Nasal Configuration Research Articles

Ultramicroscopic organization of the exterior olfactory organ in Anguilla vulgaris in relation to its spawning migration.

Catadromous fishes have well-developed elongated olfactory organs with numerous lamellae and different types of receptor neurons related to their breeding migration. The current study showed how the olfactory system adapted to the catadromous life. Our work declared the need of the migratory fishes for the sense of smell that is exhibited by a higher number of the olfactory lamellae and the receptor neuron verification in the olfactory epithelium. Ten specimens of fully grown, but pre-matured, silver eels of Anguilla vulgaris were captured at the outlet of Edco Lake, overlooking the Mediterranean Sea, east of Alexandria. Olfactory rosettes were dissected and fixed for scanning electron microscope (SEM) and transmission electron microscope (TEM). Our study gave a morphological description of the olfactory system of A. vulgaris. At the ultrastructural level using SEM and TEM, one olfactory rosette was provided with 90-100 flat radial olfactory lamellae. The nasal configuration allowed water to enter and exit, transferring odorant molecules to olfactory receptor cells which comprise long cylindrical ciliated and microvillous receptors as well as rod-tipped cells. These cells are bipolar neurons with upward dendritic knobs. The olfactory epithelia also include crypt receptor cells. Interestingly, the olfactory neurons are delimited by nonsensory supporting cells, including long motile kinocilia and sustentacular supporting cells beside mucus secretory goblet cells and ionocytes or labyrinth cells that contribute to the olfaction process. Olfaction is crucial in all vertebrates, including fishes as it involves reproduction, parental, feeding, defensive, schooling, and migration behaviors. Here, A. vulgaris is an excellent model for catadromous fishes. It has a well-developed olfactory organ to cope with the dramatic climate change, habitat loss, water pollution, and altered ocean currents effect during their catadromous life for reproduction.

The novel traction-suturing technique in correction of caudal end deviation of the nasal septum.

Caudal end correction is one of the main challenges during septoplasty that needs extra steps and skills. This complex area affects the shape of the nose. Moreover, the caudal end represents the medial boundary of the internal nasal valve. Thus, any deviation may disturb this critical area causing nasal obstruction. This study aimed to evaluate the novel traction-suture technique to correct septal caudal end deviation and its postoperative impact. This prospective case-series study. It was held in a tertiary referral university institute between January 2019 to February 2022. We included 95 cases who suffered from nasal obstruction and a cosmetic problem because of mild or moderate caudal end deviation. Under general anesthesia, the caudal end was corrected by the novel traction-suturing technique (TST). To evaluate the surgical outcomes and patients' related quality of life, we used two validated questionnaires; the Nasal Obstruction Symptom Evaluation and the Rhinoplasty Outcome Evaluation before the surgery and 1 year after the surgery. NOSE and ROE questionnaires showed statistically significant improvements after the surgery (P value was < 0.001). Complications occurred in seven patients (7.3%), all of which were minor complications. Traction-suturing technique (TST) improved nasal breathing and patients' satisfaction with their nasal configuration. Traction-suturing is a simple short maneuver that junior doctors can easily learn without distinct complications or recurrence.

Olfactory Drug Aerosol Delivery with Acoustic Radiation.

Nose-to-brain (N2B) drug delivery is a new approach to neurological disorder therapy as medications can bypass the blood-brain barrier and directly enter the brain. However, the delivery efficiency to the olfactory region using the conventional delivery method is impractically low because of the region’s secluded position in a convoluted nasal cavity. In this study, the acoustic radiation force was explored as an N2B delivery alternative in a wide frequency range of 10–100,000 Hz at an increment of 50 Hz. Numerical simulations of the particle deposition in the olfactory region of four nasal configurations were performed using COMSOL. Frequency analysis of the nasal cavities revealed that eigenfrequencies were often associated with a specific region with narrow passages and some eigenfrequencies exhibited an amendable pressure field to the olfactory region. Transient particle tracking was conducted with an acoustic inlet at 1 Pa, and a frequency spectrum of 10–100,000 Hz was imposed on the airflow, which carried the particles with acoustic radiation forces. It was observed that by increasing the pulsating wave frequency at the nostrils, the olfactory delivery efficiency reached a maximum in the range 11–15 kHz and decreased after that. The correlation of the olfactory delivery efficiency and instantaneous values of other parameters such as acoustic velocity and pressure in the frequency domain was examined.

Simulation of patient-specific bi-directional pulsating nasal aerosol dispersion and deposition with clockwise 45° and 90° nosepieces

Numerical simulations of the dispersion and deposition of poly-disperse particles in a patient-specific human nasal configuration are performed. Computed tomography (CT) images are used to create a realistic configuration of the nasal cavity and paranasal sinuses. The OpenFOAM software is used to perform unsteady Large Eddy Simulations (LES) with the dynamic sub-grid scale Smagorinsky model. For the numerical analysis of the particle motion, a Lagrangian particle tracking method is implemented. Two different nosepieces with clockwise inclinations of 45° and 90° with respect to the horizontal axis are connected to the nostrils. A sinusoidal pulsating airflow profile with a frequency of 45 Hz is imposed on the airflow which carries the particles. Flow partition analysis inside the sinuses show that ventilation of the sinuses is improved slightly when the 45° nosepiece is used instead of the 90° nosepiece. The flow partition into the right maxillary is improved from 0.22% to 0.25%. It is observed that a closed soft palate increases the aerosol deposition efficiency (DE) in the nasal cavity as compared to an open soft palate condition. The utilization of pulsating inflow leads to more uniform deposition pattern in the nasal airway and enhances the DE by 160% and 44.6%, respectively, for the cases with clockwise 45° and 90° nosepieces, respectively. The bi-directional pulsating drug delivery with the same particle size distribution and inflow rates as the PARI SINUS device results in higher total DEs with 45° nosepiece than with the 90°. Thus, the numerical simulation suggests that the 45° nosepiece is favorable in terms of the delivered dose.

The Possibilities of Multislice computed Tomography in nasal Anthropometry

Background. Nasal anthropometry is an important aspect of maxillofacial and plastic surgery especially in the preoperative stage of rhinoplasty. Multislice computed tomography (MSCT) permits to assess quantitative the variant nasal anatomy using measuring.Aims: to determine the possibilities of MSCT-anthropometry in nasal configuration grade.Materials and methods. We performed a proand retrospective analysis of MSCT data of maxillofacial region of 50 patients (aged 35 ± 10.7 years old) with changes of nasal height and width and 35 women (32.9 ± 8.4 years old) with normal nasal configuration. The variant anatomy consists in long nose (n = 16), short nose (n = 17), wide nose (n = 17). The nasal height was measured from the nasal root (nasion) to the nasal base (subnasion), the nasal width is the distance between the most lateral aspects of the alae nasi. Besides, the nasal index was calculated. The descriptive statistics of obtained data were presented by mean and standard deviation (SD), also the multiple regression analysis was used. Values of p = 0.005 were considered statistically significant.Results. The results showed that the average nasal height in patients with normal configuration is 51.9 ± 2.63 mm, with short nose – 45.2 ± 1.36 mm, with long nose – 60.3 ± 1.28 mm. The mean nasal widths are 34.9 ± 1.88 mm in normal configuration, 38.8±3.57 in wide nose. The nasal indexes were calculated, their features were detected. These obtained results correlate with anthropometric data of different studies.Conclusions. MSCT-anthropometry is an objective imaging method of variant nasal anatomy that could provide improving quality of diagnostics of patients seeking rhinoplasty and choose a surgical approach.

Nasal septum configuration as a basis for novel septal splints.

The objective is to use anatomical determinations of nasal septum shape and surface area in adults as a design basis for silastic septal splints of universal size and fit and offering maximum possible surface coverage. The objective is also to devise a method of securing the septal splints, so that surface pressure on septal mucosa is distributed as evenly as possible while not interfering with capillary perfusion. Nasal septum area was determined in 21 Caucasian body donors, and nasal septum thickness was measured in 20 CT scans. Septal splints of universal size and shape were prepared from silastic sheeting. The holding force of various neodymium-iron-boron (NdFeB) magnets, and the surface pressure exerted by magnet-containing septal splints was calculated. These septal splints of novel design offer a satisfactory fit in routine clinical practice. The splints can be securely attached with built-in NdFeB magnets, and surface pressure can be distributed evenly across the nasal septum while not interfering with mucosal tissue perfusion. With their simple intranasal insertion, these magnet-containing septal splints of universal size and optimised shape offer maximum possible septum coverage following septoplasty/septorhinoplasty. The absence of interference with septal tissue perfusion means that they are likely to be associated with fewer postoperative complications and better outcomes.

Changes in Nasal Configuration Following Primary Rhinoplasty: Direct Anthropometric Measurement in Patients With Complete Unilateral Cleft Lip and Palate.

With the recent advances of surgical adjuncts including presurgical naso-alveolar molding and postoperative nasal stenting, information on the anthropometric evaluation of cleft lip nasal symmetry after primary rhinoplasty is lacking. Twenty-nine nonsyndromic patients with complete unilateral cleft lip and palate undergoing modified rotation advancement cheiloplasty with synchronous primary rhinoplasty in our center were prospectively recruited in our study. All of them received our center's peri-operative management protocol, including presurgical naso-alveolar molding and postoperative nasal stenting. Direct anthropometric measurements of their nasal configuration were documented when they were anesthetized for primary lip repair at 3 months of age and for the primary palate repair at 12 months of age. Their nasal configurations were analyzed before primary rhinoplasty and at 9 months after rhinoplasty. There is a statistically significant change in nasal symmetry at 9 months after the primary rhinoplasty. There is no significant correlation between the nasal configuration before and at 9 months after the primary rhinoplasty. With significant relapse of nasal deformity at 9 months after the primary rhinoplasty despite the use of presurgical naso-alveolar molding and postoperative nasal stenting, overcorrection of the nasal configuration at primary rhinoplasty should be considered for optimal long-term nasal symmetrical outcome.

The specific features of lepto­-, meso-­ and platyforms of nasal cavity

The authors carried out a morphometric study using 200 computer-aided tomograms of the nasal cavity and paranasal sinuses of men and 100 documented macerated male skulls sawed in sagittal plane. The new index of the nasal cavity configuration that characterizes the ratio of the nasal cavity width to its height was developed. The index calculation was made in coronal plane transversing the ethmoid processes of inferior nasal turbinates. According to the nasal cavity configuration, all the material studied was divided into several groups: leptocavital – under 49.9, mesocavital –50.0 to 56.5 and platycavital – above 56.6. The authors distinguished the typical features of intranasal structures depending on the nasal cavity form. In case of increasing of the nasal cavity configuration index there is an increase of general nasal passage width in the anterior, the thickness of the front end of the middle turbinate, the decrease of general nasal passage width and nasal cavity height in its anterior part. The above-described typical features of the nasal cavity anatomy can affect the aerodynamics of the nasal cavity and paranasal sinuses.

Clinical effectiveness and safety of collagen sheet for dorsal augmentation in rhinoplasty.

In Asian rhinoplasty, dorsal augmentation often requires the use of alloplastic materials because sufficient amounts of autograft are difficult to harvest. Given considerations of aesthetics, costs, and the characteristics of the oriental nose, silicone or Gore-Tex is commonly used when augmenting the nasal dorsum to a great extent. Such materials can often result in postoperative complications and foreign-body sensations. Moreover, extrusion or visualization of the implant may occur because of thinning of the skin over time. Permacol collagen implants are specifically indicated for soft tissue reinforcement and repair of the head and face in plastic and reconstructive surgery. The handling versatility of the flexible collagen sheet allows it to be layered over itself until the requisite thickness and desired shape are obtained. A total of 50 patients who underwent nasal augmentation rhinoplasty between December 2007 and May 2011 were observed for at least 24 months. Depending on the nasal dorsum, we layered the collagen sheet up to a maximum of 4 times and we have not seen any case of severe resorption or overcorrection in the nasal configuration. Collagen implant material is safe for use in select rhinoplasty patients because of its low complication rate, as shown in our series. It could therefore be considered as a useful alternative when reconstruction is problematic because of the low quality or lack of available autologous grafts.

Assessment of Bony Nasolacrimal Parameters Among Asians

A case series evaluating racial differences in the nasolacrimal region and quantifying the anterior lacrimal crest thickness and minimum nasolacrimal duct diameter in Asians. Facial or orbital CT scans of 90 consecutive patients were retrospectively reviewed. Evidence of lacrimal fossa tumor or trauma excluded a patient. Using 3-dimensional image software, the thickness of the anterior lacrimal crest, narrowest diameter of the nasolacrimal duct, vertical diameter of the lacrimal sac fossa, frontonasal angle, and inter-frontozygomatic suture distance were measured in axial, sagittal, and coronal planes. Inter- and intraobserver correlation of a sample data proved reliability via intraclass correlation coefficient (0.706-0.917). Southeast Asians had a wider inter-frontozygomatic suture distance than South Asian and Occidental races (p = 0.025). Vertical lacrimal fossa diameter, anterior lacrimal crest thickness, and narrowest nasolacrimal duct diameter did not differ significantly between right and left sides or among ethnic groups. Narrower nasolacrimal duct diameter was significantly associated with decreased inter-frontozygomatic suture distance (p < 0.001), namely in patients with narrower faces. The anterior lacrimal crest thickness was significantly affected by the nasal configuration and thicker in patients with more acute frontonasal angle (p = 0.026). There is no significant difference in nasolacrimal duct diameter among ethnic groups, which may predispose one to nasolacrimal duct obstruction. But, this is significantly associated with inter-frontozygomatic suture distance, suggesting that a wider face is associated with wider nasolacrimal duct diameter. An acute frontonasal angle predicts a thicker anterior lacrimal crest for surgical preparation during dacryocystorhinostomy.

Why do humans have such a prominent nose? The final result of phylogenesis: A significant reduction of the splanchocranium on account of the neurocranium

During the last few decades several authors tried to clarify the anthropological aspects of the shape of the human nose and why it has so emphasized projection. Our hypothesis suggests the essentiality of the role of morphologic changes of the human skull which occurred during the phylogenesis. It seems that erectile posture of the man caused remarkable morphological changes of the skull base shape thus being a part of morphologic evolution. The changes in the shape of the human spine from birth to adulthood show a philogenesis in short: a newborn has an almost flat spine like quadrupeds (except in the sacro-coccigeal region), but the spine gets increasingly bent as the person grows (lumbar lordosis, thoracic kyphosis, cervical lordosis). It is well known that the sphenoidal angle was less emphasized in prehistoric man than in modern man. In addition, the cervical spine position in the gorilla, Neanderthal man and modern man is quite different in terms of anterior inclination. Accordingly, there is a great degree of maxillary and mandible reduction in humans. The same differences can be seen when comparing the skull shapes of gorilla, gibbons, Neanderthals and modern man. A major reason for the maxillary and mandible reduction in humans is that their way of feeding has changed remarkably with time. In lower primates and other animals, nasal function, particularly olfaction, may be essential for day-to day survival. In humans, however, this is less important although both impaired nasal breathing and olfaction may affect the function in the other body organs and, of course, influence the quality of life. Nasal configuration in recent humans seems to be associated with the internal nasal cavity wideness and nasal bridge elevation which just happened because of newly developed physiological needs. The skull base angulation leads directly to obvious changes in splanchocranium on the account of neurocranium, since previous is getting "squeezed", by angulation of the surrounding bones, and the other one gets more room for the further development according to human's intellectual needs. The final morphologic result of the squeezing of the splanchocranium, in fact a side-effect of these phylogenetic changes, is a protrusion of its most anterior parts more anteriorly, that is a prominent nose in humans which is a hallmark of the modern man.

Cerebro‐oculo‐nasal syndrome: 13 new Brazilian cases

Cerebro-oculo-nasal syndrome (CONS) is characterized by structural anomalies of the central nervous system (encephalocele, ventricular dilatation, defects of corpus callosum, and even holoprosencephaly in one instance), by ocular alterations ranging from anophthalmia/microphthalmia to normal eyes, and by proboscis-like nares. Here, we report on 13 new cases with CONS, review 7 previously published cases, and evaluate the findings in all 20 patients. Despite marked variability among cases, the nasal configuration appears to be unique and diagnostic. Although one patient had a mutation in the PTCH gene, the cause of all other cases remains unknown to date.

Functional and aesthetic outcome of nasal surgery in cleft lip palate patients

Between June 1996 and November 2000 60 patients suffering from severe nasal dysplasia due to cleft lip and palate (CLP) underwent corrective nasal surgery. Diagnoses included 37 cases of unilateral CLP and 23 cases of bilateral CLP. Age ranged from 7 to 50 years. To assess functional outcome three different methods were used pre- and postoperatively with and without nasal decongestion: active anterior rhinomanometry, rhinoresistometry, and acoustic rhinometry. For the measurement of esthetic changes frontal, lateral, and caudal photographs were analyzed. Compared to a non-cleft population esthetic and functional impairment was evident preoperatively. Postoperatively a statistically significant improvement in nasal projection and configuration was seen. Concerning nasal respiration an improvement in nasal flow and hydraulic diameter was noted in the unilateral CLP group only, whereas a statistically nonsignificant average deterioration was found in the bilateral CLP group. No correlation existed between external nasal form or the change in nasal appearance and nasal function. Whereas the esthetic outcome of nasal surgery is covered by way of photo-analysis in many centers, a distinct lack of measuring the effects on nasal function can be stated. Without using objective methods, however, no data for improving surgical procedures and for internal quality control are at hand.

Three-dimensional Analysis of the Nasal Configuration of Unilateral Cleft Lip and Palate P a tients before and after Rhinoplasty

Three-dimensional Analysis of the Nasal Configuration of Unilateral Cleft Lip and Palate P a tients before and after Rhinoplasty

The Acoustic Assessment of Nasal Area in Infants

The present study was undertaken to determine whether a modification to commercially available acoustic rhinometry (AR) instrumentation might allow equipment designed for use in adults to accurately determine the nasal cavity configuration of infants and children. The standard wave tube was replaced with a version having a narrow (0.312 cm2) internal diameter. After calibration, this device was used to generate nasal area curves for the nasal cavity of a full term infant cadaver. Direct volume measurements and area measurements of polyvinylsiloxane nasal casts of the same specimen were used to evaluate the accuracy of the acoustic method. AR correlated well with nasal cast data (r = 0.88) for total nasal cavity area. The acoustic method underestimated the total area at the nasal valve by only 1.8 mm2 (22.1 mm2 vs. 23.9 mm2) and overestimated choanal area by 10 mm2 (56.9 mm2 vs 46.9 mm2) compared to data derived from polyvinylsiloxane nasal casts. In addition, AR measured total nasal volume to within 5.2% percent of the value obtained by direct measurement. This is the first report that AR can produce useful nasal area information in infants, and it suggests that the device has utility both in airway research and as a nasal patency screening tool in the pediatric population.

Nasal augmentation using the mandibular coronoid as an autogenous graft: Report of case

The nose is one of the most important elements in facial esthetics. This is supported by the fact that in our society the most commonly requested esthetic surgery is the rhinoplasty. Many of the patients encountered by the oral and maxillofacial surgeon present with multiple functional as well as esthetic concerns, and simultaneous orthognathic and rhinoplastic surgery can be accomplished with favorable results. 1 It is important in these situations that the surgeon understand the possible changes in the nasal configuration secondary to orthognathic surgery. Because nasal dorsal deficiencies are minimally affected by maxillary surgery, simultaneous surgical correction can be accomplished. 1 The following is a case report describing a simultaneous orthognathic and rhinoplastic surgery in which nasal dorsal augmentation was accomplished using the mandibular coronoid process as an autogenous bone graft.

Distant Effects of Dorsal and Tip Grafting in Rhinoplasty

Grafts to the nasal dorsum and tip, whose local effects are well known, also have distant effects that may not be as readily obvious but that nevertheless are just as real. Dorsal and tip grafts can shorten or lengthen the nose (relatively and absolutely), affect nasal symmetry, preserve or alter nasal ethnic characteristics, and alter dorsum/tip relationships. Each of these properties increases the utility of cartilage and bone grafts in treating a variety of nasal configurations.

Long-Term Results of Functional and Cosmetic Rhinoplastic Surgery

Three hundred and twelve of 444 patients admitted consecutively for rhinosurgery for nasal obstruction have been examined 5 years postoperatively regarding adequacy of nasal configuration and functional nasal passages. The surgery was introduced with special consideration given as to whether functional and esthetic surgery could be combined without jeopardizing the percentages of patients cured of nasal obstruction. An open nasal passage was found in 233 of the 312 patients at the follow-up examination, while 28 of 65 were relieved of their preoperative nasal deformities. The functional results were independent of whether only reconstruction surgery of the septum and the valve area or additional reshaping of the bony pyramid was performed. These results in the latter group were less satisfactory in males although the cosmetic results were significantly better in the group treated with additional repair of the bony pyramid. A substantial number of patients (26.7%) without saddling of the nose preoperatively had this deformity at the follow-up examination, indicating that training and/or improved surgical approaches were warranted.

Surgery of the crooked nose.

The approach to surgery of the crooked nose has changed significantly in the last two decades due in a large measure to a better understanding of the growth, anatomy, and physiology of the nose. The crooked nose often presents a challenging problem to the surgeon because of the multiplicity of deformities. In most cases, deformities of the external bony and cartilaginous nose, septum and turbinates must all be corrected simultaneously in order to obtain a satisfactory and lasting restoration of the nasal airway as well as the external nasal configuration.

Adaptations in the Nasal Passages for Sand Burrowing in the Saurian Genus Uma

Members of the iguanid genus Uma possess looped, U-shaped nasal passages which in structure and functioning prevent the inspiration of sand particles during subsurface respiration. The following factors are involved in the exclusion and elimination of sand particles: (1) The sand particles interfere with one another as they are drawn toward the external naris during inspiration. There is a tendency toward the formation of a grill of interlocking fragments which obstruct other loose grains. (2) When Uma lies buried the vestibule is situated at an angle to the horizontal. The sand particles must be drawn up the approach tube against the pull of gravity before reaching the principal nasal cavity. (3) Sand grains which adhere to the walls of the vestibule tend to impede the movement of free grains. (4) Under conditions of subsurface respiration the valve at the external naris reduces the nasal aperture to a narrow crescentic slit, limiting the inspiration of particles. (5) The postulated reduction in the diameter of the nasal tubes concomitant with the valvular action of the floor of the vestibule adjacent to the external naris, may tend to obstruct sand particles. (6) Gradual inspiration coupled with explosive expiration aids in avoiding the accumulation of sand in the nasal tubes. The configuration of the olfactory channels accentuates the explosive effect of expiration. (7) The small number of sand grains reaching the principal cavity are conveyed in a mucous film moved by ciliary action into the mouth, ultimately passing into the digestive tract. The genus Uma is not unique with respect to nasal structure. A number of other genera of the Iguanidae were found to possess a nasal configuration closely similar to that occurring in this genus. Callisaurus, Phrynosoma, Uta, Sceloporus are such genera. A tendency toward soil submergence occurs among these groups as based on field and laboratory observation. Other nonburrowing genera of the Iguanidae exhibited a nasal configuration quite different from the Uma-like types. The occurrence of the looped nasal structure within the Iguanidae doubtless was of considerable importance in the development of the almost completely psammophilous habit of the genus Uma.