Nasal Respiratory Function Research Articles

Comparative Study of the Effectiveness of sub mucosal Partial Inferior Turbinectomy and Out fracture of Inferior Turbinate in the Nasal Respiratory Function of Rhinoplasty Patients

IntroductionThe inferior turbinate is a critical and dynamic structure during rhinoplasty in the internal valve. Many surgeons try to preventively reduce its resistance against the path in the post-rhinoplasty period. To this end, the two methods of “sub mucosal partial inferior turbinectomy” and “inferior turbinate out fracture” are compared in the present study.MethodsIn this clinical study, 110 rhinoplasty candidates were randomly divided into two groups, namely sub mucosal partial inferior turbinectomy and out fracture of the inferior turbinate. To assess the complications, the Sino-Nasal Outcome Test (SNOT-22) was used prior to surgical intervention, and 1, 2, 3, 6, and 12 months following the rhinoplasty procedures.ResultsBased on the results of this clinical study and according to the SNOT-22 questionnaire, there was no significant difference between the two groups prior to surgery and a month following the surgery (P > 0.05). However, the average SNOT-22 score for the sub mucosal partial inferior turbinectomy group was significantly lower than that of the group with the out fracture of the inferior turbinate, 2, 3, 6, and 12 months following the surgery.ConclusionBoth “sub mucosal partial inferior turbinectomy” and “out fracture of inferior turbinate” are effective methods in improving the respiratory function of rhinoplasty patients, yet the former method is more effective than the latter as regards improving the respiratory function of patients.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 Functions in Three-Dimensional Endoscopic Skull Base Surgery.

Endoscopic transnasal transsphenoidal surgery has become the standard procedure for the majority of skull base diseases, including sellar, parasellar, and clival pathologies. The aim of this study was the objective evaluation of nasal airflow resistances and olfactory function in 3-dimensional (3D) endoscopic transnasal transsphenoidal surgery. One hundred patients who underwent 3D transnasal endoscopic surgery for sellar, parasellar, and clival diseases were enrolled. Active anterior rhinomanometry and Sniffin' Sticks tests were performed before endoscopic surgery and at 3 and 6 months postoperatively. No significant difference about nasal airflow resistance and olfactory function was observed between preoperative and postoperative subjective and objective scores. In the group of patients with sellar and parasellar diseases, a worst nasal respiratory function was seen when crusting was present, and a worst olfactory function was observed in patients with synechiae. Nasal functions returned to previous levels when crusting or synechiae solved. No statistically significant correlation was observed between the evaluated nasal functions and the reconstruction with flaps. The 3D endoscopic transnasal transsphenoidal surgery represents a more and more important tool in skull base surgery. It does not determine nasal respiratory and olfactory alterations after the treatment, without an increase in nasal complaints that could worsen quality of life.

Effects of Craniofacial Morphology on Nasal Respiratory Function and Upper Airway Morphology.

Craniofacial skeletal patterns change after orthognathic surgery. The present study aimed to investigate the effects of different craniofacial patterns on nasal respiratory function and the upper airway. Forty-seven healthy subjects were selected and divided into 3 groups according to their mandibular position. Sixteen were in the skeletal Class I group, 15 were in the skeletal Class II group, and 16 were in the skeletal Class III group. Cone beam computed tomography was performed, and nasal airflow and nasal resistance were measured. Differences in nasal respiratory functions and upper airway were compared among the groups. A correlation analysis was conducted for nasal respiratory function, upper airway, and skeletal patterns. There were significant differences among the 3 groups regarding dominant-side nasal inspiratory capacity (P = 0.001), bilateral nasal inspiratory capacity (P = 0.005), nasal partitioning ratio-inspiration (P = 0.007), and velopharyngeal minimum cross-sectional area (P = 0.029). The values were significantly higher for the skeletal Class III group than the skeletal Class I and II groups. A correlation analysis showed that the nasal partitioning ratio and nasal airway resistance were mostly negatively correlated with SNA, but the upper airway volume and cross-sectional area were positively correlated with SNB and negatively correlated with ANB. The dominant-side nasal expiratory capacity was mainly negatively correlated with the mean velopharyngeal cross-sectional area (r = -0.324, P = 0.026), mean glossopharyngeal cross-sectional area (Glosso-A mean) (r = -0.293, P = 0.046), and mean total airway cross-sectional area (Total-A mean) (r = -0.307, P = 0.036). Craniofacial skeletal morphology may affect nasal respiratory function and the upper airway.

Changes of nasal and oronasopharyngeal airway morphologies and nasal respiratory function following orthognathic surgery

ObjectiveThe aim of this study was to determine the effects of maxillomandibular movements by orthognathic surgery on nasal and oronasopharyngeal airway morphologies and nasal respiratory function. MethodsThe subjects were 32 patients in whom jaw deformities were corrected by two jaw surgery. The amount of jaw movements was evaluated on cephalograms taken before surgery and more than six months after surgery, and morphological changes were evaluated using helical computed tomography (CT), and nasal airway resistance (NAR) for the objective evaluation of nasal respiratory function was measured by anterior rhinomanometry. The results showed that the volume of the nasal cavity and NAR was not changed significantly after surgery. However, the change of NAR was negatively correlated with changes of nasopharyngeal volume and the cross-sectional area in the palatal section (P-CSA). The change of NAR correlated with horizontal movement at B-point. Furthermore, the amount of vertical movement of the maxilla at the posterior nasal spine (PNS) was significantly correlated with reductions in the volume of the oropharynx upper region. ConclusionThere was little association of changes in maxillomandibular position or nasal and oronasopharyngeal airway morphologies with nasal respiratory function. This might be because of compensatory biomedical action to maintain nasal respiratory function.

Computational Fluid Dynamic Study of Nasal Respiratory Function Before and After Bimaxillary Orthognathic Surgery With Bone Trimming at the Inferior Edge of the Pyriform Aperture

This study aimed to evaluate the influence of maxillary impaction orthognathic surgery on nasal respiratory function and the efficacy of bone trimming at the inferior edge of the pyriform aperture. The participants were 10 patients (3 male and 7 female patients) with mandibular prognathism who underwent bimaxillary orthognathic surgery with maxillary impaction. The surgical procedures performed were Le Fort I osteotomy with bone trimming at the inferior edge of the pyriform aperture and bilateral sagittal split osteotomy. Three-dimensional models of the nasal cavity were reconstructed from preoperative and postoperative computed tomography images. Furthermore, we remodeled the nasal valve region based on the postoperative models by adding a 1-mm and 2-mm stenosis to investigate the effects of bone trimming at the inferior edge of the pyriform aperture on the pressure effort. The 3-dimensional models were simulated with computational fluid dynamics, and the results of the pressure effort and the cross-sectional area (CSA) were compared for the anterior, middle, and posterior parts of thenasal cavity. The Wilcoxon signed rank test and Spearman rank correlation coefficients were used for statistical comparisons (P < .05). In the preoperative and postoperative models, there were considerable correlations between the CSA and the pressure effort in each part of the nasal cavity. The postoperative pressure effort showed a tendency to decrease and the CSA showed a tendency to increase in each part of the nasal cavity. In four 2-mm stenosis models, the pressure effort in the anterior nasal cavity was larger than the preoperative pressure effort and the CSA of the anterior nasal cavity was smaller than the preoperative CSA. Bone trimming at the inferior edge of the pyriform aperture appears to be useful for avoiding nasal respiratory complications with maxillary impaction.

Osteoectomy in Rhinoplasty: A New Concept in Nasal Bones Repositioning.

Modern techniques of osteotomy have evolved to take into account the effects of bony repositioning on functional as well as aesthetic outcomes. Although a variety of methods have been described to appropriately mobilize and reposition the bony nasal vault, there is still no single procedure that can successfully manage nasal bones in its entirety. We present the bone chisel scraping osteoectomy technique for lateral and medial osteotomies with the aim of managing nasal bone deformities that can overcome diverse shortcomings of the conventional methods. The new operative method was performed in 184 nasal bone osteoectomies (92 patients, 22 men and 70 women), ranging in age from 18 to 69 years (mean age, 38 years). The functional results were evaluated postoperatively by the Nasal Obstruction Symptom Evaluation scale, a brief and easy to complete validated questionnaire with a final score grading from 0 to 100 at 3 and 6 months postoperatively. With this new approach, no functional problems were reported. The mean Nasal Obstruction Symptom Evaluation scale score was 5.3 at 3 months and 1.9 at 6 months. Only 1 primary case was reoperated for open roof deformity. Comparing the results with the previous osteotomy series of the senior author osteoectomy and osteotomy revision rates for inadequate bone mobilization were similar but osteoectomy technique did not create functional problems as the osteotomy technique did. Although this technique prolongs the operating time, it could offer considerable advantages in comparison with the classical techniques using osteotomies and hammer. This is because it offers a greater respect to the nasal respiratory function and gives a much better nasal base width control, resulting in more predictable results, less trauma, and therefore a lower risk of postoperative complications.

Concomitant dynamic changes in autonomic nervous system function and nasal airflow resistance during allergen provocation.

Allergic rhinitis is a major chronic respiratory disease which more than 500 million people suffer from around the world. It is considered to be an immuno-neuronal disorder, but little is known about the part played by the neural system in nasal allergic reaction. This is due mainly to the lack of objective measurement techniques producing accurate, reliable and continuous measurement data about the dynamic changes in nasal respiratory function. Here, a method to assess the association of nasal airflow resistance and the underlying function of autonomic nervous system (ANS) is presented and used during the birch pollen provocation test. Ten allergic volunteers were challenged with allergen. Continuous nasal airflow resistance and spectral heart rate variability parameters were computed and analyzed for the dynamic changes. The derived signals show in detail the timing and intensity differences in subjects' reactions. After the provocation, the nasal airflow resistance rose gradually, whereas LF power and LF/HF ratio decreased gradually for all subjects. This implies gradually increasing sympathetic withdrawal in allergic patients during the provocation with allergen. The proposed method opens entirely new possibilities to assess accurately the dynamic and short-term changes in non-stationary nasal function and could increase the accuracy and reliability of diagnostics and assessment of the effect of nasal treatments.

Extracorporeal Septoplasty

Severe nasoseptal deviations still represent challenging situations for plastic surgeons. Septal surgery plays a central role in the management of complex cosmetic and functional problems, and should be considered as a basic procedure in nasal surgery. The classic septoplasty approach seems to be unsuitable for severe septal deviations. Other authors have found the standard extracorporeal septoplasty approach more reliable for a correct functional and cosmetic surgery. However, a drawback of this technique is the destabilization of the keystone area. In an effort to minimize the risk of destabilization, we have modified the classic technique with a more conservative approach that spares the dorsal cartilage and a portion of the caudal septum. This study included 153 patients who underwent primary rhinoplasty from January 2006 to June 2009. The purpose was to evaluate the effectiveness of this technique in terms of objective (Active Anterior Rhinomanometry) and subjective (Nasal Obstruction Symptom Evaluation [NOSE] scale) improvements of the respiratory function and in terms of postoperative complications. There was a significant improvement in mean NOSE score at 3 and 6 months postoperatively. Rhinomanometrical assessment showed a significant increase of the nasal inspiratory flow at 3 and 6 months after surgery. No complications were reported. The results obtained with NOSE score and with rhinomanometrical assessment revealed that this technique increases patient's quality of life and nasal respiratory function, respectively. Furthermore, our approach avoids the most important complication of classic extracorporeal septoplasty, thus preserving a structured support of the nasal archway.

Orthodontic measurements and nasal respiratory function after surgically assisted rapid maxillary expansion: an acoustic rhinometry and rhinomanometry study

The present study sought to assess nasal respiratory function in adult patients with maxillary constriction who underwent surgically assisted rapid maxillary expansion (SARME) and to determine correlations between orthodontic measurements and changes in nasal area, volume, resistance, and airflow. Twenty-seven patients were assessed by acoustic rhinometry, rhinomanometry, orthodontic measurements, and use of a visual analogue scale at three time points: before surgery; after activation of a preoperatively applied palatal expander; and 4 months post-SARME. Results showed a statistically significant increase (p<0.001) in all orthodontic measurements. The overall area of the nasal cavity increased after surgery (p<0.036). The mean volume increased between assessments, but not significantly. Expiratory and inspiratory flow increased over time (p<0.001). Airway resistance decreased between assessments (p<0.004). Subjective analysis of the feeling of breathing exclusively through the nose increased significantly from one point in time to the next (p<0.05). There was a statistical correlation between increased arch perimeter and decreased airway resistance. Respiratory flow was the only variable to behave differently between sides. The authors conclude that the SARME procedure produces major changes in the oral and nasal cavity; when combined, these changes improve patients’ quality of breathing.

Fibroscopic findings in patients following maxillary osteotomies in orthognathic surgery

Objective To evaluate the intranasal complications in patients submitted to maxillary Le Fort osteotomy within the orthognathic evaluation through flexible fibroscope, method which is safety, reliable and minimally invasive. Materials and methods A prospective, systematic non-randomized study is presented with a series of 47 patients who underwent a Le Fort I maxillary osteotomy due to dentofacial deformity between January 2008 and December 2008. The patients who were included underwent an evaluation of nasal respiratory function using a questionnaire designed for this objective, after which a fibroscopic examination was carried out. Results With regards to the results of the NOSE questionnaire, 4/47 patients had Grade 2 nasal obstruction before the surgery. After the intervention, three improved to a 0–1 grade. 3/47 patients reported snoring during sleep without OSAS that was not modified as a result of the surgery. 2/47 patients presented with sequelae regarding the deviation of the septum, and 1/47 had a luxation of the anterior nasal spine that had not been recorded before the orthognathic surgery. The presence of synechiae was observed in 3/47 cases. A septal perforated mucosa was found in the IV area of the nasal septum. Hypertrophy of the lower turbinate was observed in 4/47 cases. Conclusion The fibroscope procedure is minimally invasive and it does not require local anesthesia or sedation, and it allows the surgeon to carry out an immediate and exhaustive evaluation, on an outpatient basis, of possible septal and nasal sequelae in patients undergoing orthognathic surgery.

Indications, placement and management of tracheostomy tubes

Placement of a tracheostomy tube is a simple procedure and can be a lifesaving intervention. However, the presence of a tube within the trachea that allows air to bypass the...

The Effect of Maxillary Multidirectional Movement on Nasal Respiration

Deformities of the maxilla may exist on all planes, and we treat these problems by mobilizing and repositioning the maxilla on all planes. Some authors have examined the effects of maxillary movement on the nasal airway. In clinical, practice, active anterior rhinomanometry is the most reliable and frequently used method to assess nasal respiratory function. The purpose of this study was to evaluate changes in nasal airflow and nasal airway resistance after maxillary movement performed by active anterior rhinomanometry. We studied 25 patients (18 female patients and 7 male patients; aged 16-30 years) in this clinical trial. Three days before surgery and 6 months after surgery, after a rest period of 30 minutes, active anterior rhinomanometry with a tube was performed at a fixed transnasal pressure of 150 Pa. The surgical treatment plan included bimaxillary surgery consisting of a 1-piece Le Fort I osteotomy combined with a bilateral sagittal split osteotomy. Mean and median total nasal airflow and nasal resistance rate were calculated before surgery and after surgery and compared by use of SPSS software (version 11.5; SPSS, Chicago, IL) and paired t test. An increase in nasal airflow (P = .009) and a decrease in nasal resistance (P = .022) were observed in the maxillary impaction and advancement group. In the maxillary impaction and setback group, there was a significant difference in nasal resistance changes (P = .027); however, postsurgical nasal airflow compared with presurgical values showed no statistically significant difference (P = .244). Impaction and advancement of the maxilla can improve nasal respiratory function, but maxillary impaction and setback reduce nasal respiratory function. Hence candidates for maxillary impaction and setback must be informed about decreased nasal respiratory function.

Results of a Prospective Anthropometric and Functional Study About Aesthetics and Nasal Respiration After Secondary Rhinoplasty in Cleft Lip and Palate Patients

In contrast to the multitude of investigations regarding aesthetic changes in nasal surgery, few data are available concerning nasal function. This is especially important for cleft patients with a compromised nasal respiration.In this prospective study, 68 cleft patients, who underwent nasal surgery, were evaluated concerning aesthetic and respiratory outcome. To assess nasal respiration, active anterior rhinomanometry, rhinoresistometry, and acoustic rhinometry were performed preoperatively and 6 months postoperatively (without and with nasal decongestion, according to international standards). For analyzing the changes in aesthetic parameters, photographs from 3 directions, which were taken preoperatively and at least 6 months postoperatively, were compared. Thus, 57 angles and relations of lines were created out of 54 anthropometric points. The Wilcoxon test was used to compare preoperative and postoperative data (P < 0.05). Regarding aesthetic outcome, a significant improvement in many parameters was seen. The noses postoperatively proved to be significantly narrower and more symmetric and showed a better projection.Although analysis of functional respiratory data showed a significant increase in nasal volume, no change in nasal airflow and hydraulic diameter could be found.Whereas aesthetic improvement of the cleft nose is a goal, which can be achieved regularly, nasal respiration still seems to be a challenge in cleft patients. This study highlights the necessity of taking functional data to learn more about the effects of surgery. Objective methods to assess nasal respiratory function are important for planning and performing nasal surgery and are a means of quality control.

Nasal reconstruction in advanced sinunasal sarcoidosis

Sarcoidosis can lead to devastating nasal deformities and impairment of nasal respiratory function. There is only very little published experience with nasal reconstruction in this disease entity. In general, a cautious attitude prevails out of fear of complications or failure due to the underlying granulomatous inflammation. A 57-year-old lady presented to our institution with a 20-year history of sarcoidosis with sinunasal involvement. The findings included a saddle nose deformity, absent nasal septum and conchae, left-sided alar collapse and cutaneous involvement of the nasal tip with discoloration. In a first procedure, we performed a reconstructive nasal surgery with porous polyethylene grafts. In a second procedure, we used a paramedian forehead flap for a partial nasal reconstruction. The functional and asthetic improvement was very satisfactory for the patient during the 2-year follow-up period. This is the first reported use of a forehead flap in nasal sarcoidosis. It demonstrates that major reconstructive nasal surgery and implantation of porous polyethylene grafts can successfully be performed in patients with sinonasal sarcoidosis during remission.

Nasal Trumpet Orthosis to Maintain Nares Opening during a Melolabial Interpolation Flap

The nasal trumpet has been used in emergency resuscitation, anesthesia, and facial burns to maintain nares openings. The dermatologic surgery literature is not as familiar with this device to improve respiratory function during the postoperative period after reconstruction of large defects on the nose. To present a novel way of using a modified nasal trumpet orthosis to maintain nasal valve patency and improve nasal valve respiratory function postoperatively following a melolabial interpolation flap. A sterile nasal trumpet orthosis. We present a novel way of using a modified nasal trumpet orthosis after a melolabial interpolation flap procedure. For large defects involving the nares and/or nasal valve of the nose, the nasal trumpet is well tolerated by the patient and can lead to increased postoperative respiratory function while acting as a "bolster" for the closure.

Objective measurement of nasal airway dimensions and resistance using acoustic rhinometry and rhinomanometry in habitual snorers compared with non-snorers

Snorers represent a heterogeneous group that requires adequate assessment before recommending surgical treatment. Most studies of the pathophysiology of snoring and obstructive sleep apnea have emphasized anatomical abnormalities in the oropharyngeal and hypopharyngeal airways. It is still unclear if nasal airway restriction plays an important role in sleep-disordered breathing and there is no general consensus if treatment of nasal pathology should be included in the management of patients with snoring or sleep apnea. The aim of this study was to compare nasal dimensions and airflow resistance of habitual snorers with non-snoring individuals by means of acoustic rhinometry and rhinomanometry. Sixty individuals were enrolled in this analytical cross-sectional study. They were divided in two groups: group A (case) consisted of 30 patients with a main complaint of chronic snoring referred to ear, nose, and throat (ENT) clinic of Hazrat-e-Rasoul University Hospital, Tehran, Iran. Group B (control) consisted of 30 individuals without any complaint of snoring. The subjects were assessed objectively with acoustic rhinometry and rhinomanometry. Nasal dimensions and airflow resistance were recorded for all individuals. The most common site of minimum cross-sectional area (MCA) was at the left concha-notch in both snoring and non-snoring individuals. Significant reduction of cross-sectional area of both isthmus and concha notches was seen in habitual snorers (P < 0.05). The mean total airflow resistances in both pressures of 75 and 150 Pa was higher in habitual snorers. Whereas, these differences were not statistically significant (P > 0.05). The results of our study illustrate that acoustic rhinometry, rhinomanometry may be helpful methods for quantitative assessments of nasal airway respiratory function, and configuration in snorers; especially to evaluate site of MCA, decreased nasal cross-sectional area and increased nasal airflow resistance in habitual snorers which may lead to OSA.

Reconstruction of the columella using the prefabricated reverse flow submental flap: A case report

The reconstruction of columellar defects is still a challenging procedure because of limited local and regional flap options and the characteristics of the anatomy of this site. Although a number of methods are available to repair nasal columella defects, no treatment of choice ensuring an excellent texture- and color-matched tissue in one stage has been determined to date. In this case, we used a reverse-flow submental island flap prefabricated with the costal cartilage for the reconstruction of a complex columellar defect. The flap survived completely with reversible venous congestion. The cosmetic result and nasal respiratory function were acceptable during the follow-up time of 6 months. We propose that the prefabricated reverse submental flap may be an alternative among the surgical options for columellar defects. This flap may also be considered in the reconstructive repertoire of other composite defects of the head and neck region.

Assessment of nasal flora and respiratory function tests of bakery workers working under modern conditions

Assessment of nasal flora and respiratory function tests of bakery workers working under modern conditions

Nasal respiratory turbinate function in birds.

Nasal respiratory turbinates are complex, epithelially lined structures in nearly all birds and mammals that act as intermittent countercurrent heat exchangers during routine lung ventilation. This study examined avian respiratory turbinate function in five large bird species (115-1,900 g) inhabiting mesic temperate climates. Evaporative water loss and oxygen consumption rates of birds breathing normally (nasopharyngeal breathing) and with nasal turbinates experimentally bypassed (oropharyngeal breathing) were measured. Water and heat loss rates were calculated from lung tidal volumes and nasal and oropharyngeal exhaled air temperatures (T(ex)). Resulting data indicate that respiratory turbinates are equally adaptive across a range of avian orders, regardless of environment, by conserving significant fractions of the daily water and heat budget. Nasal T(ex) of birds was compared to that of lizards, which lack respiratory turbinates. The comparatively high nasal T(ex) of the lizards in similar ambient conditions suggests that their relatively low metabolic rates and correspondingly reduced lung ventilation rates may have constrained selection on similar respiratory adaptations.

Monitoring methods of nasal pathology

The importance of correct clinical and therapeutic monitoring of allergic rhinitis is understandable in the light of the social and economic impact of this pathology: its prevalence is over 10% of the total population all over the world. For the evaluation of the local nasal pathology we include: (1) anterior rhinoscopy, (2) active anterior rhinomanometry, (3) positioned acoustic rhinometry, (4) determination of mucociliary transport time, (5) specific nasal provocation test. Active anterior rhinomanometry allows reliable assessment of the nasal respiratory function, acoustic rhinometry shows the geometry of nasal cavity, mucociliary transport time is an indicator of the mucosa eutrophism. In our experience, the specific nasal provocation test is one of the most important tests in this field. It is more sensitive than the skin test and the radioallergosorbent test (RAST) in the asymptomatic phase and it is able to show organ allergies. In this study we review the importance of this test and the methodology we commonly use.