phenylephrine-hydrochloride and Constriction--Pathologic

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonate nasal obstruction. Because newborns are natural nasal breathers, urgent treatment may be needed. CNPAS is diagnosed by clinical symptoms and signs, and CT. In severe cases, surgical approach is needed. The most often used approach is widening of pyriform aperture via sublabial incision with nasal tubing. We report a novel surgical approach as a curative treatment for CNPAS by immediate transverse enlargement of the maxilla. We also review current literature of the condition focusing on surgical management of the disease.

Topics: Constriction, Pathologic; Humans; Hypertrophy; Infant, Newborn; Maxilla; Nasal Cavity; Nasal Obstruction; Nose

Nasal obstruction is a common presenting symptom to clinicians and affects up to one-third of the population. There are several factors that cause nasal obstruction, including anatomic, physiologic, and pathophysiologic factors. The anatomy and physiology of nasal obstruction is complicated and is influenced by patency of nasal passages, mucociliary function, airflow receptors, autonomic function, and degree of mucosal inflammation. Common anatomic causes include internal nasal valve stenosis/collapse, septal deviation, and turbinate hypertrophy. Common physiologic causes include sinonasal inflammatory disorders and iatrogenic causes.

Topics: Constriction, Pathologic; Humans; Nasal Obstruction; Nose; Rhinoplasty

Nasal obstruction is one of the most common problems seen by pediatric otolaryngologists. Prompt treatment of nasal obstruction can be critical in newborns and infants because of their obligatory nasal breathing. Older children will typically have more inflammatory, infectious, or traumatic causes of nasal obstruction. Nasal obstruction can lead to a significant decrease in the quality of life in children along with an increase health care expenditures.

Topics: Angiofibroma; Child; Choanal Atresia; Constriction, Pathologic; Diagnosis, Differential; Endoscopy; Foreign Bodies; Health Expenditures; Humans; Nasal Obstruction; Nose; Pediatrics; Quality of Life; Rhinitis, Allergic; Tomography, X-Ray Computed

Congenital nasal pyriform aperture stenosis is a rare cause of nasal obstruction in the neonate. This condition is caused by a bony overgrowth of the median nasal process of the maxilla. An appropriate workup includes evaluation for associated anomalies and fine-cut CT. Surgical treatment is indicated in patients with respiratory difficulty or poor weight gain.

Topics: Constriction, Pathologic; Humans; Infant, Newborn; Maxilla; Nasal Obstruction; Nose; Rhinoplasty

Topics: Adult; Constriction, Pathologic; Female; Fetal Diseases; Holoprosencephaly; Humans; Incisor; Magnetic Resonance Imaging; Maxilla; Nose; Pregnancy; Prenatal Diagnosis; Stillbirth; Syndrome

Upper airway disorders in children may be divided into those that are congenital in origin and those that are acquired. The presentation and management of these disorders is significantly influenced both by the anatomic location of the pathology, which is usually obstructive in nature, and by the severity of the obstruction. This discussion provides an overview of the presentation, diagnosis, management, and potential complications of the most commonly seen upper airway disorders. These disorders are presented within an anatomic framework, progressing from proximal at the nares to distal at the carina.

Topics: Airway Obstruction; Child; Choanal Atresia; Constriction, Pathologic; Hemangioma; Humans; Laryngeal Diseases; Larynx; Nose; Retrognathia; Trachea

The dedicated rhinoplasty surgeon continues to acquire throughout his or her career an increasingly detailed understanding of the anatomy and the problems that occur related to rhinoplasty and a growing armamentarium of techniques to achieve improvement or correction. This article out-lines the authors' approach and discusses selected technical problems and approaches to reducing their occurrence. Focusing on the two essential goals-making the patient happy and making this the patient's only nasal surgery-primary rhinoplasty can be a uniquely rewarding experience for the patient and the surgeon.

Topics: Constriction, Pathologic; Female; Humans; Male; Nose; Postoperative Complications; Rhinoplasty; Skin, Artificial; Tomography, X-Ray Computed

Nasal vestibular stenosis is caused by a disruption of the nasal vestibular lining with secondary proliferation of granulation and fibrous tissue. It is most commonly the result of significant nasal trauma of foreign body reaction. In the pediatric population, it is exceedingly rare, with only a few cases reported in the literature. We report the first case, to our knowledge, of complete stenosis caused by traumatic vaginal delivery. This case demonstrates the profound effect nasal vestibular stenosis can have on the developing nose. Correction can be difficult because of the tendency of wound contracture and recurrence. A new approach is presented, using a hard palate mucosal graft. This graft is tough, resilient, and easily harvested. Its ability to resist contracture obviates the need for postoperative stenting, which is especially useful in the pediatric population.

Topics: Birth Injuries; Constriction, Pathologic; Contracture; Fibrosis; Granulation Tissue; Humans; Infant; Male; Mouth Mucosa; Nasal Mucosa; Nasal Obstruction; Nose; Nose Diseases; Obstetrical Forceps; Palate; Recurrence; Wound Healing

Nostril stenosis is an uncommon deformity and its aetiology is variable. The shape alteration and nostril asymmetry may have negative aesthetic and functional effects on nostril stenosis patients. Five patients were included in this study and followed up for 24 months; four of these had congenital nostril stenosis and one had an acquired deformity. Alar stent dilators were constructed from measured diameter of the affected nostril/s. The congenital nostril stenosis patients initially received a customised chairside soft nasal dilator (CCSND), which were later replaced with a customised laboratory rigid nasal dilators (CLRND). Treatment outcomes were evaluated using a questionnaire and a visual analogue scale to assess improvements in nostril breathing, comfort, appearance and satisfaction of the treatment provided by both types of dilators. There was improvement in nostril diameter with an average expansion of 7mm and this was stable at the desired diameter. The overall number of stents used to expand the tissues to the desired dimension ranged from 3 to 8 stents. Alar stent therapy is a conservative method to expand nostril tissues and has successfully maintained the nostril diameter for both acquired and congenital stenosis. This improvement in all parameters and the patients' satisfaction would make the custom-made nostril dilator in particular the CLRND a satisfactory treatment modality for congenital and acquired nostril stenosis.

Topics: Adolescent; Adult; Child; Child, Preschool; Constriction, Pathologic; Dilatation; Follow-Up Studies; Humans; Male; Nasal Obstruction; Nose; Stents; Surveys and Questionnaires

Describe surgical guidelines for a new technique to correct stenotic nares in brachycephalic cats.. 8 client-owned brachycephalic cats with stenotic nares between April 2017 and July 2022.. 8 brachycephalic cats with severe stenotic nares presented to the Angell Animal Medical Center with the patient age ranging from 2 years to 9 years of age. Surgical correction was performed on each cat with the combined use of the "Alar Fold Lift-Up" and "Sulcus Pull-Down" techniques.. Successful correction of the stenotic nares was achieved, enabling each cat to breathe normally.. The combined use of the "Alar Fold Lift-Up" and "Sulcus Pull-Down" techniques is simple to perform on an outpatient basis. Surgery is restricted to the adjacent skin and does not require the surgical alteration of the external nose or nares. Long-term follow-up indicates the procedure is effective in improving nasal breathing in each cat.

Topics: Animals; Constriction, Pathologic; Craniosynostoses; Dog Diseases; Dogs; Nasal Cavity; Nose

Topics: Conservative Treatment; Constriction, Pathologic; Humans; Nasal Cavity; Nasal Obstruction; Nose

This article presents the literature data and our own findings on the surgical treatment congenital atresia of the choanae (CAC) in children.. To find the causes of restenosis after a choanotomy in children with CAC.. We analyzed the results of surgical treatment of 144 children with the use of an endoscopic transnasal technique (. The primary causes of the recurrence of the CAC are the concomitant anatomical features of the structure of the choanal zone, insufficient period of protector insertion in the postoperative period, and surgical intervention without visual control.. Endoscopic transnasal choanotomy with intraoperative rhino- and epipharingoscopic imaging, which is performed taking the individual characteristics of the anatomy of the anomalous zone into account, is the most optimal surgical procedure in pediatric patients. In combination with the use of a protector with a distal extended zone, high efficiency and rarity of restenosis are achieved.. В статье приведены данные литературы и собственные данные о хирургическом лечении врожденной атрезии хоан (ВАХ) у детей.. Выяснить причины рестенозирования после перенесенной хоанотомии у детей с ВАХ.. Проведен анализ результатов хирургического лечения 144 детей с использованием эндоскопической трансназальной методики (. Основными причинами рецидива ВАХ являются сопутствующие анатомические особенности строения хоанальной зоны, недостаточное по времени нахождение протектора в послеоперационном периоде, проведение оперативного вмешательства без визуального контроля.. Эндоскопическая трансназальная хоанотомия с интраоперационной рино- и эпифарингоскопической визуализацией, проводимая с учетом индивидуальных особенностей анатомии аномальной зоны, является наиболее оптимальным методом оперативного вмешательства у пациентов детского возраста, при этом в сочетании с применением протектора с дистальной расширенной зоной характерны высокая эффективность операции и редкость рестенозирования.

Topics: Child; Choanal Atresia; Constriction, Pathologic; Endoscopy; Humans; Nose; Stents; Tomography, X-Ray Computed

Topics: Constriction, Pathologic; Female; Humans; Infant, Newborn; Nasal Obstruction; Nose; Palatal Expansion Technique; Time Factors

Midnasal stenosis is a poorly defined entity that may be a component of other conditions of nasal obstruction contributing to respiratory distress in infants. We sought to establish whether midnasal vault narrowing is a component of well-defined syndromes of nasal narrowing, such as bilateral choanal atresia and pyriform aperture stenosis, and to characterize the nasal anatomy of patients with syndromic craniosynostosis.. A convenience sample of patients with pyriform aperture stenosis, bilateral choanal atresia, and Apert and Crouzon syndromes with maxillofacial CT scans was identified. Patients with Pierre Robin Sequence were used as controls. Nasal measurements were performed at the pyriform aperture, choana, and defined midnasal points on axial and coronal CT scans. Intra- and interrater reliability was quantified with the intraclass correlation coefficient.. The study included 50 patients: Eleven had pyriform aperture stenosis, 10 had Apert and Crouzon syndromes, 9 had choanal atresia, and 20 were controls. Measurements in patients with pyriform aperture stenosis and Apert and Crouzon syndromes were narrower than those of controls at all measured points (. Pyriform aperture stenosis, Apert and Crouzon patients were narrower at all measured points compared to controls. Bilateral choanal atresia patients were only narrower in the posterior half of the nose. More research is needed to evaluate the clinical implications of these radiographic findings.

Topics: Benchmarking; Constriction, Pathologic; Female; Humans; Infant; Infant, Newborn; Male; Nose; Nose Diseases; Reproducibility of Results; Tomography, X-Ray Computed

This study examines the impact of postoperative noninvasive ventilation strategies on outcomes in esophageal atresia-tracheoesophageal fistula (EA-TEF) patients.. A single center retrospective chart review was conducted on all neonates followed at the EA-TEF Clinic from 2005 to 2017. Primary outcomes were: survival, anastomotic leak, stricture, pneumothorax, and mediastinitis. Statistical significance was determined using Chi-square and logistic regression (p ≤ .05).. We reviewed 91 charts. Twenty-five infants (27.5%) were bridged with postextubation noninvasive ventilation (15 on Continuous Positive Airway Pressure (CPAP), 5 on Noninvasive Positive Pressure Ventilation (NIPPV), and 14 on High-Flow Nasal Cannula (HFNC)). Overall, 88 (96.7%) patients survived, 25 (35.7%) had a stricture, 14 (20%) had anastomotic leak, 9 (12.9%) had a pneumothorax, and 4 (5.7%) had mediastinitis. Use of NIPPV was associated with increased risk of mediastinitis (P = .005). Use of HFNC was associated with anastomotic leak (P = .009) and mediastinitis (P = .036).. These data suggest that postoperative noninvasive ventilation techniques are associated with a significantly higher risk of anastomotic leak and mediastinitis. Further prospective research is needed to guide postoperative ventilation strategies in this population.. Retrospective study.. IV.

Topics: Anastomotic Leak; Cannula; Constriction, Pathologic; Continuous Positive Airway Pressure; Esophageal Atresia; Female; Humans; Infant, Newborn; Male; Mediastinitis; Noninvasive Ventilation; Nose; Pneumothorax; Positive-Pressure Respiration; Postoperative Care; Retrospective Studies; Survival Rate; Tracheoesophageal Fistula

The aim of choanal atresia (CA) surgery is to achieve bilateral nasal patency. Among the different methods of CA repair, the endoscopic transnasal approach has gained recent popularity with the advent of endoscopic instruments and techniques. This article describes our experience regarding CA repair that was done either using or not using a stent in different periods of time in our department. Between February 2006 and February 2016, a total of 29 patients aged 2 days-53 years underwent endoscopic transnasal CA repair. While in early years stents were used to maintain nasal patency, since 2010, all cases were repaired endoscopically without stenting. Of the 29 patients, 8 were excluded because of inadequate follow-up data. The mean follow-up time for the remaining 21 patients after surgery averaged 53 months (range 12-111 months). Intranasal stents were used in 5 of 21 patients for 8 out of 32 operative sides. Of the 8 stented neochoanae, 6 (75%), restenosed at a mean time of 15.2 weeks (5-24). The restenosis rate was 25% (6/24 nasal sides) in 16 patients who underwent stentless repair. In unilateral CA, 2 of 10 (20%) patients underwent atresia repair using stents and only these cases restenosed after surgery in this group. Of the 11 patients with bilateral disease, 5 (45.4%) underwent revision surgeries. In the bilateral group, 2 of 3 (66.6%) stented patients required revision surgeries, whereas 3 of 8 (37.5%) patients who underwent stentless repair relapsed. In one patient, we have experienced an alar cartilage injury intraoperatively caused by drilling. The transnasal endoscopic repair has proved to be effective and yielded long-term satisfactory results. The use of stent seems to have no advantage over a stentless repair regarding maintenance of a patent nasal airway. Patients experienced restenosis more frequently with stenting.

Topics: Adolescent; Child, Preschool; Choanal Atresia; Constriction, Pathologic; Female; Humans; Infant, Newborn; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Postoperative Complications; Reoperation; Stents; Treatment Outcome

We present the case of a 39-year-old man with a severe glottis stenosis. The saddle nose, images of laryngotracheal stenosis and the (FDG) positron-emission tomography/computed tomography lead to a final diagnosis of relapsing polychondritis. In the patient a coexistent myelodysplastic syndrome was diagnosed. Moreover, the elevated total IgG4 exceeding 135 ml/dl requested additional immunochemistry for detection of IgG4-bearing plasma cells in the biopsies. The patient underwent an allogenic stem cell transplantation and died on day 40 after the transplantation because of an acute steroid-resistent graft vs host.

Topics: Adult; Constriction, Pathologic; Glottis; Humans; Male; Nose; Polychondritis, Relapsing

To describe a technique using labial mucosal flaps to correct stenosis of the nares subsequent to bilateral rostral maxillectomy and nasal planum resection.. Case report. Client-owned dog.. A 10-year-old, neutered male Golden Retriever developed repeated stenosis of the nares, at first after bilateral rostral maxillectomy and nasal planum resection, and again after revision surgery. Bilateral, superior labial mucosal transposition flaps were created and interpolated between the nasal mucosa and skin after debridement of scar tissue.. The stenosis did not recur after mucosal flap transposition and the dog returned to normal quality of life (last follow-up 25 months postoperative).. Single-stage, superior labial mucosal transposition flaps can be used to correct nares stenosis subsequent to previous surgery.

Topics: Animals; Bone Neoplasms; Carcinoma, Squamous Cell; Constriction, Pathologic; Dog Diseases; Dogs; Male; Maxilla; Nose; Reoperation; Surgical Flaps

Neonates are obligate nasal breathers and nasal obstruction in a neonate is an emergency. Here we report two cases of congenital mid-nasal stenosis, discuss its presentation and diagnosis with description of a novel method of management.

Topics: Constriction, Pathologic; Endoscopy; Humans; Infant, Newborn; Nasal Obstruction; Nose; Nose Diseases; Respiration; Stents; Tomography, X-Ray Computed; Urinary Catheters

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of nasal airway obstruction in newborns. The decision to operate is made clinically. Although pyriform aperture width is used for diagnosing CNPAS, it does not fully characterize stenosis of the nasal cavity.. To determine the utility of additional metrics for evaluating CNPAS.. The medical records of 13 patients with CNPAS treated from 2007 through 2012 at a single tertiary pediatric facility were retrospectively examined. Data on patient demographic characteristics, known genetic abnormalities, and hospital courses were extracted. Computed tomographic images were evaluated for pyriform aperture width; maxillary-nasal angle (MNA), defined as the angle between the anterior maxilla and anterior-posterior nasal axis; and choanal width.. Medical management and surgical management.. Pyriform aperture width, MNA, and choanal width.. Six of 13 patients underwent medical management, and 7 patients underwent surgical treatment. For patients who were managed medically as compared with those managed surgically, the evaluation revealed a larger pyriform aperture width (median [interquartile range {IQR}], 5.6 [5.4-6.1] vs 4.6 [4.5-4.7] mm; P = .03) and MNA (median [IQR], 70° [63°-73°] vs 59° [59°-64°]; P = .048) but no significant difference in choanal width (median [IQR], 11.0 [9.6-12.2] vs 11.9 [10.3-11.9] mm; P = .76).. The MNA, when used in conjunction with pyriform aperture width, provides additional pertinent information to supplement clinical decision making in the evaluation of patients with CNPAS. These measurements may be helpful in identifying patients who should undergo surgical intervention, although additional studies would be required to allow predictive use of the MNA.

Topics: Choanal Atresia; Constriction, Pathologic; Humans; Infant, Newborn; Maxilla; Nasal Obstruction; Nose; Pyriform Sinus; Retrospective Studies; Tomography, X-Ray Computed

The objective of the present study was to increase the effectiveness of the prevention of the postoperative complications by means of the newly proposed modified variant of endonasal functional dacryocystorhinostomy. The method was used to treat 230 patients presenting with chronic dacryocystitis. It was shown that the new method permits to prevent the recurrence of the pathological process by virtue of the attachment of the middle nasal turbinates to the nasal septum and the prevention of its adhesion to the dacryostoma. The prevention of fibrin precipitation near the operative field is possible thanks to the ointment discharge through the perforations towards the cavity of the newly for meddacryostoma . Simultaneously, the formation of the organized blood clots is prevented. At a later stage, the silicone plate introduced to adjoin the middle nasal turbinate becomes an obstacle to the formation of adhesions. It is concluded that the proposed functional arrangement of the nasal structures and the outflow of tears makes it possible to reduce the recurrence of the disease to 2.1% of the cases.. Цель работы - повысить эффективность профилактики послеоперационных осложнений посредством предложенной нами модифицированной функциональной эндоскопической дакриоцисториностомии. 230 больным с хроническим дакриоциститом проведены операции по модифицированной методике. Предложенная модификация предупреждает рецидивирование процесса за счет фиксации средней носовой раковины к перегородке носа и предотвращения ее слипания с дакриостомой. Профилактика фибриновых отложений у операционного поля происходит за счет того, что мазь, выделяясь через перфорации в сторону просвета вновь сформированной дакриостомы, предотвращает формирование организованных сгустков крови. Установленная силиконовая пластина, прилегающая к средней носовой раковине, будет препятствием для формирования спаек. Формирование функционального расположения носовых структур и оттока слезы позволило снизить рецедивы заболевания до 2,1% случаев.

Topics: Adult; Constriction, Pathologic; Dacryocystorhinostomy; Female; Follow-Up Studies; Humans; Male; Natural Orifice Endoscopic Surgery; Nose; Postoperative Complications; Treatment Outcome

Topics: Constriction, Pathologic; Dissection; Gastroscopy; Gastrostomy; Humans; Natural Orifice Endoscopic Surgery; Neoplasm Staging; Nose; Pharyngeal Diseases; Stomach Neoplasms

Most nasal reconstructions previously repaired with regional flaps require a revision to improve appearance and function. Many local flaps also create significant landmark and contour distortions, such as alar crease obliteration or nostril margin malposition.. Over 400 nasal reconstructions with regional tissues, primarily forehead flaps, and 100 local flap repairs were evaluated to identify the causes of failure of the primary repair, to classify late deformities, and to develop an approach to the late revision of a nasal reconstruction. Surgical timing, staging, incisional approaches, and operative technique were defined with the goal of restoring normal dimension, volume, position, projection, symmetry, skin quality, border outline, and contour.. Deformities can be classified as "minor," when overall dimension, volume, and position are satisfactory but nasal landmarks are imperfect, nostril margins are asymmetric, or the nostrils are small; or "major," when there is a significant failure to restore the basic fundamental character of the nose. It is bulky, shapeless, malpositioned and without landmarks. These characteristics determine incision sites, the extent of required flap reelevation, soft tissue excision and cartilage grafting, the number of stages, the use of secondary local flaps, surgical delay, and the need for reoperation with a second regional flap.. Revision is accomplished through new direct incisions and old peripheral border scars. Soft tissue excision and secondary cartilage grafts can effectively reestablish contour. Lining deficiencies are addressed by transferring discardable local excess skin from the nostril margin, columella, cheek, or upper lip to open the airway. If local tissues are inadequate, a second regional flap must be transferred to resurface or line the nose.

Topics: Bone Transplantation; Burns; Cartilage; Constriction, Pathologic; Facial Injuries; Humans; Lip; Nasal Cavity; Nose; Plastic Surgery Procedures; Reoperation; Surgical Flaps; Time Factors; Treatment Failure

Osteogenesis imperfecta (OI) is a genetic disorder whose primary manifestations are fractures, bone deformity and bone pain. Brainstem compression due to basilar invagination is a rare and potentially life-threatening complication of OI. Children with this condition often require significant medical input and multiple admissions to hospital. Traditionally, anterior decompression is carried out through an open trans-oral route. We describe an endoscopic endonasal approach for resection of the peg in a child with OI and basilar invagination. We believe this approach provides an excellent alternative with minimal morbidity and decreased length of stay especially in the paediatric population.

Topics: Adolescent; Brain Stem; Constriction, Pathologic; Decompression, Surgical; Female; Humans; Magnetic Resonance Imaging; Natural Orifice Endoscopic Surgery; Nose; Odontoid Process; Osteogenesis Imperfecta; Spinal Cord Compression; Spinal Fusion; Tomography, X-Ray Computed

Brachycephalic syndrome develops as a result of a specific build of splanchnocranium. In dogs of brachycephalic breeds, an impairment of correct gas exchange occurs. 5 French bulldogs at the age of 11-14 months, which suffered from continuous mixed-type dispnoea and lowered effort tolerance, were examined. Apart from the above-mentioned symptoms, the occurrence of strong external nostril stenosis was noted in the clinical examination. The symptoms observed together with the nostril stenosis indicated a possibility of an occurrence of the brachycephalic syndrome. 1 ml of full blood was drawn from the femoral artery. Acid-base balance parameters were determined in the arterial blood: pH, pCO2, HCO3-, and pO2. The wing-of-the-nostrils correction procedure were carried out in general anaesthesia. In premedication, the patients received medetomidine and after 15 minutes, fentanyl together with atropine. The induction of propofol was carried out. After four weeks from the procedure, blood was collected and the acid-base balance and pO2 parameters were again determined. The obtained values of the acid-base balance and pO2 parameters showed a noticeable influence of the wing-of-the-nostrils correction procedure on the values of the parameters determined. The results of the blood gasometry obtained prior to the procedure clearly indicate the occurrence of respiratory acidosis. The correction of wings of the nostrils significantly influenced saturation of the arterial blood with oxygen and the symptoms of dispnoea observed by the owners and episodes of apnoea and the loss of consciousness entirely subsided.

Topics: Acid-Base Equilibrium; Animals; Constriction, Pathologic; Dogs; Nose; Oxygen; Pulmonary Gas Exchange

Topics: Cholesteatoma, Middle Ear; Constriction, Pathologic; Eustachian Tube; Habits; Humans; Middle Ear Ventilation; Nose; Postoperative Complications

Stertor is a noise generated by the disturbance of the air flow passing through the nose. Its main cause -in newborns and infants- is inflammatory or infectious rhinitis. Congenital, neoplastic, traumatic or iatrogenic causes are less frequent. Congenital stenosis of the pyriform aperture is a rare etiology of nasal obstruction in the neonates. Early diagnosis and appropriate treatment are essential because of their exclusive nasal breathing. Suspicion might arise when a difficulty or even an impossibility to pass a probe of 2.8 mm (K30 tube) through anterior nares, exists. Diagnosis should be confirmed by a computed tomography of the craniofacial massif. The therapeutic behavior will depend on the severity of symptoms. We describe our experience with nine patients with this condition whose surgical correction was successful.

Topics: Constriction, Pathologic; Female; Humans; Infant, Newborn; Male; Nasal Obstruction; Nose; Respiratory Sounds

Topics: Constriction, Pathologic; Facial Bones; Female; Humans; Incisor; Infant, Newborn; Mandible; Maxilla; Nose; Syndrome

We identified four patients with congenital nasal pyriform aperture stenosis (CNPAS) with feeding and respiratory difficulties. While feeding difficulties have been described in infants with other causes of nasal obstruction (e.g., choanal atresia), little attention has been focused on feeding in infants with CNPAS.. All four patients were treated with nasal steroids and nasal saline and two underwent surgical repair of the CNPAS at 2 months of age. Except for gastroesophageal reflux in one patient, upper gastrointestinal tract (UGI) contrast studies were normal in all patients. Three patients underwent bedside swallow evaluations, two of whom participated in videoflouroscopic swallow studies (VFSS) because of limited oral intake or respiratory problems during feeding. These three patients presented with intact oral-motor coordination at rest and during non-nutritive sucking, and nasal whistling, nasal congestion, or breathing difficulties/desaturations with oral feeding. On VFSS, one infant had trace aspiration with thin and thick liquids. Three patients required supplemental feeding during the first year of life. All three patients with normal brain MRIs were successful oral feeders by 16 months of age, the fourth is undergoing feeding therapy at 24 months of age.. Feeding problems are common in infants with CNPAS and supplemental feedings may be needed even after management of airway difficulties. Infants with CNPAS should undergo comprehensive feeding/swallowing evaluations which may include bedside swallow evaluations and VFSSs. The prognosis for transitioning to total oral feedings is good and related to the extent of the airway obstruction and presence of other comorbidities.

Topics: Child, Preschool; Constriction, Pathologic; Deglutition; Feeding Methods; Fluoroscopy; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Nasal Obstruction; Nose; Video Recording

To evaluate the effect of the tympanostomy tube (TT) on postoperative retraction of the soft posterior meatal wall caused by habitual sniffing following ear surgery, including a mastoidectomy and soft-wall reconstruction of the posterior meatal wall.. Retrospective chart review.. Sixty-six ears of 64 patients with acquired cholesteatoma who underwent staged ear surgery with a soft-wall reconstruction method and mastoidectomy were enrolled; 26 out of 66 ears had habitual sniffing (sniffing positive[+]), underwent TT placement (TT positive[+]) during surgery, and were followed up for at least 8 months after surgery. Sixty-six ears were divided into sniffing+/TT+, sniffing negative(-)/TT+, and sniffing-/TT- groups, and the degree of the retraction was compared among the three groups.. The distribution of the grades of the postoperative retraction of the soft posterior meatal wall was almost the same among the three groups (P = .60). Ears with severe retraction were found in 19.2% (5/26), 33.3% (7/21), and 15.8% (3/19) in the sniffing+/TT+ group, sniffing-/TT+ group, and sniffing-/TT- groups, respectively.. The TT was found to be effective in preventing the development of postoperative retraction of the reconstructed soft posterior meatal wall and tympanic membrane among cases with habitual sniffing. We would suggest that TT placement is recommended during surgery for cholesteatoma if a patient was found to engage in habitual sniffing.

Topics: Cholesteatoma, Middle Ear; Constriction, Pathologic; Ear, Middle; Eustachian Tube; Female; Habits; Humans; Male; Mastoid; Middle Aged; Middle Ear Ventilation; Nose; Otoscopy; Postoperative Period; Retrospective Studies; Secondary Prevention

Sensitivity and specificity of active anterior rhinomanometry (RMM) and peak nasal inspiratory flow (PNIF) in the diagnosis of functionally relevant structural nasal deformities should be assessed. The reference standard was clinical judgment based on all clinical data available.. Prospective study of diagnostic accuracy at a tertiary rhinologic referral center.. RMM and PNIF were performed on 53 patients with symptomatic nasal stenosis and 40 healthy volunteers. Cut-offs for RMM and PNIF were defined by receiver operating characteristic analysis.. A cut-off between normal and pathological of 700 mL/second for RMM at a transnasal pressure difference of 150 Pa, and of 2,000 mL/second (120 l per minute) for PNIF was calculated. No significant differences in terms of sensitivity of RMM and PNIF (0.77 vs. 0.66), specificity (0.8 vs. 0.8) and diagnostic accuracy (0,79 vs. 0.72) were found.. RMM and PNIF provide valuable information to support clinical decision making. However, with both methods, approximately 25% of symptomatic patients with functionally relevant nasal structural deformity were not detected. A negative test outcome of RMM or PNIF does not exclude a functionally relevant nasal stenosis.

Topics: Adolescent; Adult; Constriction, Pathologic; Female; Humans; Inspiratory Capacity; Male; Middle Aged; Nasal Decongestants; Nasal Obstruction; Nose; Nose Deformities, Acquired; Predictive Value of Tests; Prospective Studies; Rhinomanometry; ROC Curve; Sensitivity and Specificity

The authors present their experience with reconstructive nasal valve surgery, evaluating the effects related to the use of a composite graft, which is a graft made of skin and cartilage, or mucosa and cartilage, and to the transposition of mucocartilaginous flaps. A sample of 15 patients (12 women and three men) selected among 452 cases treated with functional and aesthetic rhinoplasty at the Department of Plastic and Reconstructive Surgery of the "Tor Vergata" University of Rome was analyzed. Patients were between 25 and 50 years of age, with a mean age of 40 years, and were treated with secondary rhinoplasty for valvular stenosis. Of these patients, 12 had functional problems of the internal and external nasal valve, and three had internal valve stenosis. In our sample of 15 patients, respiratory symptoms improved at short- and long-term follow up. In all cases, a good aesthetic result was obtained. The patients were not satisfied with the aesthetic result in only three cases as a result of enlargement or asymmetry of the external valvular area. In 11 cases, an "open tip" rhinoplasty was performed with a retroauricular skin-cartilage composite graft to correct internal-external valvular stenosis. In all the cases of internal valvular stenosis (three patients) and in one case of internal-external valvular stenosis, a transposition of mucocartilaginous flaps with a section of the mucosa of the upper lateral cartilage was performed.

Topics: Adult; Cartilage; Constriction, Pathologic; Esthetics; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasal Mucosa; Nasal Obstruction; Nose; Nose Diseases; Patient Satisfaction; Plastic Surgery Procedures; Rhinoplasty; Skin Transplantation; Surgical Flaps; Treatment Outcome

Topics: Constriction, Pathologic; Female; Humans; Male; Nose; Plastic Surgery Procedures

To examine the management and outcomes of choanal atresia in children with CHARGE association compared with non-CHARGE children.. This is a retrospective chart review at a tertiary care children's hospital examining the management and outcomes of choanal atresia repair in children with CHARGE from 1990-2005. At least two CHARGE features were used to define these children. Children with CHARGE association were compared with non-CHARGE children regarding type of atresia, method of repair, post-operative management, re-stenosis rate and revision surgery.. Fifty-seven children (36 female, 21 male) with complete records were identified with 24% diagnosed with CHARGE association. The median age of primary repair was 0.75 months for CHARGE and 15 months for non-CHARGE children (p=0.047). Unilateral atresia was diagnosed in 36% of CHARGE children and 81% of non-CHARGE children. Bilateral atresia was diagnosed in 64% of CHARGE and 19% of non-CHARGE children (p=0.006). The median duration of stent placement was slightly longer in the CHARGE group with no difference in the median number of post-operative dilations. Of those with CHARGE, 36% required revision surgery compared to 44% of the non-CHARGE subjects (p=0.58). Of those undergoing primary transnasal repairs, 40% of the CHARGE and 37% of the non-CHARGE patients failed. 50% of CHARGE patients with primary transnasal repair for bilateral atresia failed. Only 25% of transpalatal CHARGE repairs failed, while 75% of transpalatal repairs failed in the non-CHARGE group. The median follow-up was 24.6 months for CHARGE and 24.9 months for non-CHARGE patients.. Children with CHARGE and unilateral choanal atresia can be managed successfully with a transnasal approach. However, our data, as well as prior published reports, suggests that CHARGE patients with bilateral atresia should have primary transpalatal repairs due to the high failure rate with the transnasal approach in this population.

Topics: Case-Control Studies; Choanal Atresia; Constriction, Pathologic; Decision Trees; Female; Follow-Up Studies; Humans; Infant; Male; Nose; Otorhinolaryngologic Surgical Procedures; Palate, Hard; Retrospective Studies; Treatment Outcome

Topics: Cleft Lip; Constriction, Pathologic; Equipment Design; Humans; Nose; Postoperative Care; Rubber; Splints

Apertura pyriformis stenosis in the newborn. Respiratory distress in the newborn can have a variety of aetiologies, the best known of which are cardiac and pulmonary diseases. Major nasal airway obstruction is probably often overlooked when acute desaturation of the neonate requires reanimation procedures, although it is well established that the baby is an obligate nose breather at birth. Nasal airway stenosis or atresia could account for a number of unexplained deaths in the delivery room. In the differential diagnosis of major nasal airway obstruction in the newborn, choanal atresia is by far the most common aetiology. However, a few cases of pyriform aperture stenosis have been reported. One child presenting this pathology was recently treated at the Brussels University Children's Hospital. Unexpectedly, the baby survived until 3 months without any medical support but had severe feeding problems. The diagnosis was confirmed by naso-sinusal CT scan. Surgery was performed at 4 months through an unusual endonasal approach which seems to be less traumatic than the classical sublabial approach. The post-operative course was satisfactory. The 9-month-old patient does not now show residual breathing problems. The presentation will focus on this unusual case.

Topics: Choanal Atresia; Constriction, Pathologic; Endoscopy; Humans; Infant, Newborn; Male; Nasal Obstruction; Nose; Respiratory Distress Syndrome, Newborn; Tomography, X-Ray Computed; Treatment Outcome

Secondary surgery of the cleft lip nose is very complex due to its specific pathological anatomical characteristics. In this article, the general and specific characteristics of the nose of the unilateral and the bilateral cleft patient are described, and careful preoperative assessment is emphasized. Considerations concerning the timing of the operation before or after the puberty growth spurt are discussed. Guidelines are given for a systematic correctional surgical approach, dividing the operative procedure into septal surgery, tip surgery, osseo-cartilaginous vault surgery, maxillary augmentation and alar base reallocation. A description is given of special postoperative care with a custom-made vestibular device to prevent stenosis of the vestibulum and deformation of the nasal tip caused by scar tissue retraction in the postoperative period.

Topics: Alveolar Ridge Augmentation; Cartilage; Cicatrix; Cleft Lip; Constriction, Pathologic; Humans; Maxilla; Nasal Bone; Nasal Septum; Nose; Patient Care Planning; Postoperative Care; Postoperative Complications; Rhinoplasty; Stents; Vestibuloplasty

The surgical correction of nostril stenosis and external nasal valve collapse typically involves the addition of tissue to widen and strengthen these areas. However, over the ensuing months, postoperative scar contracture may act to reverse the surgical modifications. This study aimed to determine the safety and efficacy of the use of nasal stents fashioned from a nasopharyngeal airway tube to prevent postoperative contracture at these sites.. Retrospective review of six patients who underwent functional rhinoplasty with alar batten graft placement for nasal valve collapse and one patient who underwent composite graft repair of unilateral nostril stenosis.. Patients completed a survey inquiring about the ease of use, discomfort, presence of infection, and ability to breathe with these nasal stents. Patients also completed the NOSE (nasal obstruction symptom evaluation) instrument to compare their overall level of preoperative and postoperative nasal breathing. The functional rhinoplasty patients were examined for degree of dynamic airway nasal wall collapse and position of the lateral nasal wall on intranasal examination.. Six of seven patients overall reported no to minimal discomfort, easy application, and no to minimal obstruction of nasal breathing with the use of the stents. One patient reported difficulty with application. Preoperative NOSE scores averaged 67.1 (SD 10.4), 18.6 (SD 14.6) at the time of splint removal, and 21.4 (SD 15.2) at 3 months after stent removal. Paired t test analysis showed significant differences between the NOSE scores preoperatively as compared with the time of splint removal (P = .0002) or 3 months after splint removal (P = .0003). All patients demonstrated a significant reduction of lateral nasal wall collapse with inspiration on physical examination.. The use of nasal stents made from nasopharyngeal airway tubes is a safe, convenient, and economic treatment for the prevention of contracture after surgical correction of nostril stenosis or nasal valve insufficiency.

Topics: Constriction, Pathologic; Contracture; Humans; Nasal Obstruction; Nose; Postoperative Complications; Retrospective Studies; Rhinoplasty; Stents; Surveys and Questionnaires

Topics: Adolescent; Burns; Cicatrix; Constriction, Pathologic; Female; Humans; Laser Therapy; Nose; Skin Transplantation

Topics: Congenital Abnormalities; Constriction, Pathologic; Female; Humans; Image Processing, Computer-Assisted; Infant, Newborn; Nasal Obstruction; Nose; Tomography, X-Ray Computed

The author lists the dysmorphic and dysfunctional causes of nasal obstruction in the child.

Topics: Child; Constriction, Pathologic; Humans; Infant; Infant, Newborn; Nasal Cavity; Nasal Obstruction; Nasal Septum; Nose; Nose Diseases; Rhinitis

Several important factors to consider in the surgical repair of the cleft lip nose are described: the importance of an adequate lip closure technique to ensure symmetry can prevent a more conspicuous deformity of the nose during growth, the consequences of secondary rhinoplasty in the growing nose in which the surgeon has to weigh the possible growth inhibition due to scar tissue against the possible functional and esthetic improvement, a systematic surgical approach in which the operative procedure is divided into different steps, and the use of autogenous graft material. In the evaluation of 52 cleft lip patients (5 bilateral clefts, 47 complete unilateral clefts) who had undergone a secondary rhinoplasty, two specific postoperative problems were encountered: slight to moderate recurrence of the caudal septal deviation (in unilateral clefts) and restenosis of the nasal vestibule at the cleft side. Adjustment of the surgical technique and the use of a custom-made vestibulum device diminished these sequellae considerably.

Topics: Adolescent; Adult; Cartilage; Cicatrix; Cleft Lip; Constriction, Pathologic; Esthetics; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Lip; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Nose Diseases; Postoperative Complications; Recurrence; Reoperation; Rhinoplasty; Splints; Transplantation, Autologous

A technique has been described that allows accurate fabrication of a surgical nasal stent, made preoperatively, based on a mirror image of the shape of the normal naris. The advantage to the surgeon is a surgical stent that has the greatest accuracy possible preoperatively, plus the ability to remake the stent postoperatively with even more accuracy should it be needed. This stent can then be worn long term with minimal visibility and maximum patient acceptance during the critical months postoperatively when relapse is most likely.

Topics: Constriction, Pathologic; Equipment Design; Humans; Methylmethacrylates; Models, Anatomic; Nose; Polyvinyls; Silicone Elastomers; Siloxanes; Stents

Micronostril is a cicatricial stenosis that may occur in the caudal-most portion of the nasal cavity of cleft lip patients. This stenosis can be severe and functionally debilitating. Previously proposed solutions have offered disappointing results. Our solution has three key elements: adequate scar release; restoration of the lining and support by way of chondrocutaneous composite graft; and post-operative custom acrylic splinting.

Topics: Acrylic Resins; Cartilage; Child; Cicatrix; Cleft Lip; Constriction, Pathologic; Equipment Design; Follow-Up Studies; Humans; Male; Nasal Cavity; Nasal Obstruction; Nose; Nose Deformities, Acquired; Postoperative Complications; Skin Transplantation; Splints

Nasal continuous positive airway pressure (CPAP) is being used more frequently in neonatal intensive care units to avoid endotracheal intubation and its attendant complications. Nasal deformities secondary to the nares-occluding prongs employed to deliver the CPAP in former preterm infants have been recognized, and prevention and surgical treatment of these deformities are discussed. An awareness of the potential for these deformities is important to all pediatric otolaryngologists as nasal CPAP is gaining increasing favor as a primary treatment for respiratory disease of the newborn.

Topics: Child, Preschool; Cicatrix; Constriction, Pathologic; Equipment Design; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Male; Nasal Obstruction; Nose; Nose Deformities, Acquired; Positive-Pressure Respiration

Topics: Burns; Constriction, Pathologic; Follow-Up Studies; Humans; Intubation; Nose; Nose Diseases; Stents; Suction; Surgical Flaps

Recent reports have described congenital nasal pyriform aperture stenosis, but do not address its etiology in detail. We describe a child with nasal pyriform aperture stenosis, submucus cleft palate, and hypoplastic maxillary sinuses. Chromosome analysis revealed a ring chromosome 18. Awareness of the association of midline facial defects with midline brain defects allowed us to predict that features of the holoprosencephaly sequence would be found. Subsequent evaluation revealed growth hormone deficit. Eventually the child manifested a single central incisor. We review the association between midline facial defects and holoprosencephaly to remind the otolaryngologist of the need to look at the whole patient as he treats specific upper airway problems.

Topics: Chromosomes, Human, Pair 18; Constriction, Pathologic; Holoprosencephaly; Humans; Infant, Newborn; Karyotyping; Male; Maxillary Sinus; Nasal Cavity; Nose; Ring Chromosomes

A case is reported of endotracheal tube obstruction due to impaction of a turbinate. This complication occurred during a first attempt of nasotracheal intubation in an ASA 1 18-year-old patient. Once the tube had been inserted into the trachea, manual ventilation was impossible. The diagnosis was made on removal of the completely obstructed tube. Differential diagnosis was sudden severe bronchospasm or a herniated cuff. Anaesthesiologists should be aware of this rare complication when carrying out nasotracheal intubation. Means of prevention are proposed.

Topics: Adolescent; Constriction, Pathologic; Female; Humans; Intubation, Intratracheal; Nose; Turbinates

When interruption of the related arteries fails to control epistaxis, angiography is recommended for identification of the vascular base, the collateral circulation, and the possibility of arterial abnormalities. Criteria are proposed for utilization of vascular mapping, and relevant cases are cited to support the specific indications for application.

Topics: Aged; Angiography; Carotid Arteries; Collateral Circulation; Constriction, Pathologic; Epistaxis; Female; Humans; Ligation; Male; Maxillary Artery; Middle Aged; Nose; Ophthalmic Artery

Topics: Adult; Burns; Constriction, Pathologic; Humans; Malaysia; Male; Medicine, East Asian Traditional; Nose; Nose Deformities, Acquired

Topics: Bile; Common Bile Duct Diseases; Constriction, Pathologic; Drainage; Gallstones; Humans; Nose

Topics: Constriction, Pathologic; Humans; Nose; Rhinoplasty

Topics: Abnormalities, Multiple; Bone Diseases, Developmental; Constriction, Pathologic; Hand Deformities, Congenital; Humans; Limb Deformities, Congenital; Male; Middle Aged; Myelography; Neck; Nose; Quadriplegia; Spinal Canal; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Airway Obstruction; Child; Child, Preschool; Constriction, Pathologic; Down Syndrome; Eustachian Tube; Humans; Nose; Otitis Media; Respiratory Tract Infections

Topics: Constriction, Pathologic; Humans; Lung; Nose; Respiratory Function Tests; Tuberculosis; Tuberculosis, Pulmonary; Vital Capacity

Topics: Adenoidectomy; Adolescent; Asthma; Bronchial Diseases; Bronchial Spasm; Child; Constriction, Pathologic; Focal Infection; Humans; Nasal Cavity; Nose; Palatine Tonsil; Respiratory Tract Infections; Tonsillectomy; Tonsillitis

Topics: Constriction, Pathologic; Humans; Larynx; Nose; Trachea

Topics: Constriction, Pathologic; Esophageal Stenosis; Esophagus; Humans; Larynx; Nose; Pharynx; Trachea; Tracheal Stenosis

Topics: Airway Obstruction; Constriction, Pathologic; Female; Humans; Nasopharyngeal Diseases; Nose; Nose Diseases; Polyhydramnios; Pregnancy

Topics: Constriction, Pathologic; Humans; Infant, Newborn; Infant, Newborn, Diseases; Nasopharyngeal Diseases; Nose; Nose Diseases

Topics: Child; Constriction, Pathologic; Deafness; Hearing Loss; Humans; Infant; Nose; Nose Diseases

Topics: Aged; Airway Obstruction; Constriction, Pathologic; Humans; Nasopharynx; Nose; Pharyngeal Diseases

Topics: Constriction, Pathologic; Epiglottis; Humans; Larynx; Nose; Respiratory System; Trachea

Topics: Animals; Coleoptera; Constriction, Pathologic; Humans; Nose