolaryngologists. Extracorporeal septoplasty, described by Gubisch constitutes an effective solution to this problem. The article describes a series of 7 cases (5 males and 2 females) in which this method was used during open rhinoseptoplasty. The technique we used is described in detail. All the patients showed improvement of the nose appearance and good nasal air flow. Hypertrophy of the right inferior turbinate complicated one case, but was resolved with electro cauterization. Although the learning curve is slow and it claims the surgeon’s imagination, the method is sometimes the only solution in complex cases of septal deviation. Our short series demonstrates that good indication and careful dissection are prerequisites for success in difficult cases.