Jörg Lindemann

Impact of unilateral sinus surgery with resection of the turbinates by means of midfacial degloving on nasal air conditioning.

Objective/Hypothesis One of the most important functions of the nose is the climatization of inspired air. The aim of the investigation was to determine the influence of radical sinus surgery with complete resection of the turbinates and the lateral nasal wall by means of midfacial degloving as treatment for inverted papilloma on the nasal humidification and heating of inspired air.

The relationship between water vapour saturation of inhaled air and nasal patency.

The nasal cavity volume and the temperature of the nasal mucosa are considered to be the most important predictors of nasal conditioning. The aim of this study was to assess the relationship between the intranasal degree of water vapour saturation of inhaled air and nasal patency. Intranasal humidity values at different locations within the nasal cavity of 15 healthy subjects were compared to nasal airway resistance detected by active anterior rhinomanometry (AAR). Repeated measurements were carried out during one day to obtain varying nasal cavity volumes due to the nasal cycle. The end-inspiratory humidity data were obtained with a miniaturised capacitive humidity sensor at defined detection sites within the anterior nasal segment without interruption of nasal breathing. Measurements were carried out at four different times during one day. The degree of water vapour saturation did not correlate with the values of the AAR at any intranasal detection site and time of detection during one day. The study supports the view that there is no correlation between the degree of water vapour saturation within the anterior nasal segment and the nasal resistance during the nasal cycle over the day. Although nasal patency varies because of the nasal cycle, the changes of nasal cavity volume due to the nasal cycle do not seem to influence the degree of water vapour saturation of the inspiratory air.

Nasal mucosal temperature after exposure to cold, dry air and hot, humid air.

Objective - To determine the influence of variations in the temperature and humidity of inhaled air on the nasal mucosal temperature at various sites int he nasal airways. Materials and Methods - Fifteen volunteers were enrolled int he study. The temperature was measured on the mucosal surface of the nasal septum at the level of the nasal vestibule, in the nasal valve area, anterior turbinate area and choanae. Temperature measurements were made using a miniaturized thermocouple. Continuous temperature readings were performed before and after 10 min of exposure to either cold, dry air, ambient air or hot, humid air. Results - Inhilation of cold, dry air significantly reduced the temperatyre of the septal mucosa at each location of measurement compared to the breathing of ambient air. Inhalation of hot, humid air significantly increased the septal mucosal temperature at all detection sites. Conclusions - The climatic condition of inhaled air can lead to significant changes in nasal mucosal temperature. As the nasal mucosa is important for nasal air conditioning, short term exposure to air of extreme temperature and humidity can rapidly compromise nasal air conditioning.

Healing of composite chondrocutaneous auricular grafts covered by skin flaps in nasal reconstructive surgery.

Objective/Hypothesis Healing of composite chondrocutaneous auricular grafts combined with overlying skin flaps for reconstruction of the internal lining in partial nasal defects should be evaluated.

Detection of particles within the nasal airways during respiration

Abstract This study introduces a new experimental set-up for particle detection within the nasal airways and describes intranasal deposition of particles at various regions of the nasal cavity and the nasopharynx. During respiration of an aerosol of starch particles the nondeposited particles in the air were detected in 11 volunteers by a transnasally placed suction probe at numerous sites of the nasal cavity and nasopharynx. Another, identical suction probe measured the initial number of inhaled particles at the nostril. The two suction probes were connected to two identical laser particle counters and allowed calculation of particle deposition. Particles 1–3 μm in size were deposited to about 60% within the entire nasal cavity, whereas most of the particles 4–30 μm in size were deposited within the entire nasal cavity. Between 80% and 90% of the particles retained in the nasal cavity were deposited at the anterior nasal segment. Studies on deposition of various drugs within the nasal cavity using this experimental set-up are conceivable.

Video-endoscopy and digital image analysis of the nasal valve area

The aim of this study was to evaluate the benefit of digital image analysis of video-endoscopic images of the valve area to study changes in cross-sections of the nasal valve area before and after nasal surgery. Fifty patients scheduled for septoplasty or septorhinoplasty were included. Successful recordings of the valve area and digitally calculated cross-sections of the nasal valve area served as main outcome measures. First, various endoscopes (rigid 0°- and 25°-endoscopes and fibreoptic 0°-endoscope) were tested and video-endoscopy was standardised in 39 patients. Second, preoperative and postoperative images of the nasal valve area in 11 patients with obstruction of the nasal valve area were digitally analysed and compared. In these patients, a significant widening of the valve area could be shown postoperatively. We conclude that digital image analysis of the nasal valve area can be helpful in the measurement of cross-sections of the nasal valve area before and after nasal surgical procedures in selected patients.

The effect of topical xylometazoline on the mucosal temperature of the nasal septum

Background The purpose of this study was to determine the short-term influence of the α2-adrenoreceptor agonist xylometazoline on the nasal mucosal temperature. Methods Thirty healthy subjects were enrolled into the study. Fifteen of these subjects got xylometazoline and 15 subjects, matched to age, got saline solution as control. A miniaturized thermocouple was used for continuous detection of the septal mucosal temperature without interruption of nasal breathing before and after application of nose spray. Results In the anterior nasal segment, the mucosal temperatures before decongestion were significantly higher than after decongestion (p < 0.05). These changes could not be found in the control group after saline solution. The mean end-expiratory mucosal temperatures were significantly higher than the end-inspiratory ones in both study groups (p < 0.005). Conclusions The reduction of the nasal mucosal blood flow because of vasoconstriction and the increase of the nasal cavity volume after decongestion with xylometazoline seem to cause a significant decrease of the septal mucosal temperature in the anterior nasal segment. This might be one possible causative factor of the common symptom of the “dry nose” in patients with nasal decongestant abuse.

Numerical simulation of humidification and heating during inspiration within an adult nose.

BACKGROUND The temperature of inhaled air is highly relevant for the humidification process. Narrow anatomical conditions limit possibilities for in vivo measurements. Numerical simulations offer a great potential to examine the function of the human nose. OBJECTIVE In the present study, the nasal humidification of inhaled air was simulated simultaneously with temperature distribution during a respiratory cycle. METHODS A realistic nose model based on a multislice CT scan was created. The simulation was performed by the Software Fluent(r). Boundary conditions were based on previous in vivo measurements. Inhaled air had a temperature of 20(deg)C and relative humidity of 30%. The wall temperature was assumed to be variable from 34(deg)C to 30(deg)C with constant humidity saturation of 100% during the respiratory cycle. RESULTS A substantial increase in temperature and humidity can be observed after passing the nasal valve area. Areas with high speed air flow, e.g. the space around the turbinates, show an intensive humidification and heating potential. Inspired air reaches 95% humidity and 28(deg)C within the nasopharynx. CONCLUSION The human nose features an enormous humidification and heating capability. Warming and humidification are dependent on each other and show a similar spacial pattern. Concerning the climatisation function, the middle turbinate is of high importance. In contrast to in vivo measurements, numerical simulations can explore the impact of airflow distribution on nasal air conditioning. They are an effective method to investigate nasal pathologies and impacts of surgical procedures.

Numerical simulation and nasal air-conditioning

Heating and humidification of the respiratory air are the main functions of the nasal airways in addition to cleansing and olfaction. Optimal nasal air conditioning is mandatory for an ideal pulmonary gas exchange in order to avoid desiccation and adhesion of the alveolar capillary bed. The complex three-dimensional anatomical structure of the nose makes it impossible to perform detailed in vivo studies on intranasal heating and humidification within the entire nasal airways applying various technical set-ups. The main problem of in vivo temperature and humidity measurements is a poor spatial and time resolution. Therefore, in vivo measurements are feasible only to a restricted extent, solely providing single temperature values as the complete nose is not entirely accessible. Therefore, data on the overall performance of the nose are only based on one single measurement within each nasal segment. In vivo measurements within the entire nose are not feasible. These serious technical issues concerning in vivo measurements led to a large number of numerical simulation projects in the last few years providing novel information about the complex functions of the nasal airways. In general, numerical simulations merely calculate predictions in a computational model, e.g. a realistic nose model, depending on the setting of the boundary conditions. Therefore, numerical simulations achieve only approximations of a possible real situation. The aim of this review is the synopsis of the technical expertise on the field of in vivo nasal air conditioning, the novel information of numerical simulations and the current state of knowledge on the influence of nasal and sinus surgery on nasal air conditioning.

The impact of septorhinoplasty and anterior turbinoplasty on nasal conditioning.

Background Septorhinoplasty and turbinoplasty is a frequently performed operation in facial plastic surgery. The aim of this study was to investigate nasal conditioning after septorhinoplasty and inferior turbinoplasty in patients with internal and external nasal deformities and hypertrophy of the inferior turbinates and to determine its relation to nasal patency. Methods Ten patients and 10 volunteers as controls were enrolled into this study. Measurement of nasal conditioning and active anterior rhinomanometry were performed before and 4–6 months after functional-esthetic septorhinoplasty and inferior turbinoplasty. Results Nasal airflow was significantly higher postoperatively than preoperatively. The preoperative nasal temperature (TEMP) and heat increase (HI) was lower in the patients compared with the controls. The postoperative TEMP, HI, total water content, and water gradient were significantly higher than the preoperative values. Conclusion Based on this relatively small series, functional-esthetic septorhinoplasty in combination with inferior turbinoplasty may be associated with improved nasal conditioning.