Dirk Jan Menger

The clinical value of peak nasal inspiratory flow, peak oral inspiratory flow, and the nasal patency index.

The aim of this study was to ascertain the most reliable objective measurement for the assessment of nasal patency by investigating the relationship between peak nasal inspiratory flow, peak oral inspiratory flow, and the nasal patency index in relation to the patients subjective perception regarding nasal obstruction.

Nasal Septal Abscess in Children Reconstruction With Autologous Cartilage Grafts on Polydioxanone Plate

OBJECTIVE To assess outgrowth and aesthetics of the nose in children after reconstruction of the cartilaginous nasal septum with autologous cartilage grafts on polydioxanone plate. DESIGN Prospective nonrandomized case series. SETTING University hospital. PATIENTS Six patients (5 boys and 1 girl), aged 3 to 11 years, with nasal septal abscess. INTERVENTION The nasal septa of 6 children with a history of nasal septal abscess and partial or complete destruction of nasal septal cartilage were reconstructed with autologous cartilage grafts of the auricle or rib fixed on polydioxanone plate. MAIN OUTCOME MEASURES Nasal outgrowth was measured by the length of the nose and by the amount of nasal tip projection and was compared with standardized growth curves. Aesthetic outcome variables included nasolabial angle, columellar retraction, and development of saddle nose deformity and were classified as normal, mild, or severe. RESULTS The duration of follow-up ranged from 10 to 68 months (mean follow-up, 38 months). Four children had complete loss of the cartilaginous septum. Areas 1 and 2 (caudal parts) had been destroyed in 2 children. Auricular cartilage was used in 5 children; costal cartilage was needed in 1 child. Compared with standardized growth curves, the length of the nose and the amount of nasal tip projection were within 1 SD in all children. None of the children developed saddle nose deformity. One child had mild columellar retraction; 3 children had mild overrotation of the nasal tip. CONCLUSION Total reconstruction of abscess-induced destruction of nasal septal cartilage with autologous cartilage grafts fixed on polydioxanone plate has, so far, resulted in normal development of the nose during follow-up, without expected aesthetic problems.

Objective Computerized Determination of the Minimum Cross-Sectional Area of the Nasal Passage on Computed Tomography

Objectives/Hypothesis: Current methods that measure cross‐sectional areas of the nasal passage on computed tomography (CT) do not determine the minimum cross‐sectional area that may be an important factor in nasal airway resistance. Objective measurement of the dimensions of the nasal passage may help in the diagnosis, as well as the choice and evaluation of surgical treatment for upper airway insufficiencies.

Irradiated Homologous Rib Grafts in Nasal Reconstruction

OBJECTIVE To assess the long-term efficacy of irradiated homologous rib grafts (IHRGs) for both augmentation and support function in rhinoplasty in general and for specific recipient sites within the nose. DESIGN A retrospective study was conducted at an academic medical center to evaluate the loss of volume and support function of IHRGs in 9 specific recipient sites in the nose. RESULTS We studied 66 patients, with a total of 177 IHRGs, dating back 9 years, with an average follow-up of 51 months. The rate of resorption increased with duration of follow-up. Complete resorption was found in 1 IHRG, and moderate resorption was observed in 55 IHRGs (31%). Resorption was characterized by a loss of support function rather than a loss of volume. Moderate resorption had a negative clinical outcome for shield grafts only. CONCLUSIONS Irradiated homologous rib grafts were safe to use in rhinoplasty. In cases requiring a shield graft, IHRGs should be avoided.

Suspension Suture Techniques in Nasal Valve Surgery

Impaired nasal breathing or collapse of the lateral side wall of the nasal valve region during inspiration is a frequently encountered symptom. In general, this is caused by a cross-sectional area that is too small, a weak lateral side wall, or a combination of both. Over the years, many techniques have been described to improve the nasal patency in these patients with the use of nasal grafts, repositioning techniques, devices, or suspension suture techniques. This article presents a systematic overview of different suspension suture techniques in nasal valve surgery.

Saddle nose deformity and septal perforation in granulomatosis with polyangiitis

Patients who have granulomatosis with polyangiitis (GPA, syn. M. Wegener) often develop an external nose deformity which may have devastating psychological effects. Therefore, reconstruction of nasal deformities by rhinoplasty may become necessary to achieve a normal appearance.

Surgical Treatment of the Twisted Nose.

The twisted nose is a challenging procedure in rhinoplasty. The goal of surgery is to realign the nasal skeleton to create symmetry in the face and restore nasal patency. Key in the surgical procedure is that all structures of the nasal skeleton be dissected free, mobilized, repositioned, and stabilized. Important surgical steps are intermediate osteotomies on the contralateral side of the deviation for the upper nasal third; for the mid nasal third, a unilateral spreader graft or splint on the nondeviated side, and for the lower nasal third, fixation of the caudal septum to the anterior nasal spine.

Complications of balloon packing in epistaxis

Although balloon packing appears to be efficient to control epistaxis, severe local complications can occur. We describe four patients with local lesions after balloon packing. Prolonged balloon packing can cause damage to nasal mucosa, septum and alar skin (nasal mucosa, the cartilaginous skeleton and the overlying soft-tissue envelope) and should, therefore, be avoided. We suggest early nasendoscopy in general anesthesia to identify and treat the bleeding focus, if bleeding cannot be controlled with regular packing.