Numerical analysis for the effcacy of nasal surgery in obstructive sleep apnea hypopnea syndrome

In the present study, we reconstructed upper airway and soft palate models of 3 obstructive sleep apnea-hypopnea syndrome（OSAHS） patients with nasal obstruction. The airflow distribution and movement of the soft palate before and after surgery were described by a numerical simulation method. The curative effect of nasal surgery was evaluated for the three patients with OSAHS. The degree of nasal obstruction in the 3 patients was improved after surgery. For 2 patients with mild OSAHS, the upper airway resistance and soft palate displacement were reduced after surgery. These changes contributed to the mitigation of respiratory airflow limitation. For the patient with severe OSAHS, the upper airway resistance and soft palate displacement increased after surgery, which aggravated the airway obstruction. The effcacy of nasal surgery for patients with OSAHS is determined by the degree of improvement in nasal obstruction and whether the effects on the pharynx are beneficial. Numerical simulation results are consistent with the polysomnogram（PSG） test results, chief complaints, and clinical findings, and can indirectly reflect the degree of nasal patency and improvement of snoring symptoms, and further,provide a theoretical basis to solve relevant clinical problems.

Nasal congestion caused by long-term retention of a nasal foreign body near the orbit:A case report

BACKGROUND Nasal trauma presents a risk of foreign body invasion into the nasal cavity.However,in the early treatment stage of nasal trauma,patients and doctors are not always aware of possible foreign body invasion,resulting in delayed detection.We describe the case of an adult patient admitted to the hospital due to left nasal congestion accompanied by yellow,purulent,and bloody discharge.CASE SUMMARY Consultation with the patient revealed a history of nasal trauma 30 years prior that did not receive thorough examinations and imaging during treatment,resulting in a glass fragment retained in the nasal cavity adjacent to the orbit.After admission,computerized tomography(CT)confirmed the presence of the foreign body in the patient’s left nasal–maxillary sinus.The nasal foreign body led to symptoms such as chronic sinusitis,nasal polyps,fungal infection,and deviated nasal septum.The foreign body was successfully removed by nasal endoscopy,polypectomy,sinus fungal removal,left middle turbinate conchoplasty,fenestration via the right inferior meatus,nasal endoscopic maxillary sinus cystectomy,and septolplasty.The operation was successful and without any complications.CONCLUSION CT scans should be performed in addition to necessary debridement sutures to avoid possible foreign body invasion during nasal trauma.Surgical planning should be tailored to the patient’s specific situation.The surgical method should be carefully selected,and sufficient preparation should be undertaken before the surgery to avoid possible displacement of the nasal foreign body.

Three-dimensional Evaluation of Nasal Surgery in Patients with Obstructive Sleep Apnea

Background： Obstructive sleep apnea （OSA） is a common sleep disorder and is characterized by airway collapse at multiple levels of upper airway. The effectiveness of nasal surgery has been discussed in several studies and shows a promising growing interest. In this study, we intended to evaluate the effects of nasal surgery on the upper airway dimensions in patients with OSA using three-dimensional （3D） reconstruction of cone-beam computed tomography （CT）. Methods： Twelve patients with moderate to severe OSA who underwent nasal surgery were included in this study. All patients were diagnosed with OSA using polysomnography （PSG） in multi sleep health centers associated with Massachusetts General Hospital, Massachusetts Eye and Ear Infirmary and the Partners Health Care from May 3 I, 2011 to December 14, 2013. The effect of nasal surgery was evaluated by the examination of PSG, subjective complains, and 3D reconstructed CT scan. Cross-sectional area was measured in eleven coronal levels, and nasal cavity volume was evaluated from anterior nasal spine to posterior nasal spine. The thickness of soft tissue in oral pharynx region was also measured. Results： Five out of the 12 patients were successfully treated by nasal surgery, with more than 50% drop of apnea-hypopnea index. All the 12 patients showed significant increase of cross-sectional area and volume postoperatively. The thickness of soft tissue in oral pharynx region revealed significant decrease postoperatively, which decreased from 19.14 ± 2.40 cm2 and 6.11± 1.76 cm2 to 17.13 ±1.91 cm2 and 5.22 ± 1.20 cm2. Conclusions： Nasal surgery improved OSA severity as measured by PSG, subjective complaints, and 3D reconstructed CT scan. 3D assessment of upper airway can play an important role in the evaluation of treatment outcome.

Septoplasty alone is not suitable for most structural nasal obstructions

Septoplasty is widely used in the treatment of structural nasal obstructions,and it also has a good effect and a high degree of postoperative satisfaction.However,there a large number of structures demonstrate abnormalities related to structural nasal obstruction,including the external nose,maxilla,nasal cavity and paranasal sinus.Nasal septum deviation is only one signs of structural nasal obstruction and does not represent all possible structural abnormalities of the nasal cavity and its surrounding structure.Septoplasty is only performed to correct deviations of the nasal septum,which in many cases is obviously insufficient in restoring the symmetry of the nasal structure.Therefore,septoplasty alone is not suitable for the treatment of most structural nasal obstructions.Nasal ventilation expansion surgery,which typically covers more abnormal structural correction procedures than septoplasty,should be used when describing the treatment of structural nasal obstruction.