[Effect of nasal swell body on nasal airflow and Artemisia pollen deposition].

Objective:The nasal swell body（NSB） consists of the nasal septal cartilage, nasal bone, and swollen soft tissue, all of which are visible during endoscopic and imaging examinations. Although the function of the NSB remains uncertain, there is evidence to suggest that it plays a vital role in regulating nasal airflow and filtering inhaled air. Based on anatomical and histological evidence, it is hypothesized that the NSB is indispensable in these processes. This study aims to investigate the impact of NSB on nasal aerodynamics and the deposition of allergen particles under physiological conditions. Methods:The three-dimensional （3D） nasal models were reconstructed from computed tomography （CT） scans of the paranasal sinus and nasal cavity in 30 healthy adult volunteers from Northwest China, providing basis for the construction of models without NSB following virtual NSB-removal surgery. To analyze the distribution of airflow in the nasal cavity, nasal resistance, heating and humidification efficiency, and pollen particle deposition rate at various anatomical sites, we employed the computed fluid dynamics（CFD） method for numerical simulation and quantitative analysis. In addition, we created fully transparent segmented nasal cavity models through 3D printing, which were used to conduct bionic experiments to measure nasal resistance and allergen particle deposition. Results:①The average width and length of the NSB in healthy adults in Northwest China were （12.85±1.74） mm and （28.30±1.92） mm, respectively. ②After NSB removal, there was no significant change in total nasal resistance, and cross-sectional airflow velocity remained essentially unaltered except for a decrease in topical airflow velocity in the NSB plane. ③There was no discernible difference in the nasal heating and humidification function following the removal of the NSB; ④After NSB removal, the deposition fraction（DF） of Artemisia pollen in the nasal septum decreased, and the DFs post-and pre-NSB removal were（22.79±6.61）% vs （30.70±12.27）%, respectively; the DF in the lower airway increased, and the DFs post-and pre-NSB removal were（24.12±6.59）% vs （17.00±5.57）%, respectively. Conclusion:This study is the first to explore the effects of NSB on nasal airflow, heating and humidification, and allergen particle deposition in a healthy population. After NSB removal from the healthy nasal cavities: ①nasal airflow distribution was mildly altered while nasal resistance showed no significantly changed; ②nasal heating and humidification were not significantly changed; ③the nasal septum's ability to filter out Artemisia pollen was diminished, which could lead to increased deposition of Artemisia pollen in the lower airway.

Nasal Swell Body Characteristics in Patients With Septal Perforation.

Objective: To determine whether septal perforations have an effect on nasal swell body (NSB) size. Study Design: Retrospective cohort study. Setting: Two tertiary academic medical centers. Methods: Computed tomography maxillofacial scans of 126 patients with septal perforation and 140 control patients from November 2010 to December 2020 were evaluated. Perforation etiology was determined. Measurements included perforation length and height and swell body width, height, and length. Swell body volume was calculated. Results: The width and volume of the NSB are significantly smaller in perforation patients when compared to controls. The swell body is significantly smaller and thinner in perforations exceeding 14 mm in height compared to small perforations. Perforation etiology groupings into prior septal surgery, septal trauma, septal inflammatory, and mucosal vasoconstriction categories all demonstrated decreased swell body volume and width compared to controls. Inflammatory etiology had the greatest decrease in swell body size. The hemi-swell body on the contralateral side of a septal deviation is significantly thicker than the ipsilateral side. Conclusion: The NSB is smaller in patients with septal perforation regardless of perforation size or etiology.

Effect of nasal swell body on nasal airflow and Artemisia pollen deposition / 临床耳鼻咽喉头颈外科杂志

Objective:The nasal swell body（NSB） consists of the nasal septal cartilage, nasal bone, and swollen soft tissue, all of which are visible during endoscopic and imaging examinations. Although the function of the NSB remains uncertain, there is evidence to suggest that it plays a vital role in regulating nasal airflow and filtering inhaled air. Based on anatomical and histological evidence, it is hypothesized that the NSB is indispensable in these processes. This study aims to investigate the impact of NSB on nasal aerodynamics and the deposition of allergen particles under physiological conditions. Methods:The three-dimensional （3D） nasal models were reconstructed from computed tomography （CT） scans of the paranasal sinus and nasal cavity in 30 healthy adult volunteers from Northwest China, providing basis for the construction of models without NSB following virtual NSB-removal surgery. To analyze the distribution of airflow in the nasal cavity, nasal resistance, heating and humidification efficiency, and pollen particle deposition rate at various anatomical sites, we employed the computed fluid dynamics（CFD） method for numerical simulation and quantitative analysis. In addition, we created fully transparent segmented nasal cavity models through 3D printing, which were used to conduct bionic experiments to measure nasal resistance and allergen particle deposition. Results:①The average width and length of the NSB in healthy adults in Northwest China were （12.85±1.74） mm and （28.30±1.92） mm, respectively. ②After NSB removal, there was no significant change in total nasal resistance, and cross-sectional airflow velocity remained essentially unaltered except for a decrease in topical airflow velocity in the NSB plane. ③There was no discernible difference in the nasal heating and humidification function following the removal of the NSB; ④After NSB removal, the deposition fraction（DF） of Artemisia pollen in the nasal septum decreased, and the DFs post-and pre-NSB removal were（22.79±6.61）% vs （30.70±12.27）%, respectively; the DF in the lower airway increased, and the DFs post-and pre-NSB removal were（24.12±6.59）% vs （17.00±5.57）%, respectively. Conclusion:This study is the first to explore the effects of NSB on nasal airflow, heating and humidification, and allergen particle deposition in a healthy population. After NSB removal from the healthy nasal cavities: ①nasal airflow distribution was mildly altered while nasal resistance showed no significantly changed; ②nasal heating and humidification were not significantly changed; ③the nasal septum's ability to filter out Artemisia pollen was diminished, which could lead to increased deposition of Artemisia pollen in the lower airway.

[The septal tubercle: the state of the problem]. / Bugorok peregorodki nosa.

The septal tubercle is considered to be a thickened area of the nasal septum, which is located above the lower nasal concha and in front of the middle nasal concha. Taking into account its histological structure and location in the distal segment of the internal nasal valve, it is located and structured for secretory function and vasoactive regulation of the respiratory air flow. These histologically rich tissues with glandular elements are well adapted to the possible dryness that occurs under the influence of intense air flow during breathing, and the existence of a certain number of venous sinusoids of the blood confirms the connection with part of the extensive vascular tissues in the nasal cavity. It is believed that the tubercle of the nasal septum is more pronounced in patients with chronic inflammation of the sinonasal region, for example, with chronic allergic rhinitis or chronic rhinosinusitis. There is currently no consensus on the issue of surgery of the nasal septum body. Due to the lack of consensus among practitioners, many surgeons do not routinely perform operations on this structure and consider the surgical intervention too aggressive, and the effect on nasal obstruction is insignificant. However, according to the presented studies, the results of surgical reduction of soft tissues of the enlarged septal tubercle in the treatment of nasal obstruction using radiofrequency ablation, coblation or microdebrider seem promising, which requires additional study of this issue during long-term follow-up.

Using thermal effect of 970 nm diode laser to reduce nasal swell body.

In recent decades, semiconductor lasers have been successfully used in rhinology. However, their usage in the reduction of the nasal swell body (NSB) is barely studied. Our research aimed to conduct an experimental selection of the laser exposure mode in the NSB zone using a 970 nm diode laser for safe and effective NSB reduction. The thermometric parameters of a diode laser with a wavelength of 970 nm were evaluated in a continuous contact mode of exposure at the power from 2 W to 10 W with 2 W step. The laser was targeted at the liver of cattle, given its similar optical properties to the NSB region. After a series of experiments with every power rate and the analysis of temperature data, we estimated an optimal exposure mode at a power of 4 W. The collected thermometric data demonstrate the safety of this mode in a clinical setting for NSB reduction due to causing no thermal damage to the adjacent tissue. Based on the experiment, a technique for laser reduction of the NSB was developed to improve nasal breathing in patients with severe hypertrophy of this area. The proposed technique was applied to 39 patients with chronic vasomotor rhinitis and the NSB. All patients were divided into 2 groups. Group 1 consisted of 20 patients who underwent surface contact laser-turbinectomy and the NSB reduction using a 970 nm diode laser. Group 2 included 19 patients with the same pathology who underwent laser-turbinectomy, without reduction of the NSB. No statistically significant difference was observed during the dynamic observation with an objective assessment of nasal respiration according to active anterior rhinomanometry when comparing these subgroups with each other according to the t-criterion for independent samples (p > 0.05). As a result of comparing the data obtained on the NOSE scale using the Student's t-test, a statistically significant difference is observed (p < 0.001). Thus, patients who did not perform the reduction of the NSB subjectively noted the insufficiency of nasal breathing. This fact indicates that the NSB is involved in the regulation of airflow.

The Nasal Swell Body and Septal Perforation Repair.

OBJECTIVES: To review our experience with secondary surgery for persistent nasal obstruction following successful septal perforation repair and describe the potential contribution of the nasal swell body (NSB) to obstruction. STUDY DESIGN: Retrospective chart review. METHODS: IRB-approved retrospective chart review of perforation repairs utilizing bilateral mucosal flaps performed by the senior author from October 2008 through April 2019 was performed. Patients who underwent secondary surgery for persistent nasal obstruction were identified. Data regarding patient demographics, perforation characteristics, primary closure technique, and secondary surgical procedures for persistent postoperative obstruction were analyzed. Nasal Obstruction Symptom Evaluation (NOSE) scores were assessed pre and post revision surgery. RESULTS: Thirty-four patients (14.7% of 232 successful repairs) met study criteria. Of those, 30 patients underwent revision septal surgery. An inferiorly advanced NSB was surgically reduced in 9.9% (23/232) of patients following successful closure to improve persistent obstruction. There was no incidence of reperforation. All patients undergoing NSB reduction reported improved nasal airflow postoperatively and 13 completed the NOSE questionnaire. The mean preoperative NOSE score (95% CI) was 52.7 (42.2-63.2; median, 50). The mean postoperative NOSE score (95% CI) was 19.2 (12.8-25.6; median, 15). The difference between the preoperative and postoperative NOSE scores was statistically significant (P < .001). CONCLUSIONS: Repair of a septal perforation using a superior bipedicle flap carries the potential for the NSB to contribute to persistent postoperative nasal obstruction. The swell body can be surgically reduced, without re-perforation, to relieve obstructive symptoms in the patient with a successful perforation repair. LEVEL OF EVIDENCE: IV Laryngoscope, 2020.

A systematic review of the nasal septal turbinate: An overlooked surgical target.

OBJECTIVE: The nasal septal turbinate (NST) is a conspicuous structure located in the anterior nasal cavity that impacts the internal nasal valve. Its structure and function is often thought to be poorly characterized, and it is rarely addressed surgically. The authors perform a systematic review in an attempt to synthesize what has been learned of this structure and to evaluate its potential as a treatment target. METHODS: A query of the Medline, Embase, Web of Science and Cochrane databases was undertaken in search of studies evaluating the NST. This qualitative systematic review was performed in accordance with PRISMA guidelines. Study quality and risk of bias were assessed with established criteria. RESULTS: Of the initial 1069 hits from the four databases, 16 articles were ultimately included in the review, which varied in quality and risk of bias. The included articles consisted predominantly of radiographic and histopathologic studies. Four studies evaluated NST treatment outcomes. The NST represents a fusiform-shaped region of erectile tissue, similar in structure and function to that of the inferior turbinates. Preliminary treatment outcomes suggest the NST represents an important surgical target in nasal airway surgery. CONCLUSION: When evaluating nasal obstruction patients, surgeons should assess the NST and consider addressing it surgically.