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Rivista Italiana di Chirurgia Maxillo-Facciale 2001 April;12(1):17-23


language: English

Surgical procedure for restoring nasal airways in severe nasal respiratory insufficiency (“narrow nose”)

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.

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