Anatomical and Ultrasonographic Analyses of the Levator Labii Superioris Alaeque Nasi Muscle at the Level of the Nasal Ala / Análisis Anatómico y Ecográfico del Músculo Elevador Nasolabial a Nivel del Ala Nasal

SUMMARY: We aimed to determine the width of the levator labii superioris alaeque nasi muscle (LLSAN) at the level of the nasal ala through cadaveric dissections and ultrasonography (US), to provide essential anatomical information for use during both invasive and noninvasive procedures in the nasal ala region. The LLSAN was investigated in the 40 hemifaces of 20 Korean cadavers, comprising 10 males and 10 females with a mean age of 73.6 years. The LLSAN width of the 40 specimens at the level of the midpoint of the nasal ala was 5.02±2.35 mm (mean±standard deviation), and ranged from 1.45 mm to 10.11 mm. The LLSAN widths were 5.96±2.36 mm and 3.93±1.89 mm in males and females, respectively, with ranges of 2.40-10.11 mm and 1.45-6.96 mm, respectively. The LLSAN widths on the left and right sides were 4.77±2.72 mm and 5.26±1.99 mm, respectively. The proportions of the LLSAN fibers inserting into the nasal ala and upper lip were similar in 13 specimens (32.5 %), while more fibers inserted into the nasal ala in 11 specimens (27.5 %) and more fibers inserted fibers of the LLSAN into the upper lip in 16 specimens (40 %). When clinicians need to target or avoid the LLSAN, the present width and range data can be helpful for ensuring the efficacy and safely of both invasive and noninvasive procedures. In addition, the possibility of asymmetry in the width of the LLSAN in the nasal ala region should be confirmed by US before performing such procedures.

Nuestro objetivo fue determinar el ancho del músculo elevador nasolabial (MENL) a nivel del ala nasal mediante disecciones cadavéricas y ecografía, para proporcionar información anatómica esencial, para su uso durante procedimientos invasivos y no invasivos, en la región del ala nasal. El MENL se estudió en 40 hemicaras de 20 cadáveres coreanos (10 hombres y 10 mujeres) con una edad media de 73,6 años. El ancho de MENL de las 40 muestras a nivel del punto medio del ala nasal fue de 5,02 ± 2,35 mm (media ± desviación estándar) y osciló entre 1,45 mm y 10,11 mm. Los anchos de MENL fueron 5,96 ± 2,36 mm y 3,93 ± 1,89 mm en hombres y mujeres, respectivamente, con rangos de 2,40 a 10,11 mm y 1,45 a 6,96 mm, respec- tivamente. Los anchos de MENL en los lados izquierdo y derecho fueron 4,77 ± 2,72 mm y 5,26 ± 1,99 mm, respectivamente. Las proporciones de fibras de MENL que se insertaban en el ala nasal y en el labio superior fueron similares en 13 muestras (32,5 %), mientras que se insertaron más fibras en el ala nasal en 11 muestras (27,5 %) y además, se insertaron fibras de MENL en el labio superior en 16 ejemplares (40 %). Cuando los médicos necesitan apuntar o evitar el MENL, los datos actuales de ancho y rango pueden ser útiles para garantizar la eficacia y seguridad de los procedimientos, tanto invasivos como no invasivos. Además, la ecografía puede ser utilizada para confirmar una posible asimetría en el ancho del MENL en la región del ala nasal antes de realizar los procedimientos.

Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery.@*METHODS@#The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation.@*RESULTS@#All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied.@*CONCLUSION@#Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery.

Mordedura humana em dorso nasal: relato de caso / Human bite on nasal dorsum: case report / Mordida humana en espalda nasal: reporte de caso

As lesões na face decorrentes de mordedura humana estão entre os tipos de trauma causados por violência interpessoal. Injúrias causadas nesta região podem gerar uma série de morbidades como perdas teciduais importantes, infecções, além de cicatrizes irreversíveis quando a ferida é passível de reparo, portanto, os cuidados pós-trauma devem visar à minimização de cura, além da funcionalidade, buscando o máximo de estética possível. Este trabalho tem como objetivo relatar um caso clínico de mordida humana em região de dorso nasal, com avulsão da ponta nasal, atendida no Hospital da Restauração Governador Paulo Guerra, Recife-PE, pelo serviço de Cirurgia Buco-Maxilo-Facial. Procedeu-se com reparo primário e antibioticoterapia profilática, no qual o resultado do tratamento foi considerado satisfatório, boa cicatrização tecidual e sem queixas funcionais e estéticas... (AU)

Injuries to the face resulting from human bite are among the types of trauma caused by interpersonal violence. The injuries caused in this region, can generate a series of morbidities such as major tissue loss, infection, and irreversible scarring when the wound is repairable, therefore, posttrauma care should aim to minimize healing, in addition to functionality, seeking maximum aesthetics as possible. This paper aims to report a clinical case of human bite in the nasal dorsum region, with avulsion of the nasal tip, attended at the Hospital da Restauração Governador Paulo Guerra, Recife-PE, by the service of Oral and Maxillofacial Surgery. It was proceeded with primary repair and prophylactic antibiotic therapy, in which the result of the treatment was considered satisfactory, good tissue healing and without functional and aesthetic complaints... (AU)

Las lesiones faciales producidas por mordeduras humanas se encuentran entre los tipos de traumatismos causados por la violencia interpersonal. Las lesiones causadas en esta región pueden generar una serie de morbilidades como la pérdida de tejidos importantes, la infección y la cicatrización irreversible cuando la herida es reparable, por lo tanto, los cuidados posttrauma deben tener como objetivo minimizar la cicatrización, además de la funcionalidad, buscando la máxima estética posible. Este trabajo tiene como objetivo reportar un caso clínico de mordedura humana en la región del dorso nasal, con avulsión de la punta nasal, atendido en el Hospital da Restauração Governador Paulo Guerra, Recife-PE, por el servicio de Cirugía Oral y Maxilofacial. Se procedió a la reparación primaria y a la terapia antibiótica profiláctica, en la que el resultado del tratamiento se consideró satisfactorio, con buena cicatrización de los tejidos y sin quejas funcionales y estéticas... (AU)

Análisis de las Variaciones Anatómicas y Dimensionales del Canal Nasopalatino Mediante Tomografía Computarizada de Haz Cónico / Analysis of the Anatomical and Dimensional Variations of the Nasopalatine Canal by Cone Beam Computed Tomography

El conocimiento anatómico del canal nasopalatino (CNP) es fundamental para la realización de cirugías en el sector anterior del maxilar y así prever posibles complicaciones. El objetivo de este trabajo es evaluar y determinar las variaciones anatómicas y dimensionales del CNP según sexo, edad y estado dental. Este estudio transversal analizó un total de 251 imágenes de TCHC obtenidas de la base de datos del Servicio de Imagenología Oral y Maxilofacial de la Facultad de Odontología de la Universidad Andrés Bello, Viña del Mar, Chile. Para evaluar la asociación estadística entre variaciones del CNP con sexo, edad y estado dentario se realizó la prueba T de Student, chi-cuadrado y ANOVA (p0,05). Además, se detectó diferencia significativa entre el estado dentario y la dimensión de la tabla vestibular en relación con el CNP (p<0,01). Se deben considerar las variaciones de CNP para evitar posibles complicaciones durante los procedimientos quirúrgicos.

SUMMARY: Anatomical knowledge of the nasopalatine canal (PNC) is essential for performing surgeries in the anterior sector of the maxilla and thus anticipating possible complications. The objective of this work is to evaluate and determine the anatomical and dimensional variations of the CNP according to sex, age and dental status. This cross-sectional study analyzed a total of 251 CBCT images obtained from the database of the Oral and Maxillofacial Imaging Service of the Faculty of Dentistry of the Andrés Bello University, Viña del Mar, Chile. To evaluate the statistical association between CNP variations with sex, age and dental status, the Student's T test, chi-square and ANOVA (p0.05). In addition, a significant difference was detected between the dental state and the dimension of the vestibular table in relation to the CNP (p<0.01). CNP variations should be considered to avoid potential complications during surgical procedures.

Polígonos de la punta nasal / Nasal tip polygons

La estética de la superficie de la nariz y especialmente de la punta nasal se crea mediante ciertas líneas, sombras y reflejos, con proporciones y puntos de ruptura específicos. La evaluación de la estética de la superficie nasal se logra utilizando el concepto de polígonos geométricos como subunidades estéticas, tanto para definir la deformidad existente como los objetivos estéticos. Los principios de los polígonos geométricos permiten al cirujano analizar las deformidades de la nariz, definir un plan operatorio para lograr objetivos específicos y seleccionar la técnica operatoria adecuada

The aesthetics of the surface of the nose and specially of the nasal tip is created through certain lines, shadows and reflections with proportions and specific breaking points. The evaluation of the aesthetics of the nasal surface is achieved using the concept of geometric polygons like aesthetics subunits to define the existing deformity as for the aesthetics objectives. The principles of the geometric polygons allow the surgeon to analyze the deformities of the nose, to define an operating plan to achieve specific objectives and to select the most accurate operating technique

Rinoplastia en nariz mestiza, un desafío quirúrgico / Rhinoplasty in mestizo nose, a surgical challenge

Las características anatómicas de pacientes con nariz mestiza, generalmente, incluyen una nariz aparentemente grande, un dorso convexo con radix bajo y una base nasal ancha. La longitud de la columela y punta nasal se ve disminuida debido a que los cartílagos alares son cortos, débiles y delgados, proporcionando un soporte estructural insuficiente, mala definición y proyección de la punta nasal. La principal dificultad al manejar este tipo de narices es un marco osteocartilaginoso mal estructurado y débil. En los últimos años se han desarrollado técnicas quirúrgicas para mejorar los resultados estéticos y funcionales de la rinoplastía en estos pacientes. Se realizó una revisión exhaustiva de la literatura describiendo las técnicas quirúrgicas utilizadas en este tipo de nariz.

The anatomical characteristics of patients with mestizo nose usually include an apparently large nose, a convex dorsum with a deep radix, and a wide nasal base. The length of the nasal columella and tip is decreased because the alar cartilages are short, weak and thin, providing insufficient structural support, poor definition and nasal tip projection. The main difficulty in managing this type of noses is a poorly structured and weak osteocartilaginous framework. In recent years, surgical techniques have been developed to improve the aesthetic and functional results of rhinoplasty in these patients. A comprehensive literature review was conducted describing the surgical techniques used in this type of nose.

Extranodal NK/T cell lymphoma, nasal type involving the larynx and digestive tract: a case report and literature review / 临床耳鼻咽喉头颈外科杂志

Extranodal NK/T cell lymphoma, nasal type（ENKTL） is a highly aggressive malignant tumor derived from NK cells. This article reports a case of ENKTL invading the larynx and digestive tract. The clinical clinical manifestations include hoarseness and intranasal masses.

Application of U-Net network in automatic image segmentation of adenoid and airway of nasopharynx / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the effect of fully automatic image segmentation of adenoid and nasopharyngeal airway by deep learning model based on U-Net network. Methods:From March 2021 to March 2022, 240 children underwent cone beam computed tomography（CBCT） in the Department of Otolaryngology, Head and Neck Surgery, General Hospital of Shenzhen University. 52 of them were selected for manual labeling of nasopharynx airway and adenoid, and then were trained and verified by the deep learning model. After applying the model to the remaining data, compare the differences between conventional two-dimensional indicators and deep learning three-dimensional indicators in 240 datasets. Results:For the 52 cases of modeling and training data sets, there was no significant difference between the prediction results of deep learning and the manual labeling results of doctors（P>0.05）. The model evaluation index of nasopharyngeal airway volume: Mean Intersection over Union（MIOU） s （86.32±0.54）%; Dice Similarity Coefficient（DSC）: （92.91±0.23）%; Accuracy: （95.92±0.25）%; Precision: （91.93±0.14）%; and the model evaluation index of Adenoid volume: MIOU: （86.28±0.61）%; DSC: （92.88±0.17）%; Accuracy: （95.90±0.29）%; Precision: （92.30±0.23）%. There was a positive correlation between the two-dimensional index A/N and the three-dimensional index AV/（AV+NAV） in 240 children of different age groups（P<0.05）, and the correlation coefficient of 9-13 years old was 0.74. Conclusion:The deep learning model based on U-Net network has a good effect on the automatic image segmentation of adenoid and nasopharynx airway, and has high application value. The model has a certain generalization ability.

The current status and expectation of pediatric total facial management / 临床耳鼻咽喉头颈外科杂志

The pediatric total facial management refers to a series of diagnosis and treatment processes to achieve the healthy development of the face through reasonable medical intervention. The main reason for the poor treatment effect is that the first contact doctor is limited to his own disciplinary analysis and treatment. The importance of multidisciplinary cooperation in the diagnosis and treatment of facial dysplasia in children has become increasingly prominent. it is necessary to comprehensively analyze and find the pathogenic factors of patients and formulate a comprehensive treatment plan to restore normal upper airway structure and nasal breathing, and then reshape the healthy craniomaxillofacial tissue structure, and the monitoring of the results of medical intervention should accompany the whole process of children's growth and development. This paper summarizes the current situation of the treatment of children with facial dysplasia and puts forward the concept of orderly individualized multi-disciplinary diagnosis and treatment of pediatric oral maxillofacial management.

One-year clinical observation of muscular force balance reconstruction technique for the correction of secondary nasal malformation after cleft lip surgery / 华西口腔医学杂志

OBJECTIVES@#The long-term effect of muscular force balance reconstruction technique combined with intranasal fixation for correcting secondary nasolabial deformity after unilateral cleft lip was evaluated. The aim was to provide a basis for further improving the surgical treatment effect of secondary nasolabial deformity of acleft lip.@*METHODS@#A total of 40 patients aged 4-28 years with secondary nasal deformity and unilateral cleft lip were selected as research subjects. The two-dimensional photo measurement analysis method was used in comparing the surgical results before and immediately after the operation (7 d) and 1 year after the operation.@*RESULTS@#Columellar angle, nostril height ratio (NHR), alar rim angle, alar rim angle ratio, and nostril shape (NS) increased dimmediately after the operation, whereas alar base width ratio (ABWR) and nostril width ratio decreased (NHR) immediately after the operation (P<0.01). The ABWR, NHR, and NS immediately after the operation were not significantly different from those 1 year after the operation (P>0.05).@*CONCLUSIONS@#Muscular force balance reconstruction technique combined with intranasal fixation is effective in the repair of unilateral secondary nasolabial deformity, and stable results can be obtained 1 year after surgery.

Three-dimensional reconstruction reveals the correlation between the extent of alveolar clefts and secondary nasal deformity in adults / 华西口腔医学杂志

OBJECTIVES@#This study aimed to explore the relationship between alveolar cleft and secondary nasal deformity post unilateral cleft lip repair in adults.@*METHODS@#A total of 27 patients aged 16-30 years old with unilateral secondary nasal deformity and alveolar cleft were included, 13 of whom underwent bone grafting. Spiral CT data of all preoperative and postoperative patients who had alveolar bone grafting were collected. Then, Mimics software was used for three-dimensional reconstruction to evaluate the correlation between the width, height, and volume of the alveolar cleft and those of the nasal deformity. The difference in nasal deformity before and after alveolar bone grafting was also explored.@*RESULTS@#The width of the alveolar cleft was positively correlated with the difference in bilateral nostril floor width (P<0.05). As the effective depth of the alveolar cleft increased, the sub-alare inclination angle largened (P<0.05). However, no significant difference was found in the nasal deformity between before and after alveolar bone grafting.@*CONCLUSIONS@#Alveolar cleft is closely related to secondary nasal deformities post unilateral cleft lip repair, especially nasal floor deformities. Alveolar bone grafting benefits adult patients for the improvement of secondary nasal deformities post unilateral cleft lip repair.

Impact of sinonasal anatomic changes after endoscopic anterior skull base surgery on nasal airflow and air conditioning: a computational fluid dynamics study / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the impact of the sinonasal anatomic changes after endonasal endoscopic anterior skull base surgery on the nasal airflow and heating and humidification by computational fluid dynamics (CFD), and to explore the correlation between the postoperative CFD parameters and the subjective symptoms of the patients. Methods: The clinical data in the Rhinology Department of the First Affiliated Hospital of Zhengzhou University from 2016 to 2021 were retrospectively analyzed. The patients received the endoscopic resection of the anterior skull base tumor were selected as the case group, and the adults whose CT scans had no sinonasal abnormalities were chosen as the control group. The CFD simulation was performed on the sinonasal models after reconstructed from the patients' sinus CT images during the post-surgical follow-up. All the patients were asked to complete the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) to assess the subjective symptoms. The comparison between two independent groups and the correlation analysis were carried out by using the Mann-Whitney U test and the Spearman correlation test in the SPSS 26.0 software. Results: Nineteen patients (including 8 males and 11 females, from 22 to 67 years old) in the case group and 2 patients (a male of 38 years old and a female of 45 years old) in the control group were enrolled in this study. After the anterior skull base surgery, the high-speed airflow moved to the upper part of the nasal cavity, and the lowest temperature shifted upwards on the choana. Comparing with the control group, the ratio of nasal mucosal surface area to nasal ventilation volume in the case group decreased [0.41 (0.40, 0.41) mm-1 vs 0.32 (0.30, 0.38) mm-1; Z=-2.04, P=0.041], the air flow in the upper and middle part of the nasal cavity increased [61.14 (59.78, 62.51)% vs 78.07 (76.22, 94.43)%; Z=-2.28, P=0.023], the nasal resistance decreased [0.024 (0.022, 0.026) Pa·s/ml vs 0.016 (0.009, 0.018) Pa·s/ml; Z=-2.29, P=0.022], the lowest temperature in the middle of the nasal cavity decreased [28.29 (27.23, 29.35)℃ vs 25.06 (24.07, 25.50)℃; Z=-2.28, P=0.023], the nasal heating efficiency decreased [98.74 (97.95, 99.52)% vs 82.16 (80.24, 86.91)%; Z=-2.28, P=0.023], the lowest relative humidity decreased [(79.62 (76.55, 82.69)% vs 73.28 (71.27, 75.05)%; Z=-2.28, P=0.023], and the nasal humidification efficiency decreased [99.50 (97.69, 101.30)% vs 86.09 (79.33, 87.16)%; Z=-2.28, P=0.023]. The ENS6Q total scores of all patients in the case group were less than 11 points. There was a moderate negative correlation between the proportion of the inferior airflow in the post-surgical nasal cavity negatively and the ENS6Q total scores (rs=-0.50, P=0.029). Conclusions: The sinonasal anatomic changes after the endoscopic anterior skull base surgery alter the nasal airflow patterns, reducing the efficiency of nasal heating and humidification. However, the post-surgical occurrence tendency of the empty nose syndrome is weak.

Study on static parameters of internal nasal valve in 3-dimensional model of nasal cavity space / 中华耳鼻咽喉头颈外科杂志

Objective: To identify the internal nasal valve (INV) and to evaluate its key parameters in the established 3D models of nasal cavity space via Mimics from CT images, in order to provide evidence for quantitative diagnosis of nasal valve compromise. Methods: A total of 32 Han adults without nasal diseases who underwent maxillofacial CT test in Shanghai Ninth People's Hospital from January 2015 to December 2018 were retrospectively recruited, including 16 males and 16 females, with the age ranged from 20 to 80 years (50% age<50 years old). Maxillofacial CT images were used to create 3D model of nasal cavity space. The INV was identified and the following parameters were measured: the angle between the INV and the nasal bone (θINV-B), unilateral cross-sectional area of the INV (AINV-R, AINV-L), total cross-sectional area of the INV (AINV), unilateral height of the INV (HINV-R, HINV-L), unilateral nasal valve angle (αINV-R, αINV-L), and the sum of nasal valve angle (αINV). The AINV in our study was compared with the results of the previously adopted planes (PlaneC, perpendicular to the hard palate and PlaneB, plane perpendicular to the nasal bone). The parameters above were compared among genders, age and race groups. SPSS 26 and GraphPad Prism 9 software were used for statistical analysis and mapping of data. Results: The AINV in our study was (214.87±52.94) mm², which was significantly less than that of PlaneC (254.97±47.80) mm² and PlaneB (226.07±57.36) mm². The measured parameters were as follows: θINV-B was (82.07±7.06)°; AINV-R was (112.66±31.39) mm²; AINV-L was (102.21±27.14) mm²; AINV was (214.87±52.94) mm²; HINV-R was (24.87±4.62) mm; HINV-L was (24.35±4.86) mm; αINV-R was (20.48±2.99)°; αINV-L was (19.65±3.82)°; αINV was (40.13±6.24)°. The AINV-R was larger than AINV-L (t=2.33, P<0.05); The HINV, AINV-R, AINV-L and AINV of males were more than those of females (t value was 5.77, 3.21, 2.91 and 3.52, respectively, all P<0.01). The AINV of the young group (<50 years) was larger than that of the old group (t=2.83, P<0.01); The θINV-B was different between the Han people and the Caucasian (t=2.92,P<0.01). The αINV of the Han people was larger than that of Caucasians (Z=-6.92, P<0.01), but the HINV was smaller (Z=-3.89, P<0.01). Conclusion: The AINV carried out in 3D models of nasal cavity space is significantly smaller than that obtained by the previous methods of CT evaluation. INV static parameters differ among genders, age and race groups.

External rhinoplasty based on the classification of alar retraction associating with exposure of the nostrils / 中华耳鼻咽喉头颈外科杂志

Objective: To introduce a classification of alar retraction, and to discuss the therapeutic strategy of alar retraction with cartilage graft and the satisfaction evaluation of patients after operation. Methods: A retrospective analysis was performed on 88 patients with alar retraction admitted to the Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital of Central South University from January 2015 to December 2020, including 20 males and 68 females, aged 20 to 48 years, with an average age of 28.98 years. All patients underwent external rhinoplasty according to a series of treatment plans determined by the classification of alar retraction based on nostril exposure. Visual Analogue Scale (VAS) and Rhinoplasty Outcomes Evaluation (ROE) were used to conduct satisfaction survey before and 12 months after operation. Wilcoxon signed-rank test was used to analyze patient satisfaction. Results: A total of 88 patients were included in this study. According to the classification of alar retraction based on nostril exposure, 45 cases were mild, 23 cases were moderate, and 20 cases were severe. There were 16 cases of unilateral and 72 cases of bilateral alar retraction. The patients were followed up for 12 to 18 months, with an average of 13.37 months. The VAS score and ROE score after each type of surgery were higher than those before surgery, with statistically significant (all P<0.05). Among them, the difference in VAS score (6.75±1.29) and in ROE satisfaction (67.70±7.38) of patients with severe alar retraction were the most significant improvement. Conclusion: The classification of alar retraction based on nostril exposure in the frontal view can comprehensively evaluate the severity of alar retraction, and makes the treatment algorithms systematic and comprehensive. The satisfaction of patients is relatively high.

Two-stage alveolar bone grafting for nasal floor reconstruction in adult cleft patients / 华西口腔医学杂志

Alveolar cleft is one of the key links of cleft lip and palate reconstruction due to its close relationship with tooth and jaw coordination and nasolabial deformity. The alveolar bone graft repairs the hole in the gum ridge and stabilizes the bone arch, providing better support for the base of the nose and new bone for the roots of the developing teeth to grow into. Unfortunately, bone graft failure in the traditional way, even among minor clefts, bony hypoplasia, or absence that affects the nasal base and piriform rim, is common. Two-stage alveolar bone grafting, which has advantages in addressing the underlying skeleton and deficiency, could be an optional surgical procedure for nasal floor reconstruction in adult patients with a broad alveolar cleft.

Analysis of related factors for postoperative recurrence of antrochoanal polyps in children / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the correlation between nasal resistance and lung function in children with allergic rhinitis（AR）, and explore whether AR children with increased nasal resistance are accompanied by potential lower respiratory tract involvement. Methods:A total of 88 children diagnosed with AR from December 2021 to December 2022 were selected as the study group, while 20 normal children were selected as the control group during the same period. Both the study group and the control group children underwent lung function tests, bronchodilator tests, and nasal resistance measurements. Spearman correlation analysis and multiple linear regression analysis were performed on the results of nasal resistance and lung function tests to explore the relationship and influencing factors between the two groups.According to the results of nasal resistance measurement, children with increased nasal resistance and abnormal lung function were divided into a mild increase in nasal resistance with abnormal lung function group and a moderate to severe increase in nasal resistance with abnormal lung function group. The degree of increased nasal resistance was analyzed to determine whether it would affect lung function. Results:The FEF25, FEF50, and FEF75 levels in the study group were significantly lower than those in the control group（P<0.05）. The FEV1of children with moderate to severe increase in AR nasal resistance was significantly lower than that of children with mild increase in AR nasal resistance（P<0.05）. There was a correlation between nasal resistance and FEV1/FVC, R20 in AR children, and FEV1/FVC, R20 were the influencing factors of nasal resistance in AR children（P<0.05）. There was no correlation between total serum IgE, lung function, and bronchodilation test in AR patients（P>0.05）. Conclusion:The nasal ventilation function of AR patients has changed, and there is a downward trend in small airway function. Children with moderate to severe increase in AR nasal resistance have a more significant decrease in lung ventilation function than those with mild increase. The nasal resistance of AR children is influenced by FEV1/FVC and R20, and FEV1/FVC and R20 decrease as the nasal resistance value increases. The improvement rate of lung function and FEV1 are not influencing factors for the elevation of total serum IgE.

Evaluation of subjective scale in allergen nasal provocation test / 临床耳鼻咽喉头颈外科杂志

Objective:To compare the clinical value of visual analogue scale （VAS）, Lebel scale and total nasal symptom scores （TNSS） in evaluating nasal allergen provocation test （NAPT）. Methods:A total of 151 patients suspected of allergic rhinitis admitted to the Department of Otolaryngology-Head and Neck Surgery of our hospital from April 2020 to September 2020 were included, of which 76 were positive for house dust mites and 75 were negative for allergens. Nasal airway resistance（NAR） was measured by active anterior nasal manometry. Nasal symptoms were evaluated by VAS, Lebel and TNSS. House dust mite allergen was used for NAPT by spray method. An increase≥40% in NAR was used as the gold standard for objective evaluation of NAPT. ROC curves of VAS, Lebel and TNSS were drawn to compare the evaluation effectiveness of different subjective evaluation methods, and the optimal critical point of each ROC curve was obtained. Results:With NAR increased by ≥40% as the gold standard, the area under ROC curve of VAS was 0.884, and the sensitivity and specificity were 97.75% and 80.65%, respectively. The area under ROC curve of Lebel was 0.773, and the sensitivity and specificity were 68.54% and 75.81%, respectively. The area under ROC curve of TNSS was 0.792, and the sensitivity and specificity were 68.54% and 79.03%, respectively. There was no significant difference between Lebel and TNSS（P>0.05）. The VAS differed significantly from Lebel and TNSS（P<0.05）. The Kappa values of VAS, Lebel, TNSS and NAR were 0.803, 0.432 and 0.459, respectively. Conclusion:The VAS, Lebel, TNSS subjective scale and NAR are consistent in evaluating the efficacy of NAPT, with the VAS assessment showing highest consistency with NAR. As objective assessment instruments are not widely used in China, subjective assessment method could be adopted to evaluate the efficacy of NAPT in clinical practice, and VAS scale is recommended as a priority.

Different rapid maxillary expansion methods in the treatment of adult patients with obstructive sleep apnea hypopnea syndrome / 中华口腔医学杂志

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep respiratory disorder characterized by upper respiratory collapse during sleep, with a high prevalence and potentially fatal complications. Currently, maxillary transverse deficiency are considered to be an important pathogenic factor of OSAHS. For patients with poor compliance with positive airway pressure therapy, rapid maxillary expansion can increase the volume and ventilation of the upper respiratory tract, which is an alternative treatment. This paper reviewed the current research on surgically assisted rapid palatal expansion, miniscrew assisted rapid palatal expansion, and distraction osteogenesis maxillary expansion in the treatment of adult OSAHS. By comparing the indications, contraindications, complications, efficacy and long-term stability of the three treatment methods, it provided reference for treatment of patients with OSAHS.

Resultados de la técnica septum bisagra en desviación de la punta nasal / Septum hinge technique outcomes in nasal tip deviation

Introducción: La desviación de la punta nasal suele producir alteración estética y funcional nasal. Generalmente, asocia alteraciones morfológicas de los cartílagos alares, además de dismorfia del cartílago septal. Objetivo: Presentar una técnica quirúrgica alternativa para el tratamiento de la laterorrinia en tercio inferior nasal y sus resultados. Material y Método: Se trataron 27 pacientes con una laterorrinia en punta nasal con la técnica del septum bisagra, incluyendo la colocación de uno o dos injertos de expansión. Describimos el protocolo de anamnesis y exploración que seguimos en estos pacientes y la descripción detallada de la técnica quirúrgica. Resultados: En 19 pacientes se utilizó un injerto de expansión unilateral para completar la técnica y en ocho de forma bilateral. Se obtuvo una puntuación media en la escala visual analógica (EVA) de ventilación de 8,3, con una mejoría de seis puntos, y en la EVA de aspecto estético de 8,1, mejorando en 4,6 puntos. Conclusión: la utilización de la técnica del septum bisagra es beneficiosa para el tratamiento de la desviación de la punta nasal, tanto a nivel funcional como estético. Presenta ciertas diferencias frente a otras técnicas descritas. La indicación se debe adecuar a cada paciente de manera individualizada.

Introduction: Deviation of nasal tip usually produces aesthetic disturbance and nasal ventilation decrease. It is usually associated with alar cartilages morphologic disturbances and dysmorphia of the septal cartilage. Aim: To present an alternative surgical technique for treating laterorrhinia in the nasal inferior third and its outcomes. Material and Method: 27 patients with nasal tip laterorrhinia were treated with the hinge septum technique, including the placement of one or two spreader grafts. We describe the anamnesis and exploration protocol that we carried out in these patients and a detailed description of the surgical procedure. Results: Unilateral spreader graft was used in 19 patients to complete the technique, and bilateral spreader graft was used in eight. The average score in visual analogue scale (VAS) related to nasal flow was 8.3, which means an improvement of six points, and in VAS related to aesthetic appearance the score was 8.1, improving 4.6 points. Conclusion: The use of the hinge septum technique is useful to treat the deviation of the nasal tip in a functional and aesthetic way. There are several differences compared to other described techniques. The indication has to be suitable for each patient individually.

Rinoplastia cerrada: una técnica vigente / Closed Rhinoplasty: a current technique

La rinoplastia cerrada es una cirugía que se realiza con el fin de cambiar la estructura de la nariz, con fines cosméticos o reparadores. Se busca realizar pequeños retoques que logren un aspecto natural. Es una de las cirugías estéticas más complejas y representa un reto para el cirujano, pues combina técnica con sensibilidad y ciencia con arte. En este artículo describimos esta técnica con el objetivo de demostrar su eficacia y vigencia, sin compararla con la rinoplastia abierta, pues no es motivo de discusión en este trabajo, por lo que no podemos asegurar que una opción es mejor o peor que la otra. Lo más conveniente es que los cirujanos estén capacitados para realizar cualquiera de estas. Con la rinoplastia cerrada se logran resultados que llenan las expectativas tanto de los pacientes, como de los cirujanos y el post operatorio es breve y prácticamente sin incidentes. Es una propuesta que tiene indicaciones precisas en el marco de una rinoplastia preservadora, que es tendencia a nivel mundial en la actualidad.

Closed rhinoplasty is a surgery that is performed in order to change the structure of the nose, for cosmetic or restorative purposes. It seeks to make small touches that achieve a natural appearance. It is one of the most complex cosmetic surgeries and represents a challenge for the surgeon, as it combines technique with sensitivity and science with art. In this article, we describe this technique in order to demonstrate its effectiveness and validity, without comparing it with open rhinoplasty, since it is not a matter of discussion in this work, so we cannot guarantee that one option is better or worse than the other. It is best if surgeons are trained to perform any of these. With closed rhinoplasty, results are achieved that meet the expectations of both patients and surgeons, and the postoperative period is brief and practically uneventful. It is a proposal that has precise indications within the framework of conservative rhinoplasty, which is currently a worldwide trend.