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Eng J, Sivam SK. Repairing the Nose after Failed Minimally Invasive Procedures. Facial Plast Surg 2023; 39:654-659. [PMID: 37321261 DOI: 10.1055/a-2111-1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Minimally invasive nasal procedures can be aimed at treating both functional and cosmetic problems. These procedures include lateral nasal wall implants, dermal fillers, thread lifting, and radiofrequency ablation. Though increasingly popular, nasal surgeons have limited data to draw from when faced with operating in a nose that has been altered by these techniques. In this article, best practice recommendations are described based on the available data for each of the techniques.
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Affiliation(s)
- James Eng
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Sunthosh Kumar Sivam
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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2
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Wilkins SG, Sheth AH, Kayastha D, Abdou H, Salehi PP, Citardi MJ, Peter Manes R. Adverse Events Associated With Bioabsorbable Nasal Implants: A MAUDE Database Analysis. Otolaryngol Head Neck Surg 2023; 168:1253-1257. [PMID: 36939542 DOI: 10.1002/ohn.227] [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: 09/18/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 01/29/2023]
Abstract
Bioabsorbable implants (eg, Latera) have recently been approved for addressing nasal valve collapse. The purpose of this study is to summarize adverse events and treatment sequelae associated with bioabsorbable nasal implants queried in the Manufacturer and User Facility Device Experience (MAUDE) database. Of the 26 device reports entered between March 2017 and April 2022, the most frequently reported complications included abscess (n = 13) and implant protrusion (n = 5). Other common symptoms reported greater than 1-year postimplantation included facial pain/discomfort (n = 3) and failure to absorb (n = 3). Management of adverse events included treatment with antibiotics (n = 9), steroid injections (n = 4), and explantation (n = 20). In 3 reports, adverse reactions required a biopsy of adjacent tissue for pathologic analysis. These findings suggest that further research is required to assess the potential long-term complications and optimize the management of bioabsorbable nasal implants. Furthermore, standardized reporting templates may improve the utility of the MAUDE database.
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Affiliation(s)
- Sarah G Wilkins
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amar H Sheth
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Darpan Kayastha
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hisham Abdou
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Parsa P Salehi
- Nassif MD Plastic Surgery, Beverly Hills, California, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - R Peter Manes
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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3
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Winkler AA, Pham TT. Promising Implants in Rhinoplasty. Facial Plast Surg 2022; 38:455-460. [DOI: 10.1055/s-0042-1748766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AbstractMany dilemmas in rhinoplasty tempt surgeons to use exogenous materials. We have long looked toward implants to decrease operative time, to achieve a more reliable result, or when there is a paucity of autologous material. More than ever, the innovative and highly lucrative field of nasal implantology is developing technologically advanced products. This article looks at some popular nasal implant choices with a look toward what might be on the horizon.
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Affiliation(s)
- Andrew A. Winkler
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Tiffany T. Pham
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado
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4
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Clark CM, Hakimi AA, Parsa KM, Tanenbaum Z, Wang H, Chu E, Reilly MJ. Comparison of Nasal Obstruction Symptom Evaluation Score Outcomes After Autologous Cartilage Grafts and Latera Nasal Implants. Ann Otol Rhinol Laryngol 2022:34894221121405. [DOI: 10.1177/00034894221121405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare quantitative Nasal Obstruction Symptom Evaluation (NOSE) scores for ACG and Latera implants for nasal valve repair. Methods: Retrospective chart review of patients who underwent ACG or Latera placement between January 2016 through May 2019 by a single surgeon. Patients who had completed NOSE surveys pre- and post-operatively were identified and eligible for inclusion. Data regarding baseline demographic characteristics, adjunctive surgical procedures, NOSE scores at 1, 3, and 6-month post-operative visits, complications, and total operative time were collected. Unpaired t-tests and linear mixed models were performed to analyze differences between study groups. Results: There were 24 and 39 patients who underwent ACG and Latera, respectively, who met eligibility criteria. There were no differences in demographic characteristics or pre-operative baseline NOSE scores (ACG: 65.1 and Latera: 64.4; P = .92) between groups. Mean operative times were not significantly different between groups (ACG: 113 minutes and Latera: 102 minutes; P = .76). Within each group, NOSE scores were significantly improved at each post-operative visit compared to pre-operative baselines. Between groups, mean NOSE scores were lower at each post-operative visit for ACG compared to Latera (1-month ACG: 21.7 and Latera: 45.9, P = .002 ; 3-month ACG: 14.5 and Latera: 39.9, P = .034; 6-month ACG: 8.4 and Latera: 44.2, P = .003). Conclusions: Both ACG and Latera offer significant improvements in patient-reported nasal obstruction severity; however, ACG may yield more favorable subjective symptom scores.
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Affiliation(s)
- Christine M. Clark
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Amir A. Hakimi
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Keon M. Parsa
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Haijun Wang
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Washington, DC, USA
| | - Eugenia Chu
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Michael J. Reilly
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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5
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Effect of alar nasal valve stent on nasal breathing. Am J Otolaryngol 2022; 43:103473. [PMID: 35523100 DOI: 10.1016/j.amjoto.2022.103473] [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: 02/14/2022] [Revised: 04/08/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Lateral nasal wall insufficiency has previously been a surgical challenge. In 2018, the Alar Nasal Valve Stent (Medtronic) was taken into use at Helsinki University Hospital. The alar cartilages are repositioned and locked into position with the Alar Nasal Valve Stent on the mucosa. The stent gives support and widens the alar valve while cartilages scar into their new position presumably facilitating breathing after removal of the stent. The aim of this prospective, observational study was to investigate whether the Alar Nasal Valve Stent has an effect on nasal breathing in patients with lateral nasal wall insufficiency. MATERIALS AND METHODS Symptom questionnaires (Sino-Nasal Outcome Test-22, Nasal Obstruction Symptom Evaluation, five-step symptom score) were analyzed preoperatively and at 3, 6, and 12 months postoperatively. Acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow were analyzed preoperatively and 3 months postoperatively. The patients performed a stress ergometry preoperatively and 3 months postoperatively, with their noses being photographed and filmed. RESULTS In a series of 18 patients, a significant positive difference was seen in subjective symptom scores preoperatively versus postoperatively. The difference remained stable throughout the follow-up. No difference in objective symptom measurements was observed. CONCLUSIONS Patients suffering from lateral nasal wall insufficiency experience a significant subjective improvement in nasal breathing after Alar Nasal Valve Stent surgery.
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6
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Sivam S, Jones E. Minimally invasive nasal valve treatment. Facial Plast Surg 2022; 38:353-358. [PMID: 35545120 DOI: 10.1055/a-1849-5594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Nasal valve insufficiency can be addressed using endonasal and open structure surgical techniques. However, some patients may prefer or be better suited for minimally invasive techniques that allow for more expedient treatment in the clinical setting. Techniques include internal dilators, external dilators, suture suspension, lateral wall implants, and radiofrequency remodeling. Understanding the indications for each technique as well as the available evidence can help facial plastic surgeons assess the role of incorporating these techniques into the care of patients with nasal valve insufficiency.
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Affiliation(s)
- Sunthosh Sivam
- Otolaryngology, Baylor College of Medicine, Bellaire, United States
| | - Evan Jones
- Otolaryngology, Baylor College of Medicine, Houston, United States
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7
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Bikhazi N, Ow RA, O'Malley EM, Perkins N, Sidle DM, Stolovitzky P. Long-Term Follow-up from the Treatment and Crossover Arms of a Randomized Controlled Trial of an Absorbable Nasal Implant for Dynamic Nasal Valve Collapse. Facial Plast Surg 2021; 38:495-503. [PMID: 34965603 DOI: 10.1055/s-0041-1740948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
We report the long-term safety and efficacy outcomes of the treatment and crossover arms of a randomized controlled trial evaluating an absorbable nasal implant to address dynamic nasal valve collapse. Participants were adults with severe/extreme nasal airway obstruction primarily due to nasal valve insufficiency who had implant placement. Follow-up visits were at 3, 6, 12, 18, and 24 months post implant. Visits included collection of the following patient-reported outcome measures: nasal obstructive symptom evaluation (NOSE), nasal obstruction visual analog scale (VAS), and the Epworth Sleepiness Scale (ESS). Adverse events were evaluated at each visit. One-hundred-eleven participants with implants were followed. Of the 111, 90 completed the 12-month visit and 70 completed the 24-month visit. NOSE responder rates are greater than 80% at all follow-ups through 24 months. Mean reduction from baseline in NOSE scores is ≥30 points and statistically significant (p <0.001) at all time points through 24 months. Mean VAS score reduction is ≥29.7 points and statistically significant (p <0.001) at all time points. The subgroup of participants with baseline ESS values >10 experienced statistically significant (p <0.001) and clinically meaningful reductions at all postimplant periods, suggesting that the reduction in nasal symptoms may reduce daytime sleepiness for patients who have problems with sleep quality. No serious device-/procedure-related adverse events were reported. Implant migration/retrieval rate was 4.5% (10/222) of total implants or 9% of participants (10/111). The implant is safe and effective for dynamic nasal valve collapse in patients with severe/extreme nasal obstruction and provides durable symptom improvement 24 months after placement.
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Affiliation(s)
| | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, California
| | | | - Nora Perkins
- Department of ENT, Albany ENT and Allergy Services, Albany, New York
| | - Douglas M Sidle
- Department of Otolarygology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pablo Stolovitzky
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
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8
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Update on the Evaluation and Management of Nasal Valve Collapse. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Olson MD, Barrera JE. A comparison of an absorbable nasal implant versus functional rhinoplasty for nasal obstruction. Am J Otolaryngol 2021; 42:103118. [PMID: 34171694 DOI: 10.1016/j.amjoto.2021.103118] [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: 01/07/2021] [Revised: 05/13/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE An absorbable nasal implant for the treatment lateral nasal wall collapse was approved for use in patients with nasal obstruction. It remains to be seen whether this treatment is equivalent to open techniques for the treatment of nasal valve incompetence from collapsibility. MATERIALS AND METHODS Two groups were analyzed for the study. One group had surgery which included the implant, septoplasty, and inferior turbinate submucous reduction and the other group had a variety of functional rhinoplasty techniques for lateral wall insufficiency in addition to septoplasty and inferior turbinate submucous reduction. NOSE and SNOT-22 were used to demonstrate pre and post-operative changes. RESULTS Ninety total patients were identified. Fifty patients underwent insertion of an absorbable nasal implant and 40 underwent a traditional open technique to stabilize the LNW. For the implant group the mean NOSE score was 63.4 (SD 24) and post-operative was 22.9 (SD 19.9), in addition, the SNOT-22 score was 38.8 (SD 19.8) and post-operative was 18.5 (SD 15.2). For the open rhinoplasty group, the mean NOSE score was 57.9 (SD 23.2) and post-operative was 17.6 (SD 16.4). The SNOT-22 score was 33.6 (SD 14.9) and post-operative score was 11.5 (SD 15.2) The delta between pre and post-operative NOSE and SNOT-22 test were not different at an average of 3.95 months post-operatively between the groups (NOSE, P = 0.94 and SNOT-22, p = 0.53). CONCLUSION In patients with multiple structural causes of nasal obstruction, including lateral wall insufficiency, insertion of an absorbable nasal implant, to support the LNW, seems to be equally effective as functional rhinoplasty techniques over a 4 month timeframe.
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10
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Nguyen TV, Beumer HW, Wong BJF. Failed Absorption of Nasal Polylactic Acid Implants (Latera). Facial Plast Surg Aesthet Med 2021; 24:318-319. [PMID: 34142872 DOI: 10.1089/fpsam.2021.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Theodore V Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, Irvine, California, USA
| | - Halton W Beumer
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine Medical Center, Orange, California, USA
| | - Brian J F Wong
- Department of Otolaryngology - Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, Irvine, California, USA.,Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine Medical Center, Orange, California, USA.,Department of Biomedical Engineering, Henry Samueli School of Engineering, Irvine, California, USA
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11
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Sidle DM, Stolovitzky P, O'Malley EM, Ow RA, Nachlas NE, Silvers S. Bioabsorbable Implant for Treatment of Nasal Valve Collapse with or without Concomitant Procedures. Facial Plast Surg 2021; 37:673-680. [PMID: 33853139 PMCID: PMC8492107 DOI: 10.1055/s-0041-1726464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of the study is to report outcomes after treatment of nasal valve collapse with a bioabsorbable nasal implant. It involves two prospective, multicenter, post-market studies evaluating long-term effectiveness of the LATERA implant for severe to extreme nasal obstruction. Participants underwent implant alone or with concomitant inferior turbinate reduction (ITR) and/or septoplasty. Outcome measures included the change from baseline Nasal Obstruction Symptom Evaluation (NOSE) scores, NOSE responder rates, visual analog scale (VAS) scores, and adverse events. A total cohort of 277 participants (109 implants only, 67 implants + ITR, 101 implants + septoplasty + ITR) enrolled at 19 U.S. centers was available for analysis with 177 participants (69 implants only, 39 implants + ITR, 69 implants + septoplasty + ITR) available at 2 years. The mean changes from baseline in NOSE scores and VAS scores were statistically significant (
p
< 0.001) at all follow-up periods. The baseline NOSE score of 77.8 ± 13.6 was improved to 24.2 ± 23.6 at 24 months. Greater than 90% of participants were NOSE responders across all follow-up periods, 6.1% withdrew for lack of treatment effect. The baseline VAS score of 66.7 ± 18.8 was improved to 21.1 ± 23.9 at 24 months. There were no serious adverse events related to the device or implant procedure. Implant retrieval rate was 4.0% (22/543 implants). Nonserious adverse events were mild to moderate in severity, typically occurred within 6 months of implant, and resolved or were stable. Significant reductions in NOSE and VAS scores and high responder rates from our large population of patients with nasal obstruction who had nasal valve implants confirm sustained effectiveness at 24 months after treatment. The studies are registered on
www.clinicaltrials.gov
(NCT02952313 and NCT02964312).
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Affiliation(s)
- Douglas M Sidle
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pablo Stolovitzky
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, California
| | - Nathan E Nachlas
- Ear, Nose, Throat, and Allergy Associates of Florida, Boca Raton, Florida
| | - Stacey Silvers
- Madison ENT and Facial Plastic Surgery, New York, New York
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12
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Gilifanov EA, Lepeyko BA, Ardeeva LB, Ivanets IV, Tilik TV, Klemeshova TP, Prokhorenko AV, Sulimova PI. [External and internal nasal valve. Diagnostic and treatment methods for dysfunction]. Vestn Otorinolaringol 2020; 85:102-108. [PMID: 32242000 DOI: 10.17116/otorino202085011102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of the work is the analysis of diagnostic methods of nasal valve dysfunction according to Pubmed database and national medical journals during the period from 1997 to 2019. A brief analysis of the definition of the zones of the external and internal nasal valve, diagnostic methods, including external nasal dilators, spiral computed tomography, assessment of the degree of displacement of the nasal wing using various aspirators is given. Various methods for treating nasal valve dysfunction, such as external and internal dilators, strengthening the nasal wings, suture techniques, expanding the edge of the pear-shaped hole, implantation of absorbable polymers into the side wall of the nose are critically evaluated. Our own original correction method is described for dysfunction of the external nasal valve caused by the vertically located legs of the inferior lateral cartilage.
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Affiliation(s)
- E A Gilifanov
- Pacific State Medical University of the Ministry of Health of Russia, Department of Ophthalmology and Otorhinolaryngology, Vladivostok, Russia, 690002
| | - B A Lepeyko
- Vladivostok Clinical Hospital No. 1, Vladivostok, Russia, 690078
| | - L B Ardeeva
- Pacific State Medical University of the Ministry of Health of Russia, Department of Ophthalmology and Otorhinolaryngology, Vladivostok, Russia, 690002
| | - I V Ivanets
- Medical Center 'Zdorovye', Vladivostok, Russia, 690002
| | - T V Tilik
- S.M. Kirov Military Medical Academy, Vladivostok Branch, Russia, 690005
| | | | - A V Prokhorenko
- Kamchatka Regional Center for Medical Prevention, Petropavlovsk-Kamchatsky, Russia, 683016
| | - P I Sulimova
- Vladivostok clinical hospital No. 2, Vladivostok, Russia, 690105
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13
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Treating Symptomatic Midvault Soft Tissue Collapse in Revision Rhinoplasty with a Nasal Wall Implant. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2887. [PMID: 32766052 PMCID: PMC7339293 DOI: 10.1097/gox.0000000000002887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 01/09/2023]
Abstract
Persistent nasal airway obstruction (NAO) due to midvault soft tissue collapse in patients following rhinoplasty or nasal surgery is a clinical challenge for surgeons. An absorbable lateral nasal wall implant is one option available to help treat midvault soft tissue collapse and to improve NAO symptoms. Previous studies have not investigated its use in complex revision functional rhinoplasty with respect to patient-reported outcomes. Data were collected on all patients with a history of previous nasal procedures who underwent Latera implant placement in conjunction with functional rhinoplasty from January to December 2018. The Nasal Obstructive Symptom Evaluation and Visual Analogue Scale were used to evaluate functional outcomes. Eight implants were placed in 6 revision functional rhinoplasty patients with midvault collapse. All patients responded to the survey. Mean follow-up was 16 ± 4 months. There were no implant-related adverse events. Mean Nasal Obstructive Symptom Evaluation score was 33 ± 33, and mean Visual Analogue Scale score was 20 ± 9. In total, 1 patient reported complete resolution of NAO, whereas 2 patients reported mild, 1 reported moderate, 1 reported severe, and 1 reported extreme symptoms. Four of the 6 patients reported nasal obstruction improvement, with all reporting improvement in midvault soft tissue collapse. Apart from being used in nasal valve collapse treatment, a lateral nasal wall implant is a potentially useful solution that may help surgeons improve patients’ NAO symptoms in complex functional rhinoplasty cases. However, in certain cases, a patient’s nasal obstructive symptoms may continue to be multifactorial.
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14
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Wakefield CJ, Eggerstedt M, Tajudeen BA, Smith RM, Revenaugh PC. Adverse Events Associated with Absorbable Implants for the Nasal Valve: A Review of the Manufacturer and User Facility Device Experience Database. Facial Plast Surg Aesthet Med 2020; 22:391-392. [PMID: 32423363 DOI: 10.1089/fpsam.2020.0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Connor J Wakefield
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Eggerstedt
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan M Smith
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter C Revenaugh
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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15
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Brandon BM, Stepp WH, Basu S, Kimbell JS, Senior BA, Shockley WW, Madison Clark J. Nasal Airflow Changes With Bioabsorbable Implant, Butterfly, and Spreader Grafts. Laryngoscope 2020; 130:E817-E823. [PMID: 32364619 DOI: 10.1002/lary.28691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Internal nasal valve compromise is a major cause of nasal obstruction, with a growing number of ways to treat this condition. In this study, we compared the effects of butterfly graft, spreader graft, and the bioabsorbable nasal implant on nasal airflow resistance. STUDY DESIGN Cadaver study. METHODS Computational fluid dynamics (CFD) simulations were completed from nine preoperative and postoperative cadaveric subjects. Each cadaveric head underwent placement of a bioabsorbable nasal implant (BNI) (Spirox Latera; Stryker ENT, Plymouth, MN), butterfly graft, or spreader graft. Pre- and postoperative computed tomography (CT) scans were used to generate three-dimensional models of the nasal airway used in steady-state CFD simulations of airflow and heat transfer during inspiration. RESULTS Butterfly graft placement resulted in a mean improvement in nasal airway resistance of 24.9% (±7.3), whereas BNI placement resulted in a 6.7% (±1.2) improvement, and spreader graft placement also resulted in a consistent improvement of 2.6% (±13.5). Pressure within the main nasal cavity was consistently lower following butterfly graft placement versus a spreader graft or BNI. Butterfly and spreader graft placement also resulted in modest improvements in airflow allocation, whereas BNI demonstrated more variation (-1% to 12%). Heat flux was not significantly different; however, a small improvement in total heat flux was seen with all three interventions. CONCLUSIONS The results of this study demonstrate reduction in nasal airway resistance in all three surgical interventions, with the butterfly graft demonstrating superiority to the other two techniques. However, these data only reflect a static environment and not dynamic changes in airflow seen during respiration. LEVEL OF EVIDENCE NA Laryngoscope, 130:E817-E823, 2020.
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Affiliation(s)
- Bryan M Brandon
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Wesley H Stepp
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Saikat Basu
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.,Department of Mechanical Engineering, South Dakota State University, Brookings, South Dakota, U.S.A
| | - Julia S Kimbell
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Brent A Senior
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - William W Shockley
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - J Madison Clark
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
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16
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Kim DH, Lee HH, Kim SH, Hwang SH. Effectiveness of using a bioabsorbable implant (Latera) to treat nasal valve collapse in patients with nasal obstruction: systemic review and meta-analysis. Int Forum Allergy Rhinol 2020; 10:719-725. [PMID: 32282129 DOI: 10.1002/alr.22543] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/20/2020] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nasal obstruction is a common cause of breathing problems with lateral wall insufficiency (LWI) a key anatomic contributor. Recently, a bioabsorbable nasal implant was introduced to correct LWI and treat nasal obstruction. The goal of this study was to perform a systematic review with meta-analysis to determine the efficacy of the bioabsorbable nasal implant for treating nasal obstruction caused by LWI. METHODS Five databases (PubMed, SCOPUS, EMBASE, Web of Science, and the Cochrane Database) were independently reviewed by 2 researchers, starting at the earliest time point recorded in the database to September 2019. Studies that scored endoscopic lateral wall movement and nasal obstruction related to quality of life (QOL) postoperatively before and after bioabsorbable nasal implants and those that compared the outcomes of nasal implants (treatment group) with outcomes of sham surgery (control group) were included in the analysis. RESULTS Five studies (396 patients) met the inclusion criteria. Bioabsorbable nasal implants significantly reduced endoscopic lateral wall motion compared to pretreatment values and also improved QOL at 12 months postoperatively. Most adverse effects following the nasal implant, such as skin or mucosal reaction, infection, or implant retrieval, were reported with a 5% incidence rate. All adverse outcomes were resolved without significant sequelae. Compared with sham surgery, bioabsorbable nasal implants significantly improved disease-specific QOL. CONCLUSION Bioabsorbable nasal implants may reduce nasal wall movement and subjective symptom scores compared to preoperative status. More randomized clinical trials must be conducted to further verify the effectiveness of bioabsorbable nasal implants.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Ho Lee
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Hong Kim
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Ge M, Kim JH, Wrobel B, Smith SS, Kochhar A, Ference EH. Emerging Trends in Nasal Surgery: What Is the Impact of a Bioabsorbable Nasal Implant? Laryngoscope 2020; 130:2785-2790. [PMID: 31922610 DOI: 10.1002/lary.28462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/10/2019] [Accepted: 11/13/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND A bioabsorbable nasal valve implant (NVI) was introduced in 2016 as a minimally invasive solution to nasal valve collapse. Historically the introduction of less invasive procedures performable in-office has resulted in an increase in volume. Our objective is to evaluate this trend as it relates to nasal vestibular repair, and its impact on healthcare utilization. METHODS We interrogated the Medicare Part B national database for nasal vestibular repair (CPT code: 30465), Unlisted nasal procedure (30999) and septoplasty (30520) from 2010 to 2017. Septoplasty was used as a surrogate for overall nasal procedural rate. Linear regression modeling was used to examine the changes in reported vestibular repair rate adjusting for septoplasty rate. RESULTS In the Medicare population, the rate of septoplasty was stable from 2010 to 2017, increasing from 26,962 to 30,194 at an annual rate of 1.5%. Coding for unlisted nasal procedure increased from 272 to 333 at an adjusted annual rate of 1.1% over this time period. Coding for nasal vestibular repair increased from 2026 to 5331 over this interval at an adjusted annual rate of 0.9% from 2010 to 2016 but significantly increased to 5% between 2016 to 2017 (P < .0001). CONCLUSION The reported volume of nasal vestibular repair increased significantly in the year following Food and Drug Administration approval of NVIs. In the absence of a corresponding increase in septoplasty, this temporal relationship suggests that the introduction of NVIs impacted the utilization of this procedural code. LEVEL OF EVIDENCE N/A Laryngoscope, 2020.
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Affiliation(s)
- Marshall Ge
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Jee-Hong Kim
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Bozena Wrobel
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Stephanie Shintani Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicao, Illinois, U.S.A.,Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicao, Illinois, U.S.A
| | - Amit Kochhar
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Elisabeth H Ference
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
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Sidle DM, Stolovitzky P, Ow RA, Silvers S, Matheny K, Bikhazi N, Wani M, Scurry WC, Most SP. Twelve-month outcomes of a bioabsorbable implant for in-office treatment of dynamic nasal valve collapse. Laryngoscope 2019; 130:1132-1137. [PMID: 31254279 PMCID: PMC7217163 DOI: 10.1002/lary.28151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 01/31/2023]
Abstract
Objectives To examine 12‐month outcomes for in‐office treatment of dynamic nasal valve collapse (NVC) with a bioabsorbable implant. Study Design Prospective, multicenter, nonrandomized study. Methods One hundred sixty‐six patients with severe‐to‐extreme class of Nasal Obstruction Symptom Evaluation (NOSE) scores were enrolled at 16 U.S. clinics (November 2016–July 2017). Patients were treated with a bioabsorbable implant (Latera, Spirox Inc., Redwood City, CA) to support the lateral wall, with or without concurrent inferior turbinate reduction (ITR), in an office setting. NOSE scores and Visual Analog Scale (VAS) were measured at baseline and 1, 3, 6, and 12 months postoperatively. The Lateral Wall Insufficiency (LWI) score was determined by independent physicians observing the lateral wall motion video. Results One hundred five patients were treated with implant alone, whereas 61 had implant + ITR. Thirty‐one patients reported 41 adverse events, all of which resolved with no clinical sequelae. Patients showed significant reduction in NOSE scores throughout 12 months postoperatively (77.4 ± 13.4 baseline vs. 36.2 ± 22.7 at 1 month postoperatively, 33.0 ± 23.4 at 3 months, 32.1 ± 24.6 at 6 months, and 30.3 ± 24.3 at 12 months; P < 0.001). They also showed significant reduction in VAS scores postoperatively (69.7 ± 18.1 baseline vs. 31.3 ± 27.1 at 12 months postoperatively, P < 0.001). These results were similar in patients treated with implant alone and those treated with the implant + ITR. Consistent with patient‐reported outcomes, postoperative LWI scores were demonstrably lower (1.42 ± 0.09 and 0.93 ± 0.08 pre‐ and postoperatively, P < 0.001). Conclusion In‐office treatment of dynamic NVC with a bioabsorbable implant improves clinical evidence of LWI at 6 months and improves nasal obstructive symptoms in a majority of patients up to 12 months. Level of Evidence 2b Laryngoscope, 130:1132–1137, 2020
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Affiliation(s)
- Douglas M Sidle
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pablo Stolovitzky
- the Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | - Randall A Ow
- the Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, California
| | - Stacey Silvers
- the Madison ENT & Facial Plastic Surgery, New York, New York
| | - Keith Matheny
- the Collin County Ear, Nose and Throat, Frisco, Texas
| | | | | | - W Cooper Scurry
- Piedmont Ear, Nose & Throat Associates, PA, Winston-Salem, North Carolina, U.S.A
| | - Sam P Most
- the Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, California
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Abstract
PURPOSE OF REVIEW This article reviewed studies that support the use of implants for nasal valve surgery and augmentation rhinoplasty. RECENT FINDINGS For nasal valve collapse, there is a trend for rhinoplasty surgeons to use Monarch nasal implant, absorbable valve implant and titanium butterfly implant rather than traditional cartilaginous grafts. For augmentation rhinoplasty, it is still a gold standard to use autologous cartilage. However, alloplastic implants are still very popular for Asian rhinoplasty. A combination of implant materials for augmentation rhinoplasty can improve outcomes while minimizing complications. SUMMARY Application of implants and newer techniques in nasal valve surgery and augmentation rhinoplasty are important to enhance the outcome in rhinoplasty.
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Stolovitzky P, Senior B, Ow RA, Mehendale N, Bikhazi N, Sidle DM. Assessment of bioabsorbable implant treatment for nasal valve collapse compared to a sham group: a randomized control trial. Int Forum Allergy Rhinol 2019; 9:850-856. [PMID: 31226238 PMCID: PMC6771676 DOI: 10.1002/alr.22362] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 11/30/2022]
Abstract
Background Dynamic nasal valve collapse (NVC) is a common factor contributing to nasal obstruction; however, it is often underdiagnosed and untreated. An in‐office, minimally invasive procedure addressing dynamic NVC uses a bioabsorbable implant (Latera) to support the lateral nasal wall. This study aimed to evaluate the safety and effectiveness of the treatment in a randomized controlled trial (RCT) with sham control. Methods In this prospective, multicenter, single‐blinded RCT, 137 patients from 10 clinics were randomized into 2 arms: treatment arm (70 patients) and sham control arm (67 patients). Outcome measures were followed through 3 months after the procedure. The primary endpoint was the responder rate (percentage of patients with reduction in clinical severity by ≥1 category or ≥20% reduction in Nasal Obstruction Symptom Evaluation [NOSE] score). Results Before the procedure, there were no statistically significant differences in patient demographics and nasal obstruction symptom measures between the 2 arms. Three months after the procedure, responder rate was significantly higher for the treatment arm compared to the control (82.5% vs 54.7%, p = 0.001). Patients in the treatment arm also had a significantly greater decrease in NOSE score (–42.4 ± 23.4 vs –22.7 ± 27.9, p < 0.0001) and significantly lower visual analogue scale (VAS) scores (–39.0 ± 29.7 vs –13.3 ± 30.0, p < 0.0001) than the sham control arm. Seventeen patients reported 19 procedure/implant‐related adverse events, all of which resolved with no clinical sequelae. Conclusion Our study shows the safety and effectiveness of the bioabsorbable implant in reducing patients’ nasal obstruction symptoms.
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Affiliation(s)
- Pablo Stolovitzky
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA
| | - Brent Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, CA
| | | | | | - Douglas M Sidle
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Kim J, Kochhar A, Ference E. Regarding: A prospective study for treatment of nasal valve collapse due to lateral wall insufficiency: Outcomes using a bioabsorbable implant. Laryngoscope 2019; 129:E227. [PMID: 31034609 DOI: 10.1002/lary.28014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Jeehong Kim
- Keck School of Medicine of the University of Southern California, Department of Otolaryngology, Los Angeles, California, U.S.A
| | - Amit Kochhar
- Keck School of Medicine of the University of Southern California, Department of Otolaryngology, Los Angeles, California, U.S.A
| | - Elisabeth Ference
- Keck School of Medicine of the University of Southern California, Department of Otolaryngology, Los Angeles, California, U.S.A
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