Vestibular Stenosis Research Articles

All-cause claims analysis of the LATERA absorbable nasal implant vs surgical repair in patients with nasal valve collapse

Aims To compare all-cause claims associated with the LATERA Absorbable Nasal Implant and surgical repair of nasal vestibular stenosis in patients with nasal valve collapse. Methods This retrospective cohort study utilized data from STATinMED RWD Insights. A defined set of HCPCS, ICD-10-CM and CPT codes were used to identify patients with ≥1 claim for a LATERA procedure, and patients with ≥1 claim for surgical repair between June 1, 2015– March 31, 2023. Patients with continuous capture for at least 12 months before and at least 6 months after the index date were selected. The index date was defined as earliest date of encounter for a LATERA or surgical repair procedure. Inverse probability of treatment weighting (IPTW) was used to ensure balance between cohorts. Descriptive analyses were provided for all claims data using standard summary statistics. All-cause claims were assessed during the baseline, index date, and follow-up period. Chi-squared tests and independent sample t-tests were used to assess differences in cohorts for categorical and continuous variables, respectively. Results The study population included 5,032 LATERA patients and 26,553 surgical repair patients. During the baseline and follow-up periods, the matched cohorts exhibited similar all-cause claims. On the index date, LATERA patients incurred lower claims vs. surgical repair, likely due to LATERA’s ability to be implanted in the physician office setting. LATERA patients and surgical repair patients mean (SD) total costs were $9,612 [$14,930] vs $11,846 [$17,037] (p ≤ 0.0001), respectively. Conclusions Treatment with the LATERA Absorbable Nasal Implant is a potentially cost saving option for payers on the index date compared to traditional surgical repair in patients with nasal valve collapse due to the ability to be performed in the office. All-cause claims were similar in the baseline and follow-up periods. When performed with concomitant procedures, all-cause claims during follow-up were similar between groups.

Comparison of the effectiveness of three different rhinoplasty techniques to correct stenotic nostrils using silicone models: A case study.

To compare the effects of three different rhinoplasty techniques on the postoperative cross-sectional areas (CSAs) of the nares and nasal vestibuli. Experimental study. Ninety-nine 3D-printed, remolded silicone models of a single French bulldog's rostral nose. Models were fabricated based on a computed tomographic (CT) scan of the nose of a French bulldog with moderately stenotic nares. Each model underwent either vertical wedge resection (VW), modified horizontal wedge resection (MHW), or ala-vestibuloplasty (AVP) performed by a single surgeon (n = 33 per group). Preoperative and postoperative CT scans of the models were performed, and CSAs of the airway from the nares to the caudal end of the nasal vestibules were calculated. All three rhinoplasty techniques increased CSAs (adjusted p values <.001) but to different levels caudally within the nasal vestibule. Vertical wedge resection achieved this up to the start of the alar fold, MHW up to halfway between the nares and the alar fold and AVP up to the caudal nasal vestibule. Average percentage increases in CSA were 26%, 15% and 74%, respectively. Ala-vestibuloplasty led to larger CSAs than VW and MHW from the nares to the caudal nasal vestibule (adjusted p values <.05). The proportional difference within each technique was <7%. Ala-vestibuloplasty resulted in a larger increase in the airway CSA of silicone modeled nares and nasal vestibules of a single French bulldog in comparison with VW and MHW. Ala-vestibuloplasty can be considered for French bulldogs with moderately stenotic nares and evidence of nasal vestibular stenosis.

A technique for fabricating a hollowed nasal stent using a connector of an intravenous infusion set to manage iatrogenic nasal vestibular stenosis in an infant

The presented technique describes the steps for fabricating a hollow and rigid intranasal stent to maintain the patency of the nasal passage after iatrogenic nasal vestibular stenosis in an infant. The technique uses a connector between the injection bulb or site and the hypodermic needle of an intravenous infusion set to ease the impressionmakingand avoid the additional step of hollowing the stent.

Surgical Repair of Nasal Vestibular Stenosis A Case Report

Vestibular stenosis is an uncommon but debilitating cause of nasal obstruction leading to serious impairment of airway. It is caused by granulation and fibrosis of vestibular lining and there is circumferential scar retraction in the inlet of nasal cavities. Stenosis may be congenital or acquired. Causes of acquired stenosis include burns, trauma, infections, and iatrogenic insult to the lining of vestibule. Surgical correction is usually done by excision of fibrous tissue. A number of studies have been reported on surgical correction but not a single technique is widely accepted due to different diseases and different levels of deformities. Here we are suggesting a technique in which flaps have been raised and scar fibrous tissue is removed. This technique gives a good outcome and satisfactory result in a patient with post traumatic unilateral stenosis.

Septoplasty Revision Rates in Pediatric vs Adult Populations

Although septal deviations are highly prevalent in the pediatric population and pediatric septoplasties are garnering more discussion, to date, there are no large-scale studies characterizing pediatric septoplasty revision rates. To identify rates of pediatric septoplasty revision in the US. This retrospective, observational cohort study used administrative claims data from the IBM MarketScan Commercial Database (which contains inpatient and outpatient data for millions of patients and dependents covered by employer-sponsored private health insurance in the US) to identify patients undergoing septoplasty between January 1, 2007, and December 31, 2016. Patients 18 years or younger were included in the study as the pediatric cohort, and patients aged 19 to 65 years were included as the adult cohort for comparison. Patients were excluded if the initial surgery included rhinoplasty, nasal vestibular stenosis, or costal cartilage grafts or if the second surgery did not have nasal vestibular stenosis, septoplasty, rhinoplasty, and/or cartilage grafts. Outcomes included septoplasty revision rate, septoplasty-to-rhinoplasty conversion rate, and associated risks for revision surgery. Collected data were analyzed between January 1 and July 30, 2022. A total of 24 322 pediatric patients (mean [SD] age, 15.7 [2.5] years; 15 121 boys [62.2%]) who underwent an initial septoplasty were identified, of whom 704 (2.9%) received a revision. In the adult cohort of 286 218 patients (mean [SD] age, 41.4 [12.2] years; 162 893 [56.9%] men), 3081 individuals (1.1%) received a revision. Within the pediatric revision group, 66 patients (9.4%) received a rhinoplasty vs 162 (5.3%) in the adult revision group. All pediatric age groups had higher revision rates than the adult population, with the 9- to 13-year-old group having the highest rates of revision (118 of 2763 [4.3%]). Patients in the West and Northeast, along with those with point of service and health maintenance organization health plans, were more likely to receive a revision. The findings of this cohort study suggest that pediatric patients are more likely to receive a revision surgery than their adult counterparts. Furthermore, pediatric patients are more likely than adults to receive a rhinoplasty as their revision surgery. These findings provide valuable information that may be used to inform clinical decision-making, although further research is needed to better identify the causes for pediatric septoplasty revision.

Application of 3D printed nasal vestibular support in the treatment of anterior nostril stenosis

Objective:To evaluate the efficacy of 3D printed nasal vestibular support on the recovery of nasal ventilation function and nostril shape after nostril stenosis treatment. Methods:Thirty-eight patients with unilateral traumatic nasal vestibular stenosis were selected and treated with 3D printed nasal vestibular support after operation. Subjective evaluation indicators, objective nostril local morphological and structural parameters, and nasal airflow dynamics parameters by numerical simulation were used. To evaluate the nostril morphological and nasal functional recovery after treatment. Results:The subjective nasal congestion and nostril symmetry satisfaction VAS scores of the patients after nasal vestibular support treatment were improved to varying degrees compared with those before surgery; The nostril morphological parameters showed that the Δlong-axis ratio and Δ short-axis ratio were significantly decreased after nasal vestibular support therapy （0.09±0.09 and 0.16±0.13） compared with those before surgery（0.21±0.20 and 0.28±0.21） respectively（P<0.01）. And the cross-sectional area of the nasal valve on the stenotic side nasal cavity increased from（0.40±0.27） cm² before operation to （0.71±0.26） cm² after treatment（P<0.01）; The nasal resistance on the stenosis side nasal cavity also decreased from （0.036±0.024） Pa·s/mL before operation to （0.022±0.008） Pa. s/mL after treatment（P<0.01）, and the total nasal resistance was decreased from （0.033±0.02） Pas/mL before operation to （0.021±0.007）Pa. s/mL after treatment（P<0.01） ; It also showed that NWE（nasal warming efficiency） and NHE（nasal humidification efficiency） on the stenotic side nasal cavity were significantly decreased after nasal vestibular support therapy（[95.92±2.8]% and [94.55±4.17]%） compared with those before surgery （[97.94±1.97 ]% and [96.19±2.94]%） respectively（P<0.01）. Conclusion:The 3D printed nasal vestibular support for postoperative support treatment on patients with anterior nostril stenosis can reflect the advantages of personalized treatment and allow patients to obtain satisfactory results, and the use of individually designed 3D printed nasal vestibular support can make the shape of anterior nostrils and nasal cavity normal ventilation function recover well, its clinical application prospect is worth looking forward to.

Modified Endoscopic Denker's Approach for Management of Anterior Maxillary Sinus Tumors: Multicenter Series of 58 Cases.

Tumors involving the anterior portion of the maxillary sinus remain technically challenging to access via an endoscopic approach. The modified endoscopic Denker's (MED) procedure was recently introduced to address such lesions. We present a multicenter series of 58 patients with tumors involving the anterior maxillary sinus successfully resected using a MED procedure and present the clinical outcomes and complications. A multi-institution retrospective chart review was performed on patients who underwent the MED approach for the management of tumors involving the anterior maxillary sinus from 2009 to 2020. Demographic data, pathology, surgical outcomes, and complications were reviewed. Fifty-eight patients were identified, including 34 (58.6%) male and 24 (41.4%) female patients. The most common pathologies included: inverted papilloma (n = 27; 46.6%), adenoid cystic carcinoma (n = 9; 15.5%), and squamous cell carcinoma (n = 8; 13.8%). Thirty-eight patients (65.5%) underwent MED alone, while 20 (34.5%) had combined expanded endonasal approaches for lesions extending beyond the maxillary sinus. All maxillary sinus lesions were successfully accessed with the MED procedure without the need for an additional approach. After a mean follow-up of 30 months (range, 1-127), 8 of 58 (13.8%) patients developed complications related to the MED, including epiphora requiring an additional procedure (n = 4; 6.9%), prolonged facial/palatal numbness (n = 3; 5.2%), severe epistaxis (n = 1; 1.7%), and vestibular stenosis (n = 1; 1.7%), the latter of which occurred following postoperative radiation. The MED procedure is a safe and highly effective approach for benign and malignant tumors involving the anterior maxillary sinus. However, patients should be counseled preoperatively on potential complications including the risk of facial numbness and epiphora.

Revision Rates of Septoplasty in the United States.

Background: Large-scale studies characterizing septoplasty revision rates are lacking. Objectives: To identify rates of septoplasty revision in the United States. Methods: Patients undergoing initial septoplasty between January 1, 2007 and December 31, 2013 were identified using the IBM® MarketScan® Commercial Database. Patients were excluded if they had nasal vestibular stenosis, rhinoplasty, or costal cartilage grafts for the initial surgery, or did not have either septoplasty, nasal vestibular stenosis, rhinoplasty, and/or costal cartilage grafts for the second surgery. Results: 295,236 patients received an initial septoplasty, and 3213 (1.1%) patients underwent a revision. Among the revision group, 178 (5.4%) patients received a septorhinoplasty, among which 13 (7.3%) required a costal cartilage graft. Older patients were less likely to need revision surgery (RS). Patients in the Northeast and West were significantly more likely than patients in the Midwest to undergo RS. Insurance plans such as comprehensive and point-of-service were associated with greater odds of RS, whereas others such as high-deductible health plans were associated with lower odds. Conclusion: Septoplasty revision rates are relatively low at 1.1% but influenced by age, region, and insurance plan.

Rhinoscleroma – still a predominant entity managed by rubber tube recanalization

Rhinoscleroma is a chronic granulomatous infection affecting the nasal cavity and nasopharynx primarily. It results in functional and esthetic sequelae in patients. A patient presented to us with chronic extensive vestibular stenosis with external deformity of the nose. The patient underwent multistaged diagnostic nasal endoscopy with biopsy and recanalization using a sterile rubber catheter which showed significant clinical improvement. This case demonstrates that medical advancements have enabled a quicker diagnosis of rhinoscleroma and recanalization still remains an essential entity in managing the sequelae of rhinoscleroma.

Assessment of the Transoral Maxillectomy

Abstract Background: Head and neck cancer accounts for 17% of all cancer cases and could affect functions such as swallowing, phonation, breathing, aesthetics and the individual's quality of life. Aim of Study: To assess the transoral approach for maxil-lectomy in selected cases of cancer maxilla. Patients and Methods: The study included patients who were diagnosed to have maxillary carcinoma after the endo-scopic biopsy. The transoral approach was used for maxillec-tomy in all cases. Then, the patients were followed-up for 5 years. Results: Within the included eleven patients with maxillary squamous cell carcinoma, transoral maxillectomy could be performed without the need for any skin incision. No uncon-trollable epistaxis, orbital injury, septal perforation, postop-erative fistula, skin necrosis, vestibular stenosis or granulation was observed. Recurrence of the tumor was detected in one case only (9.1%) throughout the follow-up. Conclusion: The transoal approach for maxillectomy can be considered as a reliable and safe approach for selected cases of cancer maxilla. So, it should be incorporated into the oncological and maxillofacial surgeon's surgical armamentar-ium to avoid external incisions.

A Case of Surgical Correction of Nasal Vestibular Stenosis

Nasal vestibular stenosis is an uncommon cause of nasal obstruction. There are various causes of the narrowing of vestibule, including previous trauma, surgery, infection, and iatrogenic injury. The disease is characterized by circumferential scar retraction in inlet of nasal cavities which are caused by secondary proliferation of granulation and fibrous tissue. A number of studies were reported on the surgical correction of vestibular stenosis, but no single technique had been widely accepted due to a wide spectrum treatment methods owing to the various causes of disease and deformities of the related anatomy. Here we suggest a new surgical technique for correcting a case of vestibular stenosis caused by trauma.

Columellar Strut in Correcting the Recurrent Vestibular Stenosis.

Management of vestibular stenosis is always a challenge in rhinology, especially for patients with complete vestibular stenosis. Tip plasty (with columella strut) can be supplemented to the primary surgery, can ensure good functional and cosmetic outcomes in patients with complete vestibular stenosis.

COMPLICATIONS AND MANAGEMENT OF ENDOSCOPIC SEPTOPLASTY AT A TERTIARY CARE CENTER IN INDIA

Introduction: Septoplasty for nasal septal deviation is one of the most commonly performed surgeries by the otolaryngologist. Though various surgical techniques have evolved for correction of a deviated septum, complications are still common. Method: A prospective study of 90 patients of symptomatic nasal septal deviation was done to investigate for development of complications after endoscopic septoplasty. Complications were catagorised into early, occurring within 7 days and late, usually detected within three months after surgery. Results; Most common early complication was haemorrhage seen in overall 16.66% of patients. 6.66% had primary hemorrhage during surgery and 8.88% had reactionary hemorrhage within 24 hours of surgery. Secondary hemorrhage and septal hematoma was rare(1.1%) . Most common late complication was persistence of subjective symptom of nasal blockage(15.55%) followed by nasal synache(5.55%). Septal perforation and vestibular stenosis are less common(1.1%). CSF leak, saddle nose, nasal tip ptosis or any ocular complications were not seen in any patient. Conclusion:. Meticulous preoperative planning with precise surgical techniques during endoscopic septoplasty can reduce the risk of complications that may have a profound effect on the functional and aesthetic aspects of a person’s life.

Bilateral Intraoral Mucosal Flaps for Repair of Vestibular Stenosis Following Rhinoplasty &amp; Airway Reconstruction: A Case Report

Background: Aesthetic rhinoplasty is a challenging specialty for surgeons as both the demands​ of patients and physicians are high. Preservation rhinoplasty brings many advances and advantages to the rhinoplasty with the intent of decreasing the need for revision or secondary rhinoplasty through change that is less destructive. Nonetheless, there are often patients in the rhinoplasty surgeon’s practice who have either aesthetic or functional sequelae from previous open or more reduction-oriented procedures. One of the more troublesome complications for the patient to live with, and the surgeon to correct, is vestibular stenosis.

Post-corrective nasal stenosis patency rehabilitation using glue gun stick: a case report on the novel management strategy

Background: Care and rehabilitation following surgical repair of post-traumatic vestibular stenosis with scarring tissue should be intense and meticulous as treatment failure and risk of re-stenosis is high. Case presentation: We present a case of a 26-year-old male presented at 1 month post-motor vehicle accident which he sustained laceration injury to the left alar nasal sulcus. Upon examination, he had narrowed right vestibular opening and pin-point opening of the left nostril. He underwent a series of dilatation of the left nostril using Hegar dilators and resection of fibrous tissue. Postoperatively, he was advised to perform daily nasal dilatation using glue gun stick for three consecutive months. Lignocaine 2% gel was supplied as a lubricant for stick entry. Upon follow-up review, the patient exhibit excellent clinical outcome with patent bilateral nostrils. Conclusion: This report highlights a noveland cost-effective post-operative care using glue gun stick to maintain a patent and functional vestibular opening.

Phakomatosis pigmentovascularis cesioflammea

nCPAP-induced nose skin injury is a common issue in NICUs all over the world. Damage may vary from simple hyperemia in the region of application of nasal cannulae up to complete destruction of the columellar region. We here report a case series of three patients displaying various grades of nasal damage, ranging from soft hyperemia to ulcerative lesions, up to complete columellar breakdown. Not only lesions with loss of substance are documented in literature; cases of post-discharge nasal vestibular stenosis and nasal synechiae obstruction are also reported. Risk factors for nCPAP-induced nasal injury include low birth weight, low gestational age, and increased time on nCPAP. Good clinical practices to prevent and treat nCPAP-induced skin damage are here briefly reviewed; strong efforts must be spent in NICU personnel education in order to enhance awareness about this topic and ensure a correct prevention.

Cleft Rhinoplasty Study and Evolution.

Most patients with a cleft lip will have a cleft lip nasal deformity. The nasal deformities are complex and are difficult to surgically correct as a result of the anatomical issues and deficiencies. In this study, the authors analyzed and reviewed nasal pathology and surgical maneuvers in patients with cleft lip nasal deformity treated by the senior author over the past 15 years. A retrospective review was performed on patients who underwent a rhinoplasty for a cleft nasal deformity from the years of 2002 to 2017. Patients were stratified by unilateral and bilateral cleft lip. For each variable, comparisons were made between unilateral and bilateral cases. 39 patients had a unilateral cleft lip nasal deformity, while 17 had a bilateral cleft lip nasal deformity. Patients with a unilateral cleft nasal deformity had a significantly higher incidence of vestibular stenosis and septal deviation. Regarding surgical maneuvers, unilateral cleft lip patients had a relatively higher utilization of septoplasty, spreader grafts, and alar grafts compared to bilateral cleft lip patients. Bilateral cleft lip patients had a relatively higher utilization of dorsal hump reduction, columella strut grafts, and nasal tip grafts. These differences were not statistically significant. Unilateral cleft lip patients had a statistically significant higher use of alveolar support at the time of rhinoplasty. The rhinoplasty operation in patients with cleft lip nasal deformity is uniquely challenging and rewarding. This operation has undergone an evolution in our own practice and has led to improved outcomes for these patients.

Technique in Cleft Rhinoplasty: The Foundation Graft.

Secondary cleft rhinoplasty represents a particular surgical challenge. The authors have identified the deficit in skeletal projection of the cleft-sided piriform rim as an important contributor to the pathology. A graft is described to augment the piriform crest on the cleft side. This foundation graft is suture fixated to the piriform crest after complete release of all soft tissue attachments to the alar base. The foundation graft is articulated with a long alar strut graft, which allows for powerful projection of the cleft-sided nasal tip. An advancement flap of vestibular skin is described to correct the vestibular stenosis. A transplant of diced cartilage in fascia is added to augment maxillary soft tissue volume. Subjective and objective measures of form and function are presented in a retrospective series of five cases, illustrating the efficacy of the techniques described.

To stent or not to stent? A meta-analysis of endonasal congenital bilateral choanal atresia repair.

The use of nasal stents as a postoperative adjunct following repair of choanal atresia remains controversial. The study objective was to systematically review the literature regarding the efficacy and safety of stenting following transnasal endoscopic repair of bilateral choanal atresia. Systematic review with meta-analysis. A comprehensive search in PubMed, EMBASE, CINAHL, and the Cochrane Library was conducted. Inclusion criteria included articles written in the English language with five or more subjects and clear intervention data and outcomes. Two independent reviewers screened studies for eligibility, appraised the level of evidence, extracted data, and resolved discrepancies by consensus. Successful surgery was defined as the absence of restenosis. Of 154 identified studies, 15 met inclusion criteria. Levels of evidence varied from level 3 to 4. Mean age at surgery ranged from 5 days to 25 months. Thirteen studies (n = 167 patients) included patients who were stented; the weighted pooled proportion of successful surgery was 65% (95% confidence interval [CI], 49-76%). Mean duration of stenting ranged from 48 hours to 16 weeks. Six studies (n = 42) evaluated patients who were not stented; the weighted pooled proportion of successful surgery was 64% (95% CI, 42-84%). Complications associated with stenting included alar injury, vestibular stenosis, columellar tear, and stent dislodgement or blockage. Success rates for bilateral choanal atresia repair were similar with and without the use of nasal stents. The use of nasal stents may be associated with more complications. There is insufficient data to determine if mitomycin C is a useful therapeutic adjunct.

Z‐plasty of the Alar Subunit to Correct Nasal Vestibular Stenosis

Nasal vestibular stenosis can result in a challenging cosmetic deformity, for which a variety of techniques have been described, including scar excision and replacement with local flaps, composite or cartilage grafts, with or without stents. We describe the Z-plasty technique to widen the alar base and assess patient satisfaction from the surgery. A retrospective review of patients who underwent Z-plasty to the alar subunit for nasal vestibular stenosis over a 4-year period was conducted. Demographic data and patient satisfaction were evaluated using pre- and postoperative visual analog scores and Rhinoplasty Outcome Evaluation questionnaires. Eight patients underwent the procedure, and all confirmed significant improvement in their esthetic outcome. We describe our Z-plasty technique to the alar base and review patient satisfaction.