ABSTRACT
The planning of experimental studies for evaluation of nasal airflow is particularly challenging given the difficulty in obtaining objective measurements in vivo. Although standard rhinomanometry and acoustic rhinometry are the most widely used diagnostic tools for evaluation of nasal airflow, they provide only a global measurement of nasal dynamics, without temporal or spatial details. Furthermore, the numerical simulation of nasal airflow as computational fluid dynamics technology is not validated. Unfortunately, to date, there are no available diagnostic tools to objectively evaluate the geometry of the nasal cavities and to measure nasal resistance and the degree of nasal obstruction, which is of utmost importance for surgical planning. To overcame these limitations, we developed a mathematical model based on Bernoulli's equation, which allows clinicians to obtain, with the use of a particular direct digital manometry, pressure measurements over time to identify which nasal subsite is obstructed. To the best of our knowledge, this is the first study to identify two limiting curves, one below and one above an average representative curve, describing the time dependence of the gauge pressure inside a single nostril. These upper and lower curves enclosed an area into which the airflow pattern of healthy individuals falls. In our opinion, this model may be useful to study each nasal subsite and to objectively evaluate the geometry and resistances of the nasal cavities, particularly in preoperative planning and follow-up.
Subject(s)
Models, Theoretical , Nasal Obstruction/diagnosis , Nasal Obstruction/surgery , Preoperative Care , Adult , HumansABSTRACT
The effectiveness of sinus ventilation is due to a regular anatomy of inner nose structures such as the maxillary sinus ostium. With the aid of nose and sinus manometric measurements, it is possible to show that better functional results can be achieved using a conservative surgical technique. The present study compared 30 patients subdivided in two groups. Group A underwent conservative endoscopic sinus surgery whereas group B was operated on using non-conservative endoscopic sinus surgery. Thirty days later, both groups underwent a manometric survey of the maxillary sinus ostium by means of the digital manometry system. The pressure values obtained by nasal and sinus manometry in Group A or Group B patients were referred to those obtained in a Standard Group without nasal-sinus pathologies, calculating a percentage index of functional efficacy (maxillary sinus functional efficacy). The average percentage of the maxillary sinus functional efficacy was 98,35 percent for group-A patients, and 49,73 percent for group-B patients. Student t test revealed a statistical difference only between group B patients and standard group patients (p less than 0.4). Patients submitted to a more aggressive endoscopic approach showed inadequate sinus ventilation when compared to the standard reference group.
Subject(s)
Endoscopy/methods , Manometry/methods , Maxillary Sinus/surgery , Adult , Aged , Female , Humans , Male , Maxillary Sinus/physiopathology , Middle AgedABSTRACT
Aesthetic nasal surgery has progressed in the last years, as concerning both surgical techniques and surgical instruments, which allowed the finding of new and more sophisticated surgical solutions. Clinical practice led to observe sometimes functional surgical failures, due rather than an inaccurate surgical technique, to an incomplete diagnostic approach to the patient. It has been observed that modifying the external conformation of nasal pyramidis inner-nose volumes and spaces will be subsequently reduced, giving as a result a condition which is only aesthetically but not functionally valid. 32 subjects, selected for a rhinoplasty and presenting nasal respiratory obstruction and anterior ethmoid abnormalities, confirmed by nasal endoscopy and nasal CT, were evaluated and subdivided into two groups: the first (A) group underwent only to an aesthetic rhinoplasty, the second group (B) was operated of a rhinoplasty combined with functional endoscopic sinus surgery (FESS) in order to correct the above mentioned anatomical abnormalities. The nasal airflow, and though the nasal cavities patency, was evaluated pre- and post-operatively in the two groups of patients, referring to rhinomanometric conductance values. Patients of group A reported decreased post-operative conductance values, patients of group B reported increased post-operative conductance values, showing though the functional involvement of anterior ethmoid in nasal obstruction and the necessity of correcting its anatomical abnormalities, in order to reach not only a new nasal profile, but also a better respiratory performance.
Subject(s)
Esthetics , Ethmoid Bone/surgery , Nose/physiology , Paranasal Sinus Diseases/surgery , Rhinoplasty/methods , Adolescent , Adult , Endoscopy , Ethmoid Bone/physiopathology , Female , Humans , Male , Paranasal Sinus Diseases/physiopathologyABSTRACT
La cirugía estética nasal ha progresado en los últimos años tanto en cuanto a las técnicas quirúrgicas como en cuanto a los instrumentos, que permiten encontrar nuevas y más sofisticadas soluciones quirúrgicas. La práctica clínica nos permite observar a veces fallos quirúrgicos funcionales, debidos más que a una técnica quirúrgica inadecuada, a un abordaje diagnóstico incompleto del paciente. Se ha observado que modificando la forma externa de la pirámide nasal, el volumen y los espacios internos de la nariz se verán consiguientemente reducidos, dando así pues como resultado sólo una condición estética pero no válida funcionalmente. 32 pacientes, seleccionados para rinoplastia y que presentaban obstrucción nasal y anomalias etmoidales anteriores, confirmadas por endoscopia nasal y TC, fueron evaluados y subdivididos en dos grupos: Al primer grupo (A) sólo se le practicó rinoplastia estética y al segundo (B) se le practicó rinoplastia combinada con cirugía endoscópica funcional sinusal (FESS) par corregir las anomalías anatómicas más arriba mencionadas. El flujo nasal y asi pues la permeabilidad de las cavidades nasales, fue evaluado pre y posoperatoriamente en los dos grupos, referidos a los valores rinomanométricos. Los pacientes del grupo A tuvieron valores postoperatorios inferiores y los del grupo B superiores, mostrando así pues la relación funcional del etmoides anterior en la obstrucción nasal y la necesidad de corregir sus anomalías anatómicas, para no sólo conseguir un nuevo perfil nasal, sino también una mejor respiración (AU)
