Nasal Respiratory Function Research Articles

Computational fluid dynamics (CFD), virtual rhinomanometry, and virtual surgery for neonatal congenital nasal pyriform aperture stenosis

ObjectivesInvestigate the implications of Congenital Nasal Pyriform Aperture Stenosis (CNPAS) on neonatal nasal airflow through computational fluid dynamics (CFD), create a virtual rhinomanometry, and simulate the prospective outcomes post-virtual surgical intervention. MethodsCT scanning of a neonate diagnosed with CNPAS and a control model were used to execute CFD simulations. The segmentation file of the CNPAS underwent manual modifications to simulate a virtual surgical procedure, resulting in a geometry that mirrors a post-operatively corrected patient. Virtual rhinomanometry was reconstructed, and airflow dynamics within the nasal cavity were systematically assessed. The results of the three models were compared. ResultsIn the CNPAS model, airflow dynamics underwent discernible alterations, with the principal airflow corridor confined to the nasal cavity's upper region. There was a marked pressure drop around the nasal valve, and diminished velocities. This first model of virtual surgery has allowed us to observe that the airflow parameters trended toward the control model, reintroducing an airflow trajectory between the lower and middle turbinates. Virtual rhinomanometry presented near-complete nasal obstruction in the CNPAS model, which showed considerable improvement after the virtual surgery. ConclusionCFD highlights the aerodynamic changes resulting from CNPAS. It also allows for the creation of virtual rhinomanometry and the performance of virtual surgeries. Virtual surgery confirms the therapeutic potential of pyriform aperture enlargement techniques used in clinical practice to improve nasal respiratory function. Future research will investigate additional surgical scenarios and the application of these findings to optimize surgical interventions for CNPAS.

The Reconstruction of the Nasal Columella Defect Using Domino Flaps.

Skin defects of the total nasal columella can significantly impact both nasal respiratory function and aesthetics. The reconstruction of total columella is a complex process and represents a significant challenge for plastic surgeons. Various factors can cause the loss of the columella. Numerous columella reconstruction procedures have been proposed, each with their own set of advantages and disadvantages. The main issues to address include the need for regional flaps from the forehead or nasofacial sulcus, a long pedicle to reach the columella, and the double angular folding that causes a risk of malnutrition or venous congestion. Additionally, using horizontal nasolabial flaps may lead to deformation of the upper lip. In this study, we present a new procedure to reconstruct the nasal columella using "Domino flaps" with two flaps (the horizontal upper lip island flap and nasocheek island flap). This new procedure ensures adequate skin for reconstruction of nasal columella and partial tip, minimizes rotation angle, reduces the angular folding of the pedicle, furthermore limits deformation of the upper lip. "Domino flaps" are a valuable option for surgeons when reconstructing the total nasal columella. However, it is important to consider whether the patient has a beard at the donor sites.

A New Technique for Use Instead of Lateral Crural Overlay for Reduction of Nasal Tip Projection in Revision Rhinoplasty.

Correction of nasal tip projection (NTP) deformities involve techniques for the lower lateral cartilage of the nose. Previously, it would have been surgically difficult to perform the lateral crural overlay (LCO) technique for the second time in revision rhinoplasty in patients who already had undergone rhinoplasty with the LCO technique because of the length of the NTP. In this study, we evaluated the lateral crural segmental excision (LCSE) technique in patients with overprojected nasal tip in revision rhinoplasty. We retrospectively studied the cases of 19 patients who had initially undergone rhinoplasty with the LCO technique for overprojected nasal tip, and later underwent revision rhinoplasty with the LCSE technique after insufficient NTP was observed on facial analysis between 2018 and 2022. Of the patients, 12 (63%) were male, with an average age of 29.6 years, and 7 (17%) patients were female, with an average age of 25.3 years. Using Goode's formula, NTP indexes of patients measured 79.4±1.8 preoperatively and 56.0±1.3 postoperatively. Stastically significant difference was observed between preoperative and postoperative values. None of the patients had malnutrition at the incision margins, and all patients recovered on time and without any problems. Granulation tissue was detected in the mucosa in only one patient. The LCSE technique, with a short surgical time, recovery period without complications, and satisfactory nasal respiratory function, is preferred over a second LCO application in cases of NTP.

Long-term outcome of COVID-19 patients treated with helmet noninvasive ventilation vs. high-flow nasal oxygen: a randomized trial

BackgroundLong-term outcomes of patients treated with helmet noninvasive ventilation (NIV) are unknown: safety concerns regarding the risk of patient self-inflicted lung injury and delayed intubation exist when NIV is applied in hypoxemic patients. We assessed the 6-month outcome of patients who received helmet NIV or high-flow nasal oxygen for COVID-19 hypoxemic respiratory failure.MethodsIn this prespecified analysis of a randomized trial of helmet NIV versus high-flow nasal oxygen (HENIVOT), clinical status, physical performance (6-min-walking-test and 30-s chair stand test), respiratory function and quality of life (EuroQoL five dimensions five levels questionnaire, EuroQoL VAS, SF36 and Post-Traumatic Stress Disorder Checklist for the DSM) were evaluated 6 months after the enrollment.ResultsAmong 80 patients who were alive, 71 (89%) completed the follow-up: 35 had received helmet NIV, 36 high-flow oxygen. There was no inter-group difference in any item concerning vital signs (N = 4), physical performance (N = 18), respiratory function (N = 27), quality of life (N = 21) and laboratory tests (N = 15). Arthralgia was significantly lower in the helmet group (16% vs. 55%, p = 0.002). Fifty-two percent of patients in helmet group vs. 63% of patients in high-flow group had diffusing capacity of the lungs for carbon monoxide < 80% of predicted (p = 0.44); 13% vs. 22% had forced vital capacity < 80% of predicted (p = 0.51). Both groups reported similar degree of pain (p = 0.81) and anxiety (p = 0.81) at the EQ-5D-5L test; the EQ-VAS score was similar in the two groups (p = 0.27). Compared to patients who successfully avoided invasive mechanical ventilation (54/71, 76%), intubated patients (17/71, 24%) had significantly worse pulmonary function (median diffusing capacity of the lungs for carbon monoxide 66% [Interquartile range: 47–77] of predicted vs. 80% [71–88], p = 0.005) and decreased quality of life (EQ-VAS: 70 [53–70] vs. 80 [70–83], p = 0.01).ConclusionsIn patients with COVID-19 hypoxemic respiratory failure, treatment with helmet NIV or high-flow oxygen yielded similar quality of life and functional outcome at 6 months. The need for invasive mechanical ventilation was associated with worse outcomes. These data indicate that helmet NIV, as applied in the HENIVOT trial, can be safely used in hypoxemic patients.Trial registration Registered on clinicaltrials.gov NCT04502576 on August 6, 2020

Влияние интраназального препарата рекомбинантного интерферона α-2b на динамику клинических, функциональных и иммунологических показателей у пациентов с сочетанным течением аллергического ринита и бронхиальной астмы

Objective. A longitudinal cohort study was conducted to assess the effect of intranasal recombinant interferon α-2b-based medicine (Grippferon) on clinical, functional and immunological parameters in patients with concomitant bronchial asthma (BA) and allergic rhinitis (AR). Patients and methods. Twelve children aged between 10 and 17 years were examined. Clinical symptoms and nasal respiratory function, the content of VEGF, interleukins IL-1, -2, -4, -6, eosinophilic cationic protein (ECP) and total IgE in nasal secretions were assessed on days 1 and 31. Results. The study results showed a statistically significant increase in nasal respiratory flow (p = 0.001), a decrease in the severity of nasal (p = 0.002) and sinonasal symptoms (p = 0.0015), a reduction in VEGF concentration in nasal secretions (p = 0.014) and a downward trend in ECP (p = 0.09) and IL-4 (p = 0.10) levels. No statistically significant changes in IL-1, IL-6, and IgE content were found. Conclusion. The intranasal use of recombinant interferon α-2b-based medicine (Grippferon) for prevention of acute respiratory viral infections is well-tolerated by patients with AR and BA with shown notable improvement in nasal respiratory function, decrease in the severity of nasal and sinonasal symptoms and downward trends in the content of several T2 inflammation biomarkers in nasal secretions. Key words: interferon α-2b, cytokines, allergic rhinitis, bronchial asthma, acute respiratory viral infections, prevention, Grippferon

Different Settings of Nonsynchronized Bilevel Nasal Continuous Positive Airway Pressure and Respiratory Function in Preterm Infants: A Pilot Study.

With this study, we evaluated the short-term effects of different modes and settings of noninvasive respiratory support on gas exchange, breathing parameters, and thoracoabdominal synchrony in preterm infants in the acute phase of moderate respiratory distress syndrome. A feasibility crossover trial was conducted in neonates < 32 weeks' gestation on nasal continuous positive airway pressure (n-CPAP) or bilevel n-CPAP. Infants were delivered the following settings in consecutive order for 10 minutes each: • n-CPAP (5 cm H2O) • bilevel n-CPAP 1 (Pres low = 5 cm H2O, Pres high = 7 cm H2O, T-high = 1 second, rate = 30/min) • n-CPAP (5 cm H2O) • bilevel n-CPAP 2 (Pres low = 5 cm H2O, Pres high = 7 cm H2O, T-high = 2 second, rate = 15/min) • n-CPAP (5 cm H2O). During each phase, physiologic parameters were recorded; the thoracoabdominal synchrony expressed by the phase angle (Φ) and other respiratory patterns were monitored by noncalibrated respiratory inductance plethysmography. Fourteen preterm infants were analyzed. The mean CPAP level was significantly lower in the n-CPAP period compared with bilevel n-CPAP 1 and 2 (p = 0.03). Higher values were achieved with bilevel n-CPAP 2 (6.2 ± 0.6 vs. 5.7 ± 0.5 cm H2O, respectively; p < 0.05). No statistical difference in the Φ was detected, nor between the three settings. Our study did not show any superiority of bilevel n-CPAP over n-CPAP. However, nonsynchronized bilevel n-CPAP might be helpful when additional pressure is needed. · There is currently a high degree of uncertainty about the superiority of one modality and setting of noninvasive respiratory over another.. · Our study confirmed that non-synchronized bilevel n-CPAP might be helpful when additional pressure is needed for recruitment.. · A T-high of 1 second could possibly be better tolerated in this population, but further research is needed..

Computational fluid dynamics and NOSE scale to assess nasal respiratory function, and correlation with linear maxillary measurements after surgically assisted rapid maxillary expansion

Nasal obstruction is common in patients with a transverse maxillary deficiency. The aim of this study was to determine the variation in nasal airway resistance in adult patients with a transverse maxillary deficiency before and after surgically assisted rapid maxillary expansion (SARME) by computational fluid dynamics (CFD) using computed tomography scans, and to correlate this variation with maxillary linear measurements obtained by means of plaster models. The subjective symptoms of nasal obstruction were also analysed using a visual analogue scale (VAS) for nasal breathing and the Nasal Obstruction Symptom Evaluation (NOSE) scale. There was a median reduction of 21% in nasal airway resistance post SARME (P = 0.002). The NOSE scale score decreased (P < 0.001) and nasal breathing quality VAS scores increased in both nostrils (P < 0.001). Transverse measurements between the upper canines (C–C), premolars (PM–PM), and molars (M–M), and maxillary perimeter showed significant increases (P < 0.001), while the anteroposterior maxillary arch length showed a significant decrease (P = 0.016). An inverse proportional correlation was found between PM–PM and nasal airway resistance (r = −0.395; P = 0.034) and between M–M and nasal airway resistance (r = −0.383; P = 0.040). These results demonstrate that surgically expanding the posterior region of the maxilla results in decreased nasal airway resistance, decreased obstructive symptoms, and improved patient respiratory quality.

Nasal respiratory function in children with bronchial asthma and obesity

Nasal respiratory function in children with bronchial asthma and obesity

Computational fluid dynamic analysis of the nasal respiratory function before and after postero-superior repositioning of the maxilla.

Morphological changes in the upper airway and the resulting alteration in the nasal respiratory function after jawbone repositioning during orthognathic surgery have garnered attention recently. In particular, nasopharyngeal stenosis, because of the complex influence of both jaws, the effects of which have not yet been clarified owing to postero-superior repositioning of the maxilla, may significantly impact sleep and respiratory function, necessitating further functional evaluation. This study aimed to perform a functional evaluation of the effects of surgery involving maxillary repositioning, which may result in a larger airway resistance if the stenosis worsens the respiratory function, using CFD for treatment planning. A model was developed from CT images obtained preoperatively (PRE) and postoperatively (POST) in females (n = 3) who underwent maxillary postero-superior repositioning using Mimics and ICEM CFD. Simultaneously, a model of stenosis (STENOSIS) was developed by adjusting the severity of stenosis around the PNS to simulate greater repositioning than that in the POST. Inhalation at rest and atmospheric pressure were simulated in each model using Fluent, whereas pressure drop (ΔP) was evaluated using CFD Post. In this study, ΔP was proportional to airway resistance because the flow rate was constant. Therefore, the magnitude of ΔP was evaluated as the level of airway resistance. The ΔP in the airway was lower in the POST compared to the PRE, indicating that the analysis of the effects of repositioning on nasal ventilation showed that current surgery is appropriate with respect to functionality, as it does not compromise respiratory function. The rate of change in the cross-sectional area of the mass extending pharynx (α) was calculated as the ratio of each neighboring section. The closer the α-value is to 1, the smaller the ΔP, so ideally the airway should be constant. This study identified airway shapes that are favorable from the perspective of fluid dynamics.

Effects of orthognathic surgery with maxillary impaction plus septoplasty and total turbinectomy on breathing

Complete removal of hypertrophied inferior nasal turbinates may favour the occurrence of the empty nose syndrome (ENS). Some surgeons recommend partial turbinectomy in order to minimize the occurrence of ENS. However, little is known about whether total removal of the inferior nasal turbinate is associated with ENS. The aim of the present study was to evaluate the effects of total turbinectomy and septoplasty on the breathing of individuals undergoing orthognathic surgery with maxillary impaction. A total of 20 individuals participated in this cross-sectional study, in which the relationship between exposure (maxillary orthognathic surgery) and outcome (nasal respiratory function) was investigated. The Empty Nose Syndrome 6-Item questionnaire and Nasal Obstruction Symptom evaluation scale were applied to investigate the ENS. A three-dimensional assessment of the piriform opening was performed pre- and postoperatively by computed tomography in order to measure the volume of the nasal cavities using the Dolphin Imaging software. ENS was detected in 35% of patients, while 13 reported improved breathing. Symptoms of ENS such as dryness, suffocation, nose feels too open and nasal crusting were mentioned. The mean nasal cavity volume was 7477.15 mm³ greater in the initial evaluation (p&lt;0.05). In summary, the occurrence of ENS does not constitute an absolute contraindication of total turbinectomy, a procedure that contributed to the improvement of airway permeability.

Impact of aesthetic rhinoplasty on the respiratory function of the nose in patients with a straight nasal septum

Introduction/Objective. Aesthetically, the nose adds special signature to a person?s look. This results in many nasal pyramid surgeries, either functional or aesthetic. The problem arises in aesthetic surgeries. Patients often tend to present their dissatisfaction with the appearance of the nose as a breathing difficulty, as they often lack the support of the environment in the decision to undergo cosmetic surgery. The objective of the paper was to examine, using subjective assessment and objective measurements, the change in the nasal respiratory function in patients who undergo aesthetic nose surgeries, despite having a straight nasal septum before the surgery. Methods. The study was conducted as a prospective, cross-sectional one, and involved 32 patients of both genders. Before and at six months after surgery all patients underwent subjective nasal breathing assessment using visual analog scale (grade 0?10) as well as objective nasal respiratory function assessment using rhinomanometry and acoustic rhinometry after anemization. Results. There were seven male and 25 female patients, age ranging 18?27 years. Objective measurements after surgery showed that the nasal cavity volume, minimum cross-sectional area, as well as the airflow through the nose reduced, while resistance to the nasal airflow increased, but with no statistical significance. The subjective assessment of nasal breathing statistically significantly improved after the surgery. Conclusion. The subjective assessment of nasal breathing postoperatively is not a relevant indicator of the objective state of the nasal respiratory function in patients after aesthetic rhinoplasty.

Effect of sleep-disturbed breathing on maxillofacial growth and development in school-aged children

ABSTRACT Purpose : In children, snoring and apnoea cause impairments in growth, cognitive function, attention, and school performance. In this study, we aimed to identify the association between craniofacial disharmony and paediatric sleep-disordered breathing. Materials and Methods : Forty-one patients with malocclusion (19 boys; 22 girls; mean age, 10.0 ± 2.1 years) were selected from our hospital. The relationship between maxillofacial morphology, pharyngeal airway form, and nasal respiratory function was examined using cephalometric analysis and skeletal patterns. All patients underwent portable monitoring with an overnight out-of-centre sleep testing protocol that could be performed at home using a portable computerized monitoring system. Results : The respiratory disturbance index was significantly greater in patients with mandibular retrusion than those with malocclusion. Arterial oxygen saturation and nasopharyngeal area were significantly smaller in participants with Class II malocclusion than in those with other types of malocclusion. Moreover, dental cast model analyses confirmed that patients with reduced transverse maxillary dimensions had a higher obstructive sleep apnoea syndrome (OSAS) risk than those with malocclusion. Therefore, patients with mandibular retrusion have a higher OSAS risk than those with other types of malocclusion. Conclusion : Childhood maxillofacial morphology may influence adult OSAS, and early treatment for children with OSAS may help prevent adult OSAS.

The role of fiberoptic sinoscopy in evaluation the effect of surgically rapid maxillary expansion on the nasal airways

Aim : To evaluate the effect of surgically assisted rapid maxillary expansion on the nasal airway assissted by nasofibroscopy. Subjects and methods: Nine Patients were included in the present study. They were consecutive patients selected from the oral and maxillofacial surgery department that referred from orthodontic department Faculty of Dental Medicine, Al-Azhar University, Assuit branch in the period from September 2017 to October 2019 . They were adult patients of both sexes (3 males and 6 females). All patients were subjected to history taking , sinoscopic nasal examination. All patients had maxillary transverse deficiency associated primarily with functional impairments, such as posterior uni- or bilateral cross bite, dental crowding, reduced nasal respiratory function or anterior-posterior skeletal anomalies and they were indicated for surgically assisted rapid maxillary expansion. Preoperative intracanine and intramolar distances (C1, C2, M1, M2 ) was measured by digital caliper on Study cast. Measuring area of both nasal cavities by nasofibroscopy were done in ENT department of Al Azhar university hospital, Assuit. The operation was conducted under general anesthesia. After surgery, clinical evaluations ware done at intervals of 2, 4, 7 and 15 days and then all data obtained from nasofibroscopy by pixels and transformed by typography program in to millimeters. Result: Results of the current study have indicated that nasofibroscopy showed that was improvement in nasal obstruction after maxillary expansion. Conclusion: Surgically assisted rapid maxillary expansion is an effective method of widening the nasal passages and reducing nasal resistance that assisted by nasofibroscopy.

Olfactory Perception and Different Decongestive Response of the Nasal Mucosa During Menstrual Cycle.

Sex hormones are known to have some influence on nasal functions, but their effect on the decongestive response of the nasal mucosa during menstrual cycle is still undetermined. The aim of this study was to examine the nasal physiology, the interconnectedness of olfactory and respiratory nasal function and the decongestive response of the nasal mucosa during menstrual cycle. This study included 101 healthy women aged 23.26 ± 4.81 years with a regular menstrual cycle. The nasal respiratory function and the decongestive response of the nasal mucosa were examined by rhinomanometry. Subjective sense of nasal obstruction and the subjective odor intensity were assessed by standardized questionnaires. The odor identification ability was assessed by Sniffin' Sticks test. Statistically significant higher values of nasal resistance (0.311 ± 0.107 Pa/cm3/s) and NOSE score (11.893 ± 13.83) were observed in the ovulatory phase compared to the luteal (0.281 ± 0.084 Pa/cm3/s and 9.029 ± 11.12). An odor identification test score was significantly higher in luteal phase (12.476 ± 1.48) compared to the ovulatory phase (11.971 ± 1.51), opposite of odor intensity. The difference of nasal resistance before and after decongestion was significantly higher in ovulatory phase (0.105 ± 0.097 Pa/cm3/s) compared to the luteal (0.084 ± 0.079 Pa/cm3/s). Correlation between subjective and objective parameters of the examinated nasal functions was not statistically significant in any menstrual phase. In the population of women studied, total nasal resistance and NOSE score were significantly lower in the luteal phase of the menstrual cycle. Odor identification was significantly higher in the luteal phase but odor intensity significantly higher in the ovulatory phase. The decongestive response of nasal mucosa was better in the ovulatory phase of the menstrual cycle.

The Relationship Between Indicators of Nasal Respiratory Function and Spirometric Parameters in Children With Bronchial Asthma.

Introduction: The relationship between objective indicators of nasal obstruction and airflow limitation in children with bronchial asthma (BA) and allergic rhinitis (AR) has not yet been studied.Objective: To study the relationship between objective parameters of nasal obstruction and airflow limitation, determined using the methods of anterior active rhinomanometry (AARM) and spirometry in children with BA and AR.Materials and Methods: Eighty eight children and adolescents with BA and AR, boys−65.9% (58/88), were examined. The median age was 11.09 [10.42; 11.76] years. To determine airflow limitation, the following spirometric parameters were evaluated: forced vital capacity of the lungs (FVC), forced expiratory volume in 1 s (FEV1), the ratio of FEV1/FVC, and maximum expiratory flow at the point 25% of the flow-volume loop (MEF25). Data were recorded both in absolute values and in relative units (% pred). Nasal respiratory function was determined by AARM based on the total nasal airflow (TNAF) in absolute (Pa/cm3/s) and relative units (RTNAF, % pred).Results: In the general cohort and in boys but not in girls, a statistically significant direct correlation was found between TNAF (Pa/cm3/s) and absolute spirometry parameters of bronchial patency—all had p < 0.01. Also, RTNAF and relative MEF25 values (% pred) in the general cohort were R = 0.22, p = 0.04, and in boys, R = 0.28, p = 0.03. In girls, there was no statistically significant correlation between nasal respiratory function and spirometric parameters, all p > 0.05. Additional analysis of literature was conducted to ascertain that the identified gender differences were not occasional.Conclusion: The significant positive correlation of absolute values of AARM and spirometric parameters in children with BA and AR was established, which apparently reflects the physical development of children. Of all the relative indicators of spirometry, only MEF25 (% pred), which indirectly reflects the patency of small bronchi, had a distinct direct correlation with RTNAF. These patterns are clearly expressed in boys with BA. In girls with this disease, however, the relationship between nasal respiratory function and spirometric indicators seems to be more complex and requires further study.

Impact of rapid maxillary expansion on mouth-breathing children and adolescents: A systematic review.

BackgroundRapid maxillary expansion (RME) is an orthodontic procedure used to correct transverse maxillary deficiency. Due to the anatomical relationship between the palate and the nasal cavity, RME promotes an increase in nasal dimensions, which should hypothetically improve nasal respiratory function. Objective: This review aimed to systematically verify studies that assessed the effects of RME on nasal patency in mouth-breathing children and adolescents. Material and MethodsAn electronic search was performed in the MEDLINE databases via OVID, Scopus and EMBASE. The terms were: “children and adolescents”, “rapid maxillary expansion” and “mouth breathing”. The search was conducted in October 2019, according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The assessment of the quality of the studies was conducted by two evaluators, using the Fowkes & Fulton´s guidelines for critical appraisal of medical research. Results475 titles were identified and 18 articles were selected. All of them showed high methodological quality, but without randomized clinical trials. The instruments evaluated were: teleradiography, frontal postero-anterior radiography, computed tomography, acoustic rhinometry and computed rhinomanometry. ConclusionsThis review shows that RME promotes the enlargement of dental arches and of the nasal and maxillary structures, with improved mouth breathing in the short term. However, its long-term benefits could not be proved so far. More robust results of the effectiveness of RME in mouth breathing can be achieved with meta-analysis studies, with a consensual definition of the long-term follow-up period after RME. Key words:Child, adolescent, maxillary expansion, palatal expansion, mouth breathing.

Does Nasal Cavity Enlargement Associated With Respiratory Function Improvement After Surgically Assisted Rapid Maxillary Expansion?

To systematically evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on nasal cavity and its associated respiratory function changes. Multiple electronic databases were searched, authors were contacted as required, and reference lists of potentially relevant studies were screened. Articles that included patients older than 16 who had received SARME were considered. Data extraction and quality assessment were performed independently and in duplicate. Eight articles, including 161 patients, were finally selected and analyzed. Nasal cavity significantly augmentation after SARME has been recognized by 7 studies with moderate-quality evidence. Among them, the nasal cavity volume increased <20% in 4 studies, 20% to 40% in 1 study, and >40% in 2 studies. Totally, the range of increasing in nasal cavity volume was 7.6% to 99%. One study had recorded the nasal expiratory and inspiratory flow significantly increased 18.5% and 21.7%, respectively. SARME was found to produce meaningful volume augmentation in nasal cavity with adult patients. However, the improvement of nasal respiratory function has not been well elucidated; thus, SARME is not yet recommended for the purpose of improving nasal respiratory.

The role of peak nasal and oral inspiratory flow in the evaluation of patients with sleep-related breathing disorders.

Sleep-related breathing disorders (SRBD) are common reported disorders in the adult population. The nose plays an important role in the development of SRBD; thus, the measurement of nasal respiratory function remains an important step in the management of these patients. Peak nasal inspiratory flow (PNIF) is a useful tool to assess nasal airflow and it has recently been studied together with peak oral inspiratory flow (POIF). The aim of the present study was to evaluate the role of PNIF and POIF in an adult population of patients affected by SRBD. Seventy consecutive adult patients with SRBD were included in the present study. All patients were evaluated with home-based sleep studies (type III), PNIF, POIF, SNOT-22 questionnaire, Epworth Sleepiness Scale test and VAS for nasal obstruction. Although PNIF and POIF showed to correlate with each other, no correlations were observed between Apnea Hypopnea index (AHI) and PNIF, POIF or NPI (PNIF/POIF). A further analysis showed a marginal correlation between SNOT- 22 and AHI and between SNOT-22 and POIF. Furthermore, in a multivariate analysis, also POIF marginally correlated with some of the sleep- related SNOT-22 items. In the present study neither PNIF nor POIF were found to be associated with OSAS severity. However, POIF values correlated better than PNIF with sleep related symptoms suggesting that POIF could be a more useful parameter for upper airway assessment in patients with SRBD. In addition, a correlation between OSAS severity, in terms of AHI, and SNOT-22 total score has been reported.

Short- and mid-term results of limited approach septoplasty

Limited approach septoplasty (LAS) follows the principle of respecting nasal structures and aims to minimize complications while ensuring proper nasal respiratory function. LAS is only applicable to selected cases of septal deviation. The present study aimed to: (1) compare short- and mid-term complications in two consecutive series of patients with the same type of septal deviation treated with LAS or classical septoplasty; and (2) examine postoperative respiratory function with active anterior rhinomanometry in the two series, and in a group of healthy, non-surgical volunteers. The study concerned two groups of 20 consecutive patients who underwent LAS or classical septoplasty for deviation in Cottle's areas 4/5, and a control group of 11 healthy adult volunteers with no sinonasal disorders. The mean operating time did not differ significantly between the two groups. Three patients in each group developed minor complications. In a sitting position, the mean total nasal inspiratory resistance was 0.018 and 0.019Paml/s (p = 0.46) in the LAS and classical septoplasty groups, respectively, and the total expiratory resistance was 0.019 and 0.018Paml/s (p = 0.30). In a supine position, the mean total nasal inspiratory resistance was 0.017 and 0.021Paml/s (p = 0.05), and the total expiratory resistance was 0.017 and 0.019Paml/s (p = 0.14) in the LAS and classical septoplasty groups, respectively. In selected cases, LAS achieved much the same short- and mid-term results as classical septoplasty. The mini-invasive approach is certainly more respectful of the nasal mucosa, requiring a less extensive detachment, with consequent faster healing times and less tissue damage.

The relationship between nasal respiratory function and the morphology of craniofacial and upper airway in different mandible sagittal pattern population

The relationship between nasal respiratory function and the morphology of craniofacial and upper airway in different mandible sagittal pattern population