Balanced Cantilever Graft for Supporting the Cartilaginous Side Wall of Nose

Background Many locations for the nasal valve have been suggested. Later came the concept of the flow limiting segment. Rather than an internal and external valve, flow through the nose is regulated by the cartilaginous side wall, septum and inferior turbinate. Objectives To assess the use of balanced cantilever graft (BCLG), a technique to support the lateral nasal wall. Methods Patients undergoing primary open septorhinoplasty over a 2-year period were studied. Follow up period was a minimum of 6 months to a maximum of 24 months. Subjective improvement of function was measured with VAS and aesthesis by FACE Q score. Objective assessment of airway was done by a Nasal Peak Inspiratory Flow (NPIF) meter. Strips of septal cartilage of sufficient dimensions were placed in submucosal pockets created under the area of the lateral wall to be supported. Results Sixty patients underwent BCLG. VAS for nasal obstruction increased from 2.6 pre-operatively to 8.1 post-operatively. FACE Q increased from 16.7 pre-operatively to 36.6 post-operatively. NPIF was 74.9 L/minute pre-operatively, improving to 95 L/min post-operatively. Statistically significant improvements were seen in functional and aesthetic scores. Conclusions Balanced cantilever grafts support the weakened part of lateral nasal wall by their elastance. Minimal cartilage is required and can be altered to support various parts of the lateral nasal wall. This graft does not cause an aesthetic deficiency whilst providing adequate support.

Comparing the effectiveness of nasal dilator strips: does race play a role?

Background:Nasal dilator strips are thought to widen and stiffen the anterior nasal cavity, and thus improve symptoms of nasal obstruction. It is postulated that anthropomorphic differences in external nasal proportions between races may influence the effectiveness of such dilator strips.Methods:Caucasian and Asian subjects were compared. Nasal peak inspiratory flow, nasal airway resistance, minimum cross-sectional area and visual analogue scale measurements of nasal obstruction were recorded at baseline and following the application of two different dilator strips.Results:Nine Caucasian and six Asian subjects were recruited (n = 15). There was a significant difference between races in terms of nasal peak inspiratory flow improvements following nasal strip application (mean of 29.4 litres per minute in Caucasiansvs14.6 litres per minute in Asians;p = 0.04). Only Caucasians experienced a significant decrease in nasal airway resistance (median of 0.12 Pa/cm3/s;p < 0.01).Conclusion:Nasal peak inspiratory flow, minimum cross-sectional area and visual analogue scale values improved from baseline with strip application in both populations. Only Caucasians experienced significant nasal airway resistance improvement with strip application. Both cohorts experienced nasal peak inspiratory flow improvement, with Caucasians experiencing a significantly larger improvement.

Nasal peak inspiratory flow (NPIF) as a diagnostic tool for differentiating decongestable from structural nasal obstruction

Background: Identifying the cause of nasal obstruction is critical before surgical intervention. Structural nasal obstruction, due to nasal valve stenosis, is unlikely to benefit from simple septoplasty and turbinate reduction. This study assesses changes in nasal peak inspiratory flow (NPIF) as a tool for discriminating decongestable versus structural obstruction. Methodology: Cross-sectional study of patients undergoing nasal airflow assessment was performed. Rhinomanometry, nasal obstruction visual analogue scores (VAS) and NPIF were performed pre- and post-decongestion. Population groups were defined with decongestable or structural obstruction by relative post-decongestion changes in airways resistance and symptoms. Results: Fifty two patients were assessed, 24 with decongestable, 28 with structural obstruction. Pre- and post-decongestion NPIF were similar between groups. Absolute and percentage NPIF change were larger with decongestable versus structural obstruction. Sensitivity and specificity for predicting decongestable obstruction were 75.0% and 60.7% for NPIF increase >20 L/min; 75.0% and 64.3% for NPIF increase >20%. The respective positive predictive values were 62.1% and 64.3%. Conclusion: NPIF increase after decongestion is larger with decongestable than structural nasal obstruction. NPIF alone cannot discriminate the two conditions and does not replace more formal assessment.

Reversible nasal airway obstruction: does change in nasal peak inspiratory flow following decongestion predict response to topical steroids in chronic rhinosinusitis patients?

Background:Predicting which chronic rhinosinusitis patients have nasal obstruction due to reversible mucosal inflammation could prevent unnecessary surgery.Aim:To investigate whether the change in nasal peak inspiratory flow following maximal decongestion (i.e. mucosal reversibility) at first visit predicts the response to topical steroids in chronic rhinosinusitis patients, as measured by the 22-item Sinonasal Outcome Test.Methods:Prospective study of 128 consecutive new adult patients presenting with nasal obstruction due to chronic rhinosinusitis (January 2008 to July 2010). The 22-item Sinonasal Outcome Test questionnaire was administered and the nasal peak inspiratory flow assessed. Following maximal nasal decongestion, the nasal peak inspiratory flow was again tested and the difference calculated. Topical steroids were administered for at least six weeks. The 22-item Sinonasal Outcome Test was then repeated and the difference calculated.Results:Data were analysed using means and correlation studies (Spearman's rank correlation). There was no correlation between the pre- versus post-decongestion nasal peak inspiratory flow difference and the pre- versus post-steroid 22-item Sinonasal Outcome Test difference, in chronic rhinosinusitis patients with or without nasal polyps.Conclusion:The difference between pre- and post-decongestion nasal peak inspiratory flow does not predict chronic rhinosinusitis patients' response to topical steroids.