Are we mindful of nasal dorsal integrity during septal surgery? An imaging study of nasal keystone area

Objectives: Review of radiological images of the keystone area to assess risk of disruption to the nasal dorsum when separating the osseo-cartilaginous junction in septoplasty. Methods: A Cross sectional radiological study of adults who underwent CT scan of paranasal sinuses. Outcome measures included were: The Length of the keystone area (shorter length implies a higher risk of disruption) and a high-risk shape (high risk shape implies shorter keystone area) that can predispose to disruption of nasal dorsal integrity during septoplasty surgery. Certain nasal dimensions were evaluated to determine if they add risk to the dorsum. Results: CT scans of 343 patients were reviewed. The mean keystone area length was initially 10.42 mm that came down to 7.43 mm after adjustment in patients with high-risk shape. 31.5% of subjects were at risk of disruption to the dorsum due to short keystone area length <5 mm. Relatively shorter nasal bones (nasal bone length: overall dorsal length <0.49%) were associated with a shorter keystone area length (P = 0.004). Age, gender, septal deviation are not risk factors as they did not significantly influence keystone area length. Conclusions: One third of our patients (31.5%) had short KSA length < 5mm which carries higher risk of disruption to the dorsum integrity upon complete detachment of osseo-cartilaginous junction. We recommend preoperative CT imaging for thorough evaluation and precise measurement of KSA. Patients with relatively shorter nasal bones detected on examination (and confirmed radiologically), need to be recognized as they are more likely to have shorter KSA

Analysis of Facial Skeletal Morphology: Nasal Bone, Maxilla, and Mandible

The growth and development of facial bones are closely related to each other. The present study investigated the differences in the nasomaxillary and mandibular morphology among different skeletal patterns. Cephalograms of 240 participants were divided into 3 groups based on the skeletal pattern (Class I, Class II, and Class III). The dimensions of nasomaxilla (nasal bone length, nasal ridge length, nasal depth, palatal length, and maxillary height) and mandible (condylar length, ramus length, body length, symphysis length, and entire mandibular length) were measured. One-way analysis of variance and Pearson’s correlation test were used for statistical analysis. No significant differences were observed among the skeletal patterns in terms of nasal bone length, palatal length, maxillary height, or condylar length. Class II had a significantly shorter ramus, mandibular body, and entire mandibular length compared with those of Class I and Class III. Nasal ridge length exhibited a significant moderate correlated with nasal bone length (correlation coefficient: 0.433) and maxillary height (correlation coefficient: 0.535). The entire mandibular length exhibited a significant moderate correlated with ramus length (correlation coefficient: 0.485) and body length (correlation coefficient: 0.536). In conclusion, nasal and maxillary dimensions exhibited no significant difference among the 3 skeletal patterns. Mandibular body and entire mandibular lengths were significantly positively correlations with Class III skeletal patterns.

Foetal Nasal Bone Length Measurement and Evolving Normogram in Southern Indian Population in Normal Pregnancies: A Cross-sectional Study

Introduction: Assessment of the foetus to detect aneuploidies between 12 to 24 weeks of gestation is an integral part of the ultrasound scanning. Absence or hypoplastic nasal bone is a very important marker of foetal aneuploidy. Thus, identifying the range of foetal Nasal Bone Length (NBL) in normal gestation is very important to screen for aneuploidies. Aim: This study aimed at ascertaining the reference range of foetal NBL between 11 to 24 weeks of pregnancy. Materials and Methods: A multicentre, cross-sectional study was conducted from 2018 to 2020. After obtaining Ethical approvals from each centre, NBL was measured in 826 patients between 11-24 weeks of pregnancy. Transabdominal scans were performed and the data was used to construct the NBL normogram for this Gestational Age (GA). Linear regression analysis was used to analyse the relationship between NBL and Gestational Age. Scatter plots for NBL as function of GA was constructed. The 5th and 50th percentile values were calculated for each gestational week. Results: With one unit increase in GA (weeks), NBL increased by 0.402 times (r=0.897, p<0.001). Mean NBL was 4.05 mm. The medians NBL for 12-14 weeks were 2.1-2.5 mm, 15-18 weeks was 3.0-4.6 mm, 19-21 weeks was 5.3-5.8 mm, 22-24 weeks was 6.0-6.6 mm. Conclusion: This study highlights the importance of nasal bone evaluation in the second trimester of pregnancy to detect foetuses with Down syndrome. Since NBL increases linearly with GA, it aids detecting the hypoplastic nasal bone at different GA.

Radiologic Evaluation of the Influence of Cleft Treatment on Nasal Dorsum Growth

Objective: The study addresses whether the growth of the nasal dorsum is disturbed by cleft treatments, for cleft lip only (CL) and cleft lip with cleft palate (CLP). Design: A total of 576 patients with cleft (278 CL, 298 CLP) and 333 individuals without orofacial clefts were retrospectively enrolled. Cleft lip only group was treated with a modified Millard technique combined with Tajima incision for rhinoplasty at 3 to 6 months. The CLP group underwent the same lip repair technique and then underwent a Sommerlad palatoplasty at 9 to 12 months. Lateral cephalometric radiographs of all individuals were taken to evaluate the nasal length and nasal dorsum height. Dunn test was used to analyze the difference ( P < .001). Results: Compared with control, in CL, nasal bone angle and nasal dorsum angle increase by age similarly (5-18 years, P > .05); the total dorsum is significantly shorter (5-18 years, P < .001), while the upper nasal dorsum length is similar (except in 5-6 years), and the lower nasal dorsum is shorter (5-18 years, P < .001). In CLP, nasal bone angle develops insufficiently as children grow (8-18 years, P < .001); the nasal dorsum angle is notably smaller (5-18 years, P < .001); nasal bone length is not significantly different except 11 to 13 years ( P < .05); nasal dorsal length is similar at skeletal maturity (17-18 years, P > .05), although it is shorter during 8 to 16 years ( P < .05); the upper nasal dorsum is overdeveloped (14-18 years, P < .05), whereas the lower nasal dorsum is underdeveloped (5-18 years, P < .001). Conclusion: Treatments in both CL and CLP could be the important factors in disturbing the growth of cartilaginous portion of the nasal dorsum (including nasal tip) and the nasal dorsum height.

Association of Fetal Nasal Bone Length And Gestational Age Between 14-28 Weeks of Pregnancy

Nasal bone (NB) is a significant structure to be assessed during pregnancy in 1st and 2nd trimesters. Nasal bones that start to grow as neural crest cells (NCCs) collections, can histologically be confirmed when length of fetal crown–ump is 42mm (10.9 weeks).