Internal nasal valve insufficiency is a major cause of nasal obstruction. Alar batten grafts (ABGs) are commonly used, but data on lateral crural tensioning (LCT) remain limited.To compare the efficacy of ABG and LCT techniques in improving nasal airflow. Primary outcomes were nasal obstruction symptom evaluation (NOSE) score and revision surgery rate; secondary outcome was complication rate.Retrospective cohort study (PICOS).The study included 22 patients undergoing rhinoplasty for nasal valve insufficiency (2017-2023): ABG (n = 8) and LCT (n = 14). NOSE scores were obtained via telephone survey. Data were collected from clinical records.Mean NOSE scores improved from 55 to 30.6 overall. ABG improved from 51.7 to 31.7, LCT from 56.7 to 30. One ABG patient required revision (12.5%), none in LCT group. Differences were not statistically significant between groups.LCT showed greater symptom improvement and no revisions. Further randomized trials are needed to confirm efficacy.

Septoplasty and septorhinoplasty are key procedures in functional and aesthetic nasal surgery. Over the past decade, evidence on diagnostics, techniques, and outcomes has expanded significantly.To provide a structured summary of current evidence from systematic reviews and meta-analyses, focusing on diagnostics, surgical techniques, perioperative treatment, and patient-reported outcomes.Narrative review of 86 articles, reviews, and meta-analyses published within the past 10 years.Studies were screened for relevance to functional and aesthetic rhinoplasty. Extracted data covered diagnostic methods, surgical techniques, medications, PROMs, and functional outcomes.Four-phase rhinomanometry offers promise but lacks validation. Body dysmorphic disorder (BDD) screening is gaining relevance. Evidence supports perioperative corticosteroids and tranexamic acid; routine antibiotics appear unnecessary. PROMs (NOSE, ROE, SNOT-22) are widely used.Evidence for rhinoplasty is growing but heterogeneous. Standardized diagnostics, PROM-linked objective measures, and long-term data are needed to guide future patient-centered care.

Objective:To investigate the therapeutic effect of upper airway surgery on patients with obstructive sleep apnea hypopnea syndrome（OSAHS）, observing changes in their cardiopulmonary function, and comparing the improvement of cardiopulmonary function between patients with different therapeutic effects. Methods:A total of 70 patients with moderate to severe OSAHS admitted to our hospital from July 2021 to February 2024 were selected. All patients underwent nasal cavity expansion surgery combined with palatopharyngeal and/or tongue surgery, and were followed up for 6 months. According to the therapeutic effect, patients were divided into an effective group（AHI reduction ≥ 50% and postoperative AHI<20, n=52） and an ineffective group（n=18）. The Epworth Sleep Scale（ESS） scores before and after surgery were compared to evaluate the surgical effect, and changes in tcardiopulmonary function were detected. Static and dynamic indicators of cardiopulmonary function, sleep apnea hypopnea index（AHI）, blood oxygen saturation（SaO2） were compared before and after surgery. Pearson correlation analysis was used to explore the correlation between changes in body mass index（BMI） and improvement in cardiovascular and pulmonary function indicators. Results:After surgery, RV/TLC） and dynamic cardiopulmonary function indicators（Peak VO2%, Peak O2 Pulse%, AT, Emax/MVV, etc.） showed significant improvement compared to preoperative levels（P<0.01）. The improvement amplitude in the effective group was significantly greater than that in the ineffective group（P<0.05）. Pearson correlation analysis showed that there was no significant correlation between BMI changes and improvement in cardiovascular and pulmonary function indicators（P>0.05）. Conclusion:For OSAHS patients who cannot tolerate or are unwilling to receive non-invasive assisted ventilation, simultaneous multi-plane upper airway surgery is feasible. Even if the objective efficacy is suboptimal, it can improve cardiopulmonary function and has significant clinical application value.

A randomized controlled study of the effects of sevoflurane and esketamine on cognitive function after nasal septum surgery

Olfactory dysfunction (OD) is a common symptom of SARS-CoV-2 infection. This study aimed to determine the prevalence and clinical characteristics of OD, evaluate its recovery trajectory, and identify predictors of its onset and persistence. We conducted a prospective cohort study of 3477 participants recruited through an online questionnaire between December 1 and 31, 2022. Follow-up surveys were conducted over a 12-week period ending on March 31, 2023. Among 3010 eligible participants aged 14 to 40 years, 373 (12.39%) reported new-onset OD following COVID-19 infection. Multivariable logistic regression identified older age, a history of sinusitis or nasal polyps, prior nasal surgery, and symptoms including fatigue, rhinorrhea, dyspnea, ageusia, and pruritus as independent risk factors for OD. Conversely, fever and arthralgia were negatively associated with OD. The cumulative spontaneous recovery rates were 43.70%, 23.86%, 11.26%, 8.04%, 5.63%, and 1.88% at weeks 1, 2, 3, 4, 8, and 12, respectively. No demographic or clinical variables were significantly associated with recovery time. COVID-19 related OD occurred in 12.39% of young and middle-aged individuals in China. Several demographic and clinical factors were predictive of OD, although none were associated with recovery duration. Most patients experienced spontaneous resolution within the first month of symptom onset.

Surgical treatments are important options for adult obstructive sleep apnea, especially when the treatment compliance of continuous positive airway pressure, the first-line treatment, is poor. Currently, there are several surgical procedures that had been used in treating this disease in clinical work, including nasal surgery, velopharyngeal surgery, glossopharyngeal surgery, maxillofacial surgery, bariatric surgery, and nerve stimulation surgery. These procedures involve different specialties and have varying indications. Selecting an appropriate surgical procedure basing on individual characteristics and treatment preferences is crucial for alleviating the severity of the disease.

Towards a widespread usage of computational fluid dynamics simulations for automated virtual nasal surgery planning

The role of conductive factors on olfactory acuity has received little attention. The relationships between nasal anatomy, inspiratory airflow and olfaction remain unclear, including if nasal anatomic and functional factors account for some variabilities in odor identification in the absence of sensorineural defects. This preliminary study aimed to analyze olfactory cleft airflow dynamics using computational modeling techniques and to develop linear regression models linking smell identification scores to nasal anatomy and computational-derived functional metrics. Computational fluid dynamics modeling was used to generate nasal airflow-related parameters based on radiographic images of 10 subjects with varying olfactory acuity, but without prior nasal surgery or nasal deformity. Olfaction was assessed using the University of Pennsylvania Smell Identification Test (SIT). Average olfactory airflow volume comprised only 2.43% of total nasal airflow volume. Higher olfactory resistance demonstrated strong associations with higher SIT scores. No one particular anatomic or functional parameter correlated strongly with SIT score. However, the 3-parameter linear regression model comprising bilateral nasal surface area-to-volume ratio, bilateral nasal resistance and olfactory resistance accounted for 82% of the variations in SIT scores (P = .01). Among 2-parameter linear regression models, the model comprising bilateral nasal surface area-to-volume ratio and bilateral nasal resistance accounted for 52% of SIT score variability (P = .08). These findings demonstrate that a significant portion of variability in SIT scores can be explained by the combination of nasal resistance, olfactory resistance, and nasal surface area-to-volume ratio, suggesting that nasal anatomy and airflow-related quantities contribute toward variability in olfaction. III.

Objectives: To present the cauda helicis as a novel and anatomically compatible graft source for reconstructing the cartilaginous support structure of the nasal tip, highlighting its morphological similarity to the alar cartilages and potential advantages over traditional donor sites. Methods: A surgical dissection protocol was performed on anatomical models from 14 fresh cadavers in 2017. The approach included harvesting the cauda helicis, with the possibility of extending the donor area to the scaphoid fossa. A systematic literature search was conducted, considering all publications indexed up to May 2025, no publications reporting the use of the cauda helicis as a graft were identified. Results: The cauda helicis demonstrated anatomical and structural similarities to the alar cartilages. The harvesting technique proved to be technically straightforward, with a low complication profile and imperceptible impact on the natural auricular contour. The donor area extension into the scaphoid fossa provided sufficient graft material for total or partial reconstruction, achieving consistent outcomes in terms of morphology and graft compatibility. Conclusions: The cauda helicis is a viable, safe, and technically simple alternative for structural nasal tip reconstruction. Its anatomical similarity to the alar cartilages and low morbidity at the donor site position it as a promising option for both reconstructive and aesthetic nasal surgery. To our knowledge, this technique has not been previously reported in the literature.

Pain management and hemodynamic stability during nasal and sinus surgeries remain challenging. Our study compared the efficacy and safety of sphenopalatine ganglion block (SPGB) versus infraorbital/infratrochlear nerve blocks (IOB/ITNB) across various nasal/sinus surgical procedures. The authors conducted a systematic review and network meta-analysis following PRISMA 2020 guidelines. PubMed, Scopus, Google Scholar, Cochrane Library, and Web of Science were searched from inception up to May 20, 2025. Randomized controlled trials and observational studies comparing SPGB or IOB/ITNB versus control in adults undergoing nasal/sinus surgeries were included. Outcomes included pain scores, analgesic consumption, surgical field quality, recovery metrics, and adverse events. Random-effects models and Bayesian network meta-analysis were performed. Twenty studies with a total of 1098 patients were included: 12 SPGB and 8 IOB/ITNB. Both techniques significantly reduced early postoperative pain compared with control [SPGB: SMD=-1.37 (-1.86,-0.88); IOB/ITNB: SMD=-0.75 (-1.03,-0.47)], with SPGB showing greater efficacy [SMD=-0.62 (-1.18,-0.06) versus IOB/ITNB]. SPGB demonstrated superior analgesic-sparing effects [RR=0.45 (0.33, 0.62)] and surgical field improvement [SMD=-0.87 (-1.18, -0.57)], while IOB/ITNB better reduced postoperative nausea and vomiting (PONV) [RR=0.46 (0.31, 0.68)] and recovery time [MD=-40.86 (-61.48, -20.24) min]. Both techniques showed favorable safety profiles without significant differences in adverse events. Treatment rankings confirmed procedure-specific advantages for each technique. While both techniques effectively improve perioperative outcomes, SPGB appears superior for pain control and surgical field quality, especially in the endoscopic and functional endoscopic sinus surgery procedures, whereas IOB/ITNB demonstrates advantages for PONV prevention and reduced recovery time in rhinoplasty procedures. Procedure-specific selection of nerve block technique is recommended based on surgical priorities and patient characteristics.

Aims and Background This chapter aims to provide a comprehensive overview of nasal tip support, tensioning mechanics, and suture-based techniques that refine projection, rotation, and stability in rhinoplasty. Modern approaches emphasize predictable, structurally sound methods that balance form and function while accommodating individual anatomic variability. Understanding tension vectors and ligamentous relationships is essential for optimizing both aesthetics and long-term outcomes. Historical Aspects The evolution of nasal tip surgery reflects a shift from primarily reductive maneuvers to graft- and suture-based strategies that reinforce and shape the tip framework. Early innovators recognized the limitations of aggressive cartilage excision, leading to the development of both structural cartilage grafts and suture-based techniques to provide tip stability. Anatomy Tip anatomy is governed by the relationship between the LLCs, medial crural base, the caudal septum, and the soft-tissue envelope. Cartilage grafts bolster weak or asymmetric native structures, reinforcing the medial crural pillar or lateral crural support, while sutures fine-tune shape, redistribute tension, and harmonize graft-induced forces. Optimal outcomes depend on understanding how grafts and sutures interact biomechanically within the intrinsic support system. Conclusions and Clinical Relevance Integrating cartilage grafting with targeted suture techniques enables surgeons to control projection, rotation, and definition with greater precision. A combined structural and tension-modulating strategy enhances long-term stability, counteracts postoperative contracture, and provides durable, natural tip aesthetics across primary and secondary rhinoplasty.

Effect Of Pterygopalatine Fossa Lidocaine: Adrenaline Injection on Surgical Field During Endoscopic Nasal Surgery

Discussion: Introducing Preservation Rhinoplasty Principles to Cleft Nasal Surgery: Unveiling the Role of Nasal Ligaments in Infant Anatomy.

To evaluate the relationship between primary acquired nasolacrimal duct obstruction (PANDO), internal nasal valve angle (INVA), and peak nasal inspiratory flow (PNIF) values. This retrospective clinical study was conducted in a tertiary otorhinolaryngology and ophthalmology clinic. It included 94 eyes of 47 PANDO patients (47 affected and 47 unaffected eyes) and the right eyes of 47 healthy individuals as controls. Individuals with a history of nasal or sinus surgery, pediatric patients, and cases with epiphora but patent nasolacrimal ducts on irrigation were not included in the study. The internal nasal valve angle (INVA) was measured using computed tomography (CT), and peak nasal inspiratory flow (PNIF) testing was performed. CT cross-sectional images were used to assess the diameters and directions (inner/outer) of the lacrimal canals in both sides of PANDO patients and the right side of control participants. The PNIF value was 76.50 ± 39.08 (20-170) in the PANDO group and 64.47 ± 23.50 (30-110) in the control group, with a significant difference (p = 0.045). INVA was 12.71 ± 3.94 on the affected side and 12.06 ± 3.19 on the unaffected side in PANDO patients, and 11.36 ± 5.63 in controls (p = 0.419). The mean minimum transverse diameter of the bony lacrimal canal was significantly wider on the affected side than the unaffected side and controls (p = 0.005). These findings suggest that intranasal airflow dynamics may contribute to the pathogenesis of PANDO, potentially leading to better understanding and management of nasolacrimal duct obstructions.

We read with great interest the article by Levin et al. , "Nasal Septal Perforation Reconstruction with Polydioxanone Plate: A Systematic Review," published in Facial Plastic Surgery. The review comprehensively summarized the literature on the use of polydioxanone (PDS) plates in nasal septal perforation repair and highlighted promising results with high closure rates and minimal complications. However, we would like to respectfully draw attention to one of the included studies, which may not directly pertain to septal perforation repair. The cited paper by Menger DJ, Tabink IC, and Trenité GJ (Arch Otolaryngol Head Neck Surg. 2008;134(8):842-847) describes nasal septal reconstruction following abscess formation in children, using autologous cartilage grafts mounted on a PDS plate. This study focused on septal integrity restoration after abscess-related cartilage loss rather than closure of a preexisting septal perforation. Moreover, while other studies in the review included perforations smaller than 10 mm, this particular paper was noted as involving perforations of 15 mm or greater. A careful review of the original article, however, reveals that the mentioned 15 mm refers not to the diameter of a septal perforation but to the size of the cartilaginous defect resulting from infection. Therefore, the inclusion of this reference in a systematic review specifically addressing nasal septal perforation reconstruction may not be fully appropriate. While the use of PDS plates in various nasal reconstructive settings is certainly valuable, distinguishing between septal reconstruction after abscess and true perforation repair is essential for accurate synthesis of the literature and interpretation of outcomes. We commend the authors for their thorough review and valuable contribution to the field. We hope this clarification will assist in refining the evidence base and support future research on the optimal use of PDS plates in nasal septal surgery.

BACKGROUND AND OBJECTIVE:Septoplasty, first introduced in the late modern period, has undergone several refinements and remains one of the most frequently performed nasal surgeries, alongside inferior turbinoplasty, endoscopic sinus surgery, and rhinoplasty. Postoperative pain management remains a significant consideration, particularly regarding the use of nasal packing versus transeptal suturing. This study aimed to compare pain perception between patients who received nasal packing and those who underwent transeptal suturing after septoplasty. METHODOLOGY:A quasi-experimental study was conducted in the Department of ENT at Aziz Fatimah Hospital, following approval by the Ethical Research Committee, from October 2023 to March 2024. A total of 84 patients were enrolled and divided equally into two groups. Group A received polyvinyl alcohol nasal packing, while Group B underwent trans-septal suturing using Vicryl® 3-0 absorbable sutures. Postoperative pain was assessed using the Visual Analogue Scale (VAS) after 48 hours during hospital stay and again on day 7 during follow-up. RESULTS:Of the 84 participants, 29 (34.5%) were female and 55 (65.5%) were male, with ages ranging from 18 to 54 years (mean 24.20 ± 6.937). No statistically significant difference in postoperative pain was observed between the two groups, with p-values of 0.0836 at 48 hours and 0.356 at day 7. CONCLUSION:The study concludes that nasal packing and transeptal suturing are comparable in terms of postoperative pain after septoplasty, with no significant difference between the two methods.

Emergence agitation is common after nasal surgery under general anaesthesia. Remimazolam, a novel ultra-short-acting benzodiazepine, allows haemodynamic stability and prompt postoperative recovery, but the specific impact of remimazolam on emergence agitation is not well understood. The primary aim of this study was to compare the effects of remimazolam-based total intravenous anaesthesia (TIVA) and sevoflurane-based volatile induction and maintenance of anaesthesia (VIMA) on the occurrence of emergence agitation. A prospective, randomised, assessor-blinded clinical trial. A single-centre study in a university-affiliated tertiary hospital. Ninety-eight adults undergoing nasal surgery under general anaesthesia. Patients were randomised into two groups. The Sevoflurane group ( n = 49) received VIMA with sevoflurane and nitrous oxide, while the Remimazolam group ( n = 49) received TIVA with remimazolam and remifentanil. The primary outcome was the occurrence of emergence agitation, which was evaluated using the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale. The secondary outcomes were immediate complications after extubation and postoperative pain, and the interval between discontinuation of anaesthesia and extubation. Emergence agitation, as measured by the Richmond Agitation-Sedation Scale, occurred in six of 49 patients (12.2%) in the Sevoflurane group and none (0.0%) in the Remimazolam group. The risk difference was 12.2 (95% CI, 3.0 to 21.4, P = 0.008). The occurrence measured by the Riker Sedation-Agitation Scale was identical to that with the Richmond Agitation-Sedation Scale. Coughing was more frequent in the Sevoflurane group, 53.1 vs. 12.2%, risk difference = 40.8 (95% CI, 24.0 to 57.5, P < 0.001). In addition, the interval between discontinuation of anaesthesia and extubation was lower in the Remimazolam group than the Sevoflurane group (9.00 ± 4.25 min vs. 12.18 ± 4.18 min, respectively, P < 0.001). The occurrence of emergence agitation in adult patients after nasal surgery under general anaesthesia can be significantly reduced using remimazolam-based TIVA. Clinical Research Information Service (KCT0007387).

This study aimed to evaluate the presence of Serpentine Signs on computed tomography (CT) images and its impact on the clinical symptoms in patients with empty nose syndrome (ENS). A retrospective study analysed patients with ENS enrolled in previous studies. The clinical characteristics and results of ENS-specific questionnaire evaluations were reviewed. The ratio of the maximal to minimal thickness (M/m ratio) of the septal mucosa was also calculated to demonstrate the degree of swelling. Mucosal swelling was defined as a thickness greater than twice that of the surrounding mucosa. A Serpentine Sign was identified by the presence of two or more mucosal swellings on one side of the central nasal septum. Seventy-one (74.0%) of the 96 enrolled patients with ENS exhibited Serpentine Signs on CT images. Patients with the Serpentine Sign had significantly lower symptom scores on the ENS 6-item Questionnaire (ENS6Q) and 25-Item Sino-Nasal Outcome Test (SNOT-25). Regression analysis revealed that the ENS6Q, SNOT-25, sleep, psychological, and empty nose symptom domains were significantly associated with the Serpentine Sign. The M/m ratio of the nasal septal mucosa significantly decreased in 39 participants with available postoperative CT images 6 months after nasal reconstruction surgery, along with an improvement in ENS6Q and SNOT-25 scores. The Serpentine Sign was associated with fewer ENS symptoms in patients with ENS. The severity of septal mucosal swelling decreased after surgical reconstruction. These results imply a significant impact of airflow alteration due to over-reduction of the inferior turbinate on the nasal mucosa.

To evaluate the clinical efficacy and outcomes of a single-stage surgical approach combining nasal surgery and uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnea syndrome (OSAS) and nasal obstruction. Fifty adult patients with OSAS and anatomical nasal obstruction underwent single-stage UPPP with septoplasty and conchoplasty. Pre- and postoperative evaluations included subjective symptom scoring, polysomnography, anterior active rhinomanometry (AAR), and the SF-36 quality of life questionnaire. Surgical success was defined as ≥ 50% reduction in apnea-hypopnea index (AHI) and postoperative AHI < 20. Patients were classified using the Friedman anatomical staging system. Statistical analyses included paired t-tests, ANCOVA, logistic regression, effect sizes (Cohen's d), and Bonferroni correction. Mean AHI improved significantly from 50.1 ± 17.4 to 18.8 ± 19.6 events/hour (p < .001). Surgical success and response rates were 62.0% and 72.0%, respectively. Stage-specific success was highest in Stage I (68.4%) and lowest in Stage III (46.2%). Significant reductions were observed in nasal resistance (from 0.46 ± 0.08 to 0.27 ± 0.06Pa/cm³/s; p < .001) and ESS scores (from 11.2 ± 3.7 to 5.8 ± 2.7; p < .001). All SF-36 domains improved postoperatively. Effect sizes for key parameters were large (Cohen's d > 1.0), and all p-values remained significant after adjustment. Single-stage UPPP combined with nasal surgery is a safe and effective treatment for OSAS patients with nasal obstruction. Anatomical staging plays a key role in predicting surgical outcomes. Objective airflow, sleep indices, and quality-of-life measures confirm the clinical value of this integrated approach.

OBJECTIVE Nasal topical therapy plays a pivotal role in the management of a wide range of upper airway conditions, including allergic rhinitis, chronic rhinosinusitis, and postoperative care in nasal surgeries. The aim is to report a post hoc analysis on a survey on topical nasal therapy that included an extended list of pharmacological and non-pharmacological products to manage several upper respiratory tract diseases. METHODS This survey involved a questionnaire distributed via a web platform that ensured anonymity. Fellows of ORL Italian societies participated in the survey. The panel of experts who developed the Delphi Consensus drafted the questionnaire. RESULTS One hundred eight ORLs participated in the survey. Most of them were from Southern Italy and islands (57.4%). The most common disease topically treated is chronic rhinosinusitis with nasal polyps (82.4%), followed by allergic rhinitis (78.3%), non-allergic rhinitis (76.7%), chronic rhinosinusitis without nasal polyps (76.5%), chronic adenoiditis (73.4%), and acute rhinosinusitis and adenoiditis (70% and 69.8%, respectively). CONCLUSION This survey demonstrated that a group of Italian ORLs use topical nasal therapy essentially for type 2-mediated and infectious/inflammatory diseases, prefer a pre-dosed nasal spray and irrigation, and prescribe mostly corticosteroids and saline solutions.