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.

Patient self-assessment in discriminating the more obstructed side in nasal breathing.

BACKGROUND: Correlating patient perception of nasal obstruction sidedness to causative anatomy is important in surgical planning. The accuracy of patient-perceived asymmetry of nasal obstruction, as regards objective measures, is described. METHODS: Cross-sectional study of patients undergoing nasal airflow assessment. Unilateral obstruction was assessed using visual analogue scale scores and anterior rhinomanometry, without decongestion. Subjective obstruction asymmetry was defined using either the absolute score difference (right vs left) or the minimal clinically important difference, derived statistically. Correlation between subjective and objective obstruction measures was assessed. RESULTS: In 145 patients (mean age ± standard deviation, 42.8 ± 16.6 years; 54.5 per cent female), objective obstruction was right-sided in 32.4 per cent, left-sided in 36.6 per cent and symmetrical in 31.0 per cent. Subjective perception of obstruction sidedness had a sensitivity and specificity of 86.9 and 41.1 per cent, respectively, using the minimal clinically important difference. Positive predictive value was 59.4 per cent using absolute score difference and 53.7 per cent using minimal clinically important difference. Receiver operator characteristic curve analysis indicated correlation between subjective and objective measures (p < 0.001). CONCLUSION: Subjective perception of nasal obstruction asymmetry has limited accuracy. Corroboration with objective airway assessment may be helpful in patients whose symptoms are incongruous with clinical findings.

Posterior prolongation of the cartilaginous nasal septum: an under-utilised source of autologous graft material.

AIM: To assess the clinical and radiological characteristics of the posterior prolongation of the cartilaginous nasal septum, an under-utilised source of autologous cartilage for nasal reconstruction. MATERIALS AND METHODS: Consecutive patients undergoing primary, external approach rhinoplasty were included. The septal cartilage was assessed intra-operatively prior to routine harvest. Cartilage use was recorded and post-operative cosmesis noted. Computed tomography scans from a separate patient group, with no septal surgery, were used to assess septal cartilage dimensions. RESULTS: Of the 25 rhinoplasty patients studied, 24 had harvestable septal cartilage, with a posterior prolongation mean length ± standard deviation of 24.3 ± 8.40 mm, mean height of 4.33 ± 0.34 mm and mean width of 1.1 ± 0.35 mm. The mean post-operative cosmesis score was +2.41 ± 0.71 at a mean follow up of 45 ± 8.7 weeks. All 25 radiology patients had visible posterior prolongations on computed tomography (mean length, 18.1 ± 5.1 mm; mean height, 4.2 ± 1.1 mm; mean width 1.5 ± 0.63 mm). CONCLUSION: Harvesting of the posterior prolongation would increase by 25 per cent the cartilage area available for autologous grafts. Endoscopic guidance aids this process. Cartilage is most commonly used for overlay grafts, with good cosmesis. The posterior prolongation is demonstrated on computed tomography, although dimensions may be underestimated.

Laser facial skin resurfacing: discussion on erbium:YAG and CO2 lasers.

There are two lasers for resurfacing. The erbium:YAG laser and the CO2 laser both have different physical and physiologic differences when striking the skin. Therefore, each laser gives a different result. This article reviews the use of the Sharplan Silktouch CO2 laser for 4 years and the erbium:YAG laser for 1 year. In the last year, we have performed 40 laser procedures with the erbium:YAG laser. Discussion ensues regarding the differences and similarities of the two lasers as well as the difficulties and complications.

Augmentation of the nasal spine area with tissue bone matrix sponge.

OBJECTIVE: High-density tissue bone matrix (TBM) sponge is a homograft derived from human cadaver. It is reported to be osteoinductive. The objective of this paper is to measure the bone formation and cosmetic effect of TBM sponge implanted in the nasal spine area of patients undergoing rhinoplasty with retraction of this region and loss of nasal tip support. DESIGN: The study was designed as a prospective trial. SETTING: Patients were selected from private facial cosmetic practice and from public otolaryngology practice. PATIENTS: Six patients were selected who had retraction of the nasal spine area and loss of tip support. INTERVENTION: Patients had implantation of the TBM sponge in the nasal spine area either as a sole procedure or in conjunction with other rhinoplasty maneuvers. MAIN OUTCOME MEASURES: Palpation was used to assess position, size and consistency of the implant. Cosmetic effect was assessed by computer imaging, which was used to measure nasolabial angle and tip projection. Bone formation was assessed by computed tomography scanning. RESULTS: The implant could be palpated in all six patients at 1 month postoperatively, but at 3 months was either smaller or could not be felt. Nasolabial angle and tip projection were improved in all patients initially, but 3 months following surgery this cosmetic improvement was maintained in only two patients. At 3 months, CT scanning showed no evidence of bone formation. CONCLUSION: The TBM sponge was not found to be osteoinductive or permanent when implanted in the nasal spine area and therefore is not a good implant in that region.