Septal extension graft use in the treatment of alar collapse.

OBJECTIVE: In our study, we showed that the septal extension graft (SEG) technique, which we applied for nasal projection in rhinoplasty surgery, increases the tension of the lateral cartilage (LC) and alar structures. We also demonstrated that nasal congestion could be treated by applying this technique in patients with nasal obstruction due to bilateral dynamic alar collapse. PATIENTS AND METHODS: This study was conducted retrospectively on 23 patients with nasal obstruction due to alar collapse. Bilateral dynamic nasal collapse and (+) Cottle test was present in all patients. Nasal lateral wall tissue was also found flaccid on nasal palpation and collapsed to the extent of obstruction on deep inspiration. Standard septal extension graft (SEG) and tongue-in-groove techniques were applied to all patients. RESULTS: Septal cartilage was used for SEG in all patients. No complaints of nasal obstruction on deep inspiration were noted by the patients at six months postoperative follow-up, and Cottle tests were negative. The patients' mean respiratory score was 152 postoperatively, compared to 66.5 preoperatively. This difference was statistically significant using the Wilcoxon signed ranks test (p<0.001). In evaluating postoperative cosmetic appearance due to nasal tip projection (NTP) and cephalic rotation changes, 16 men and four women reported that it was better, while two men felt that there was no change. One woman reported that her cosmetic appearance was worse than before; a revision surgery was performed for her at seven months postoperatively. CONCLUSIONS: This method is effective for patients with bilateral nasal collapse and thick-short columella. With the applied surgery, the caudal edge of the LC diverges from the septum, alar region tension and resistance increase, the columella increases in length, nasal projection increases, and the vestibule cross-sectional area is enlarged. In this way, a significant increase in nasal vestibular volume was obtained.

The intranasal trigeminal system: roles in rhinitis (allergic and non-allergic).

The aim of this paper is to review intranasal trigeminal system and associated reflexes. The literature survey was performed on PubMed, ProQuest Central database of Kirikkale University and Google Scholar. The intranasal trigeminal system and associated reflexes play an important role in humans in both health and disease, including in rhinitis of non-allergic and mixed type. The intranasal trigeminal nerve provides sensory perception to the lining of the nose, supplying information on how patent the nasal airway is and responding to various chemical signals. The reflexes known to exist within the intranasal trigeminal system are nasobronchial reflex, trigemino-cardiac reflex, nasogastric reflex, and nasal cycle. The intranasal trigeminal system and its reflexes play a vital role in normal human physiology. Alterations in how this system operates may underlie multiple forms of rhinitis and more research is needed to fully understand the mechanisms involved.