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Official Journal of the Italian Society of Maxillofacial Surgery
Frequency: 3 issues
Online ISSN 1827-1901
Corbacelli A., Cutilli T.
From the Università degli Studi - L’Aquila Dipartimento di Scienze Chirurgiche Cattedra di Chirurgia Maxillo-Facciale
Background. Often serious nasal respiratory insufficiency represents the many trouble in adult patients who show the “narrow nose”. The authors consider “narrow nose” a nasal structure that’s characterized from reduction of the transversal diameters of the nasal pyramid and simultaneous reduction of the width of the nasal fossae. In their clinical experience the authors founded that this condition reveals associated with unidimensional or threedimensional maxillary hypoplasia and underline that the only nasal surgery cannot solve the problem. The authors propose their surgical procedure that’s capable in their opinion to restore in these cases both the nasal respiratory functionality and the occlusal parameters.
Methods. 32 subjects, 18 females and 14 males, aged from 21 to 37 years, with serious nasal respiratory insufficiency and maxillary defects have been considered. In the preoperative check-up also rhinomanometric investigations was performed to value the nasal respiratory functionality. 15 subjects underwent maxillary advancement and surgical palate expansion, 9 patients maxillary advancement and unilateral Schuchardt osteotomy, in 5 cases Le Fort I osteotomy and bilateral Schuchardt osteotomy; in 3 cases Schuchardt osteotomy was associated with Wassmund osteotomy. In 7 cases iliac autogenous bone grafts have been used. In all of 32 cases septoplasty according to the Cottle technique performed backway through the same surgical pathway was executed.
Results. The authors consider that mean expansions of 4 mm of the nasal floor determine an additional triangular prism-shaped space with a volumetric increase of the entire nasal fossa that can estimates at least of 700-800 mm3 (increase of 1 cm3 of the nasal respiratory space). The rhinomanometric controls proved the normality and stability of the layouts (24 months follow-up). Also the controls of the correction of the maxillary defects showed good and stable features.
Conclusions.The authors underline that many adult subjects with nasal respiratory insufficiency associate maxillary defects. The maxillary dismorphism is the main cause of the serious reduction of the respiratory nasal space. Only nasal surgery cannot solve the problem. The one time simultaneous surgical procedure (maxillary osteotomies associated with Cottle’s septoplasty) as authors performed revealed to be very efficacious. The authors conclude that orthognathic surgery associated with the nasal septum surgery is the fundamental condition in these subjects to efficacious and stable restore of the nasal respiratory space and functionality, and morphological and functional results of the masticatory apparatus.