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Savoldi F, Dagassan-Berndt D, Patcas R, Mak WS, Kanavakis G, Verna C, Gu M, Bornstein MM. The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing. Dentomaxillofac Radiol 2024; 53:178-188. [PMID: 38265247 PMCID: PMC11003665 DOI: 10.1093/dmfr/twae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/14/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Abstract
Applications of cone-beam CT (CBCT) in orthodontics have been increasingly discussed and evaluated in science and practice over the last two decades. The present work provides a comprehensive summary of current consolidated practice guidelines, cutting-edge innovative applications, and future outlooks about potential use of CBCT in orthodontics with a special focus on upper airway analysis in patients with sleep-disordered breathing. The present scoping review reveals that clinical applications of CBCT in orthodontics are broadly supported by evidence for the diagnosis of dental anomalies, temporomandibular joint disorders, and craniofacial malformations. On the other hand, CBCT imaging for upper airway analysis-including soft tissue diagnosis and airway morphology-needs further validation in order to provide better understanding regarding which diagnostic questions it can be expected to answer. Internationally recognized guidelines for CBCT use in orthodontics are existent, and similar ones should be developed to provide clear indications about the appropriate use of CBCT for upper airway assessment, including a list of specific clinical questions justifying its prescription.
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Affiliation(s)
- Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Raphael Patcas
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, 8032, Switzerland
| | - Wing-Sze Mak
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR
| | - Georgios Kanavakis
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Carlalberta Verna
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
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Mowery AJ, Razavi CR. Functional nasal surgery in the office-based setting. World J Otorhinolaryngol Head Neck Surg 2023; 9:236-241. [PMID: 37780672 PMCID: PMC10541160 DOI: 10.1002/wjo2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/24/2023] [Indexed: 10/03/2023] Open
Abstract
Objective Nasal obstruction is a very common problem often addressed by functional nasal surgery. Increasingly, these procedures are being performed in the office setting secondary to decreased down time, cost, and obviation of general anesthesia. Our goal with this review is to discuss how to appropriately select patients for office-based procedures, what procedures may be considered, and current outcomes with in-office functional nasal surgery. Data Sources PubMed, Scopus, Google Scholar. Methods Research databases were searched for articles discussing techniques for performing functional nasal surgery in an office setting, and outcomes of various in-office functional nasal procedures. Results Studies found and included in this review discuss many aspects of office-based functional nasal surgery, including practical points on patient selection and office set-up, what procedures can safely be performed, and outcomes of different techniques to address specific problems. Broadly, procedures amenable to performance in the office address the internal and external nasal valves, the nasal septum, and the inferior turbinates. Conclusion A wide range of techniques to aaddress the nasal valves, septum, and inferior turbinates can be performed in a safe and effective manner without the need for an operative suite.
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Affiliation(s)
- Alia J. Mowery
- Department of OtolaryngologyJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Christopher R. Razavi
- Department of Otolaryngology, School of MedicineOregon Health & Science UniversityPortlandOregonUSA
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Altidor A, Ferri FA, Bakhos F, Mascaro-Pankova A. Functional Rhinoplasty. Cureus 2023; 15:e45993. [PMID: 37900451 PMCID: PMC10601979 DOI: 10.7759/cureus.45993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
The nose is composed of intricate intranasal anatomy to serve its sophisticated functions. Although it only occupies a small area, it is the central focal point of the face and demands the highest level of understanding of the delicate interplay of form and function. Functional rhinoplasty, as opposed to aesthetic rhinoplasty, primarily aims to enhance nasal breathing and olfaction without altering the nose's appearance. The goal of this study is to describe the anatomy and physiology of the nose as well as the pathophysiology of nasal obstruction and the surgical approaches available for functional rhinoplasty. Whether when performed alone or combined with cosmetic rhinoplasty, functional rhinoplasty is a procedure that can bring significant benefits and improve the quality of life of our patients. Understanding nasal anatomy and physiology is key for successful management and outcomes. To provide optimal treatment for the patients, plastic surgeons must be familiarized with various techniques that have been documented.
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Affiliation(s)
| | - Francisco A Ferri
- Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, USA
| | - Fadi Bakhos
- Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, USA
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Alshehri AA, Hakami F, Gadi W, Darraj H, Hamdi S, Awaf M, Hakami A, Zogel B. Nasal Blockage and Academic Performance Among Medical College Students in the Kingdom of Saudi Arabia. Cureus 2023; 15:e36135. [PMID: 37065372 PMCID: PMC10101197 DOI: 10.7759/cureus.36135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
Objectives The most frequent otolaryngological complaint is nasal obstruction. We aimed to determine if there is a relationship between nasal blockage and academic performance among medical college students in Saudi Arabia. Methods This cross-sectional survey carried out from August to December 2022, included 860 medical students determining the risk of obstructive sleep apnea (OSA) on the participants using the Berlin Sleep Questionnaire Risk Probability, then comparing it to their socio-demographic characteristics, while the Chi-square test was used for the comparison of categorical variables. Result The average age of the participants in our study was 21.52 years; 60% were females and 40% were males. The risk of obstructive sleep apnea was found to be two times higher in females than in males (95% CI: 1.195- 3.345; p-value 0.008). The hypertensive participants had a 27-fold increased risk of OSA compared to non-hypertensives. Grade Point Average (GPA) and snoring had a statistically significant relationship, however, a fifth of the participants reported snoring (79.8% reported not snoring). We also found that 14.8% of the participants with snoring had a GPA between 2-4.49 compared to 44.6% of participants without snoring. Conclusion Female students had a two-fold higher chance of developing OSA than males. While a GPA of 4.5 and above was more often associated with participants without snoring, the number of individuals with a GPA of 2-4.49 was greater among participants with snoring. To aid in the prevention of illness complications and the management of risk factors, additional efforts should be made to increase disease knowledge among students, primary healthcare practitioners, and specialty doctors.
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Chao YT, Nakov A, Haehner A, Poletti S, Hummel T. Olfactory stimulation may modulate the sensation of nasal patency. Rhinology 2023; 61:24-31. [PMID: 36717267 DOI: 10.4193/rhin22.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The sensation of nasal patency can be induced by inhaling menthol, which predominantly produces trigeminal stimulation. It remains unclear whether olfactory stimulation can also induce or modulate the sensation of nasal patency. METHODOLOGY A total of 118 participants (normosmia: n=67, olfactory dysfunction: n=51) were exposed to four odors in a randomized order: 1) phenylethanol (PEA), 2) menthol, 3) a mixture of PEA and menthol, 4) nearly odorless propylene glycol. The odors were presented by nasal clips. After the nasal clip had been removed, the participants rated relative nasal patency (RNP) from - 50 to +50, and their peak nasal inspiratory flow (PNIF) was measured. Repeated measures analysis of variance was used to examine the difference of RNP and PNIF among the four conditions and the influence of olfactory function. RESULTS The RNPs, other than PNIFs, differed between the four conditions. Menthol induced the highest RNP, followed by the mixed solution, PEA and the odorless condition. Normosmic participants, but not those with olfactory dysfunction, responded to PEA significantly higher than odorless condition with regard to RNP. The correlation analysis showed that the better the subjective or measured olfactory performance, the greater the PEA-induced sensation of nasal patency. CONCLUSIONS A specific olfactory stimulant that selectively induces olfactory perception can also evoke and modulate the sensation of nasal patency. Hence, patients might benefit from exposing themselves to odors in order to relieve the annoying nasal obstruction.
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Affiliation(s)
- Y-T Chao
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - A Nakov
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - A Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - S Poletti
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Department of Otorhinolaryngology, Inselspital, Bern, Switzerland
| | - T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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Muacevic A, Adler JR. Custom Nasal Stent Fabrication for Post-traumatic Nasal Obstruction - A Case Report. Cureus 2022; 14:e31843. [PMID: 36579199 PMCID: PMC9788994 DOI: 10.7759/cureus.31843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Deformities of the nose can be of congenital, traumatic, or iatrogenic etiology. The aim of treating nasal/nostril stenosis is to establish an adequate airway and restore facial profile; this may be achieved by surgical correction or prosthetic means. This case report presents the fabrication of a customized rigid acrylic stent for alar stenosis in an 18-year-old girl occurring as a result of trauma. The functional and aesthetic result is evaluated at six months. Thus, customized acrylic nasal stents provide an easy-to-fabricate, economical option for the maintenance of nasal contour and patency of the airway.
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Malik J, Spector BM, Wu Z, Markley J, Zhao S, Otto BA, Farag AA, Zhao K. Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation. Laryngoscope 2022; 132:509-517. [PMID: 34125439 PMCID: PMC8669045 DOI: 10.1002/lary.29673] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS About 260,000 septoplasties are performed annually in the US to address nasal septal deviation (NSD). Yet, we do not consistently understand what aspects of NSD result in symptoms. STUDY DESIGN Blinded cohort study. METHODS Two fellowship-trained surgeons blindly reviewed computerized tomography (CTs) of 10 confirmed NSD patients mixed with 36 healthy controls. All patients were correctly identified, however, 24/36 controls were falsely identified by both surgeons as patients (33.3% specificity), which were grouped as asymptomatic NSD (aNSD), while the remaining controls as non-NSD (healthy). Acoustic rhinometry, rhinomanometry, individual CT-based computational fluid dynamics and nasal sensory testing were applied to address the puzzling questions of why these aNSD had no symptoms and, more fundamentally, what caused symptoms in sNSD patients. RESULTS aNSD reported no nasal symptoms - Nasal Obstruction Symptom Evaluation score (sNSD: 60.50 ± 13.00; aNSD: 5.20 ± 5.41; non-NSD: 6.66 ± 7.17, P < .05); 22-item Sino-Nasal Outcome Test score (sNSD: 32.60 ± 14.13; aNSD: 10.04 ± 10.10; non-NSD: 9.08 ± 12.42, P < .001). No significant differences in measured nasal resistance, minimum cross-sectional area (MCA), degree of septal deviation, and nasal airflow distributions were found between sNSD and aNSD groups. Only three variables differentiate sNSD versus aNSD: anterior averaged heat flux on deviated side, inferior turbinate peak heat flux on non-deviated side, and nasal cool sensitivity measured by menthol lateralization threshold, with no significant differences among these variables found between the two healthy groups (aNSD vs. non-NSD). These variables by themselves or combined can differentiate sNSD from controls with higher specificity than the physicians (ROC area under the curve = 0.84 with 70% sensitivity and 91.6% specificity). CONCLUSIONS This study sheds light on the potential mechanisms of NSD symptomatology: distorted nasal cooling due to NSD exacerbated by poorer nasal mucosal sensitivity. It further supports our previous hypothesis that nasal obstruction complaints do not result directly from obstruction, rather from the capacity of our nose to subjectively sense airflow cooling. LEVEL OF EVIDENCE 3 Laryngoscope, 132:509-517, 2022.
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Affiliation(s)
- Jennifer Malik
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Barak M. Spector
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Zhenxing Wu
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Jennifer Markley
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Songzhu Zhao
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Bradley A. Otto
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Alexander A. Farag
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Kai Zhao
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
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Nasal valve repair (NVR) utilization and economic impact in the U.S. medicare population: 18-year trends. Am J Otolaryngol 2022; 43:103365. [PMID: 34972001 DOI: 10.1016/j.amjoto.2021.103365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Nasal valve repair (NVR) is an otolaryngological procedure indicated for the surgical correction of airway obstruction or collapse. Despite its growing popularity, the deployment and financial impact for NVR have not been well-described. Here, we evaluate trends in NVR utilization in the U.S. Medicare population on the state and national levels from 2001 to 2018. MATERIALS AND METHODS Historical utilization and reimbursement databases compiled by the U.S. Centers for Medicare & Medicaid Services (CMS) were queried for current procedural terminology (CPT) code 30465. Analyses were performed using Microsoft Excel v16. RESULTS Nationally, we observed a 989.60% increase in the total number of NVRs performed annually (611.07% adjusted to growing enrollment). Concomitantly, total reimbursement increased by 2025.52% (878.29% adjusted), though the average cost per procedure only rose moderately (37.58%). From 2013 to 2018, the majority of providers were male (74.79%), with an M.D. (71.37%), practicing as individuals (76.5%), operating in a facility setting (93.59%), and classified as otolaryngologists (63.25%). In 2018, Indiana had the highest utilization rate, whereas Oregon received the largest reimbursement. Connecticut had the lowest values in both categories. CONCLUSIONS The utilization and financial impact of NVR have increased substantially among the U.S. Medicare population over the last two decades.
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Abstract
Requiring both high-level technical skills and artistic sense, rhinoplasty continues to be one of the most challenging procedures in plastic surgery despite its popularity. A thorough preoperative consultation of the rhinoplasty patient forms the foundation of a successful case. During the consultation, the physician should obtain a detailed medical and nasal history, understand the patient's areas of concern, conduct a nasal analysis, and evaluate the patient's candidacy for surgery. This article reviews the key functional, esthetic, and psychosocial considerations that should be taken into account during a preoperative consultation for a rhinoplasty patient.
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Liu JF, Yan ZF, Zhang ZJ, Wang NY. Septoplasty alone is not suitable for most structural nasal obstructions. World J Otorhinolaryngol Head Neck Surg 2021; 7:322-327. [PMID: 34632347 PMCID: PMC8486691 DOI: 10.1016/j.wjorl.2020.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022] Open
Abstract
Septoplasty is widely used in the treatment of structural nasal obstructions, and it also has a good effect and a high degree of postoperative satisfaction. However, there a large number of structures demonstrate abnormalities related to structural nasal obstruction, including the external nose, maxilla, nasal cavity and paranasal sinus. Nasal septum deviation is only one signs of structural nasal obstruction and does not represent all possible structural abnormalities of the nasal cavity and its surrounding structure. Septoplasty is only performed to correct deviations of the nasal septum, which in many cases is obviously insufficient in restoring the symmetry of the nasal structure. Therefore, septoplasty alone is not suitable for the treatment of most structural nasal obstructions. Nasal ventilation expansion surgery, which typically covers more abnormal structural correction procedures than septoplasty, should be used when describing the treatment of structural nasal obstruction.
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Affiliation(s)
- Jin-Feng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zhan-Feng Yan
- Department of Otorhinolaryngology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Zhi-Jin Zhang
- The Third Clinical Medical School, Capital Medical University, Beijing, 100009, China
| | - Ning-Yu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
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Surgical Management of the Internal Nasal Valve: A Review of Surgical Approaches. Aesthetic Plast Surg 2021; 45:1127-1136. [PMID: 33399950 DOI: 10.1007/s00266-020-02075-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nasal valve collapse is relatively common with a lifetime prevalence of up to 13%. Etiologies include prior rhinoplasty, other surgical procedures, facial paralysis, congenital defects, trauma, and aging. Internal nasal valve collapse leads to impairment of nasal breathing, which significantly disturbs quality of life. Many approaches to increase the cross-sectional area of the internal nasal valve have been described. RESULTS The main categories reviewed in this article are cartilage grafting, implants, and suture suspension techniques. Cartilage grafting techniques include alar batten graft, butterfly graft, spreader graft, autospreader graft, and alar composite graft. The implant technique includes the titanium butterfly implant. The suspension techniques included are the transconjunctival approach, Mitek bone anchor, flaring suture, lateral pull-up, and piriform rim suspension. Surgeons must carefully consider functionality, cosmesis, and technical difficulty when selecting an approach. DISCUSSION We review indications, general approach, benefits, and considerations for a number of available techniques to help surgeons decide what approach might be best suited to the individual patient. LEVEL OF EVIDENCE III This 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.
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Wright L, Grunzweig KA, Totonchi A. Nasal Obstruction and Rhinoplasty: A Focused Literature Review. Aesthetic Plast Surg 2020; 44:1658-1669. [PMID: 32328743 DOI: 10.1007/s00266-020-01710-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a significant variation in the assessment, treatment, and outcomes of nasal airway obstruction and management in the published literature. This study aimed to: (1) define key components of the nasal airway, (2) identify frequent causes of nasal obstruction, and (3) review existing treatment methods. METHODS A systematic review of the literature was performed, and 135 studies were included via the following criteria: English, human subjects, and a primary endpoint of nasal airway improvement. Exclusion criteria were: abstract only, no airway data, pediatric patients, cleft rhinoplasty, sleep apnea, isolated traumatic nasal reconstruction, and cadaveric-only or animal studies. RESULTS The relevant obstructive sites include the ENV, septum, inferior turbinates, INV, and nasal bones. Addressing the alar rim alone may be insufficient, and inspection of the lateral wall and crura may be indicated. Correction of septal deviation involves attention to the bony base. Mucosal sparing treatment of inferior turbinates improves outcomes. INVs are a major source of nasal obstruction, and treatment includes spreader grafts. The bony nasal vault can contribute to nasal obstruction, including due to surgical osteotomies. CONCLUSIONS Anatomic causes of airway obstruction include the alar rims and lateral nasal walls, deviated nasal septum, inferior turbinate hypertrophy, decreased INV angle, and narrowed nasal bones. Treatments include graft placement; septoplasty; mucosal sparing turbinectomy; and lateral wall support. Pitfalls include failing to address the bony septum, over-resection of inferior turbinates, and narrowing of the nasal vault. Appreciation of airway management during rhinoplasty will improve functional outcomes. LEVEL OF EVIDENCE V This 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 .
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Affiliation(s)
- Lauren Wright
- Hurwitz Center for Plastic Surgery, Pittsburgh, PA, 15313, USA
| | - Katherine A Grunzweig
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Ali Totonchi
- MetroHealth System, Case Western Reserve University, Cleveland, OH, 44113, USA.
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Abstract
BACKGROUND Nasal surgery is one of the most common operations performed by plastic surgeons. The link between functional nasal surgery and improvement in nasal breathing is well established, but there are other metrics that have been shown to improve as a result of anatomical correction of the nose. Current literature suggests that surgery to remove nasal mucosal contact points can reduce symptoms in chronic headache patients. The authors conducted a systematic literature review to determine the validity of this hypothesis. METHODS A systematic search of the literature was performed using the terms "headache," "rhinogenic headache," "contact point," "migraine," and "surgery/endoscopy." RESULTS The authors identified 39 articles encompassing a total of 1577 patients who underwent surgery to treat mucosal contact point headaches. Septoplasty and turbinate reduction were the most commonly performed procedures, often in combination with endoscopic sinus surgery. Analysis of the combined data demonstrated improvement in the reported severity of patient symptoms, with 1289 patients (85 percent) reporting partial or complete resolution of headaches postoperatively. Average visual analogue scale scores and number of headache days in patients undergoing nasal surgery were reduced from 7.4 ± 0.9 to 2.6 ± 1.2 (p < 0.001) and 22 ± 4.3 days to 6.4 ± 4.2 days (p = 0.016), respectively. Improvement in headache symptoms was significantly associated with a positive response to preoperative anesthetic testing, and with inclusion of endoscopic sinus surgery as part of the surgery. CONCLUSION Functional nasal surgery is a viable option to improve headache symptoms in appropriately selected patients.
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Villwock JA, Kuppersmith RB. Diagnostic Algorithm for Evaluating Nasal Airway Obstruction. Otolaryngol Clin North Am 2018; 51:867-872. [PMID: 30057071 DOI: 10.1016/j.otc.2018.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Nasal obstruction is a common symptom and can have a large impact on patient quality of life. There are numerous causes, including anatomic, congenital, inflammatory, infectious, neoplastic, toxic, and systemic. An algorithmic approach can aid in ensuring all pertinent patient information is incorporated into the final diagnosis and treatment plan. Key components include a thorough history, physical examination including modified Cottle and Cottle maneuver, patient-reported outcome measures and/or quality of life questionnaires, examination with and without decongestion, and nasal endoscopy. The resultant information can then be effectively used to narrow the differential and guide the next steps in management.
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Affiliation(s)
- Jennifer A Villwock
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas University, 3901 Rainbow Boulevard, MS 3010, Kansas City, KS 66160, USA.
| | - Ronald B Kuppersmith
- Department of Surgery, Texas A&M Health Science Center, 1730 Birmingham Drive, College Station, TX 77845, USA
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Abstract
Nasal airway obstruction (NAO) is a common otolaryngic complaint with many potential causes, frequently structural or inflammatory in nature. Patients typically have multiple coexisting factors leading to symptoms. Good patient outcomes require careful preoperative evaluation, including nasal endoscopy, to accurately identify sources of obstruction and tailor intervention appropriately. Common structural causes of NAO include inferior turbinate hypertrophy, nasal septal deviation, and narrowing or collapse of the internal or external nasal valves. The internal nasal valve has the narrowest cross-sectional area within the nasal airway and is thus most sensitive to changes in dimension due to anatomic variation or surgical intervention.
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Affiliation(s)
- Theodore A Schuman
- Rhinology, Allergy, and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, 1200 East Broad Street, Suite 12-313, PO Box 980146, Richmond, VA 23298, USA
| | - Brent A Senior
- Division of Rhinology, Allergy, and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Chapel Hill, NC 27599-7070, USA.
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Perform aesthetic and functional nasal analysis to guide septorhinoplasty. 2. Recognize common complications associated with rhinoplasty. 3. Select appropriate septorhinoplasty techniques to refine nasal aesthetics and treat nasal airway obstruction. 4. Identify factors leading to poor patient satisfaction following rhinoplasty. SUMMARY Septorhinoplasty is among the most technically challenging procedures in the realm of plastic and reconstructive surgery. Moreover, it is a constantly evolving topic with extensive background literature. Surgeons must be comfortable with the traditional knowledge base and the current practices in the field. This article reviews the latest thinking on patient selection, functional indications, aesthetic analysis, and operative techniques in septorhinoplasty, with an emphasis on key cartilage grafting and tip suture techniques.
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