Cartilage Implanting To The Inferior Meatus For Nasal Hyperventilation

Inferior Meatus Augmentation With Rib Cartilage Procedure

Empty nose syndrome and intranasal air flow dynamics are still controversial and unknown issues. In cases where the intranasal airway is less than normal (nasal hypoventilation), patients experience "nasal congestion" and "feeling of low airflow from the nose" as a result of insufficient intake of air from the nose (increased nasal resistance). On the contrary, as a result of excessive reduction or resection of the "turbinates", which are mainly responsible for the air resistance in the nose, abnormally decreased nasal airway resistance, increased intranasal airflow velocity (nasal hyperventilation), and changes in intranasal aerodynamics occur. In this second case, in addition to symptoms such as accelerated and almost linear airflow from the nose, drying of the mucous membrane in the nose, affected free nerve endings, dryness in the nasal passages and dryness in the secretions, similarly, the insufficiency of the air taken from the nose, "nasal air deficiency", the nasal anatomy has been changed to a high degree. and even a "suffocating sensation" occurs in patients whose intranasal airway is very dilated. Unfortunately, the controversial issue on this issue and causing differences of opinion among physicians is why nasal air is not sufficient in patients with "open nasal airway or narrow nasal air passage". Sometimes, when the intranasal airway is quite wide, a "psychiatry consultation" may even be requested for patients who have the expression "the air I get from the nose is not enough"; Unnecessary "turbinate radiofrequency reduction" operation can be performed for the second time.

Nasal hyperventilation is less severe than the empty nose syndrome, but is also a condition that occurs due to accelerated intranasal airflow due to the altered nasal anatomy.

In this article, I would like to talk about a patient who had two previous septoplasty and turbinate radiofrequecy reduction operations with complaints of "pain in the nose", "coldness in the nose while breathing", "not enough air taken from the nose" and "dryness in the nose". When the patient applied to different clinics, it was emphasized that the intranasal airway was adequate and there was a nasal septum perforation with a diameter of several mm in the lower posterior part of the nasal septum. It was emphasized that if the air taken from the nose is not enough, turbinate reduction can be done again. Here, although distinctive and controversial, the "cotton test" or "cotton insertion into the nose" test can help in diagnosis. Should the patient's nose be made wider, or should the patient's nasal passage be narrowed?

"Inferior meatus augmentation" can be planned if the patient prepares a cotton ball impregnated with antibiotic eye ointment and regularly places it in the nose for a few hours (without closing the nose completely), if the patient's complaints decrease when the nose is narrowed. Contrary to this; If the complaints increase when dilator nasal strips are used, it can be considered that there is "nasal hyperventilation". Normally, there should be a distance of several mm between the inferior turbinate and the nasal septum. The patient, whose photograph I have shared with you below, had abnormally small inferior turbinates and when he narrowed this area by placing cotton in the lower part of the intranasal airway, rib cartilage implantation was planned in the inferior meatus for the patient, as his complaints subsided.

Cartilage graft augmentation of the inferior meatus - surgical procedure details

This procedure can be performed under local or general anesthesia. General anesthesia was preferred in our patient. After local anesthetic infiltration, a submucosal tunnel was opened after incision in the inferior meatus and nasal floor. A 1x3 cm cartilage graft obtained from irradiated costal cartilage obtained from a cadaver was placed near the lower part of the nasal septum and the nasal floor. The mucosal incision was sutured with 6/0 vicryl. Bleeding was controlled, the operation was terminated by placing spongos from which antibiotics were obtained.

Photo descriptions

In the 3 collage photographs below, the upper photograph showing a larger-than-normal air passage and a considerably smaller-than-normal inferior turbinate in the left nasal cavity, and the narrowed air passage 2 months later, after the inferior meatus augmentation, the protrusion of the inserted cartilage graft is seen. In the same way, the nasal septum perforation with a diameter of several mm is visible in the upper photo, while it can be seen to be completely closed in the lower photo.

Cartilage Implanting To The Inferior Meatus For Nasal Hyperventilation - Inferior Meatus Augmentation With Rib Cartilage Procedure

Cartilage Implanting To The Inferior Meatus For Nasal Hyperventilation - Inferior Meatus Augmentation With Rib Cartilage Procedure

Cartilage Implanting To The Inferior Meatus For Nasal Hyperventilation - Inferior Meatus Augmentation With Rib Cartilage Procedure

In which patients can this procedure be performed?

Surgical narrowing of the intranasal air passage may be appropriate in patients whose turbinates are not completely removed and their complaints are reduced by cotton test. Modified Young or Young's Operation has also been described in patients whose turbinates have been completely removed. Again, procedures can be performed to close the nasal septum perforations, which may cause abnormal acceleration in the intranasal air passage.

Patient Selection for Cartilage Implantation to Inferior Meatus Augmentation Operation

Although it is not easy to tell which patients are suitable for cartilage implantation of the inferior meatus; As a simple application, if the patients state that they are satisfied after the small balls of pauk impregnated with eye ointment are placed into the nose, or if the patients state that a positive effect is obtained when the hyaluronic acid filler is injected into the existing turbinate tissue (usually they say this within a few weeks), the intranasal airflow cartilage implantation can be planned in order to narrow the pathways.

In the links below, you can find detailed information about the definition of nasal hyperventilation, its symptoms, the functions of turbinates, and what is wrong turbinate overreduction or turbinate reduction.

Cost of Cartilage Implantation For Nasal Hyperventilation in Istanbul

In this procedure we can use the ear or rib cartilage (patien's own cartilage or cadaveric cartilage). The cost is about 3500-4500 US Dollars according to the hospitals. Prices may increase in luxury hospitals.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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