Enlargement of nasal vault diameter with closed septoturbinotomy.
BACKGROUND
Septal deviation and inferior turbinate hypertrophy are important contributors to nasal airflow obstruction. In recent years, a closed septoturbinotomy, whereby a speculum is inserted into the nose and the blades are spread, has been shown to centralize the bony septum and outfracture the turbinates in most cases. It is a minimally invasive procedure that frequently corrects bony septal deviation and reduces enlarged inferior turbinates. However, the extent of vault enlargement by that method has not been quantified. The purpose of this study was to demonstrate and quantify the extent to which a closed septoturbinotomy enlarges the maximal diameter of the nasal vault.


METHODS
Measurements and silicone molds of the nasal vault were obtained before and immediately after performing closed septoturbinotomy in nine human cadavers. Measurements were taken with standardized graduated rubber tubing. Molds were obtained with commercially available sealant.


RESULTS
All cadaver noses demonstrated enlargement of maximal internal diameter of the obstructed side on both calibrated tubing and silicone mold measurements (p < 0.05). The mean postosteotomy-to-preosteotomy vault diameter ratio was 1.64 (range, 1.25 to 2.3) for the obstructed side and 1.16 (range, 1.0 to 1.4) for the unobstructed side. This 64 percent increase in radius permits a theoretical 7-fold increase in flow by Poiseuille's law.


CONCLUSIONS
Closed septoturbinotomy is a minimally invasive technique that enlarges the nasal vault in the overwhelming majority of cases. A clinical trial with rhinomanometry is needed to verify the extent of functional improvement.
Abou-Sayed
Hatem A
HA
Palm Springs, Fla.; and Los Angeles and San Francisco, Calif. From Plastic Surgery of Palm Beach; Department of Plastic and Reconstructive Surgery, University of California, Los Angeles School of Medicine; and University of California, San Francisco School of Medicine.
Lesavoy
Malcolm A
MA
Gruber
Ronald P
RP
D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D015508:Nasal Obstruction / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery*; D009666:Nose / Q000033:anatomy & histology* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D014420:Turbinates / Q000601:surgery*
Courtiss, E. H. Diagnosis and treatment of nasal airway obstruction due to inferior turbinate hypertrophy. Clin. Plast. Surg. 15: 11, 1988.
Courtiss, E. H., and Goldwyn, R. M. Resection of inferior turbinates: A 10-year follow-up. Plast. Reconstr. Surg. 86: 152, 1990.
Courtiss, E. H., and Goldwyn, R. M. The effects of nasal surgery on airflow. Plast. Reconstr. Surg. 72: 9, 1983.
Courtiss, E. H., and Goldwyn, R. M. Resection of inferior turbinates: A 10-year follow-up. Plast. Reconstr. Surg. 86: 152, 1990.
Thomas, P. L., John, D. G., and Carlin, W. V. The effect of inferior turbinate outfracture on nasal resistance to airflow in vasomotor rhinitis assessed by rhinomanometry. J. Laryngol. Otol. 102: 144, 1988.
Warwick-Brown, N. P., and Marks, N. J. Turbinate surgery: How effective is it? A long-term assessment. O.R.L. J. Otorhinolaryngol. Relat. Spec. 49: 314, 1987.
Gruber, R., and Lesavoy, M. Closed septal osteotomy. Ann. Plast. Surg. 40: 283, 1998.
Gruber, R., and Lesavoy, M. Simple technique to correct the bony septum. Plast. Reconstr. Surg. 102: 244, 1998.
Buenting, J. E., Dalston, R. M., Smith, T. L., and Drake, A. F. Artifacts associated with acoustic rhinometric assessment of infants and young children: A model study. J. Appl. Physiol. 77: 2558, 1994.
Constantian, M. B., and Clardy, R. B. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast. Reconstr. Surg. 98: 38, 1996.
Courtiss, E. H., Gargan, T. J., and Courtiss, G. B. Nasal physiology. Ann. Plast. Surg. 13: 214, 1984.
Rohrich, R. J., Krueger, J. K., Adams, W. P., Jr., and Marple, B. F. Rationale for submucous resection of hypertrophied inferior turbinates in rhinoplasty: An evolution. Plast. Reconstr. Surg. 108: 536, 2001.
Mabry, R. L. Surgery of the inferior turbinates: How much and when? Otolaryngol. Head Neck Surg. 92: 571, 1984.
Chang, C. W., and Ries, W. R. Surgical treatment of the inferior turbinate: New techniques. Curr. Opin. Otolaryngol. Head Neck Surg. 12: 53, 2004.
Nunez, D. A., and Bradley, P. J. A randomised clinical trial of turbinectomy for compensatory turbinate hypertrophy in patients with anterior septal deviations. Clin. Otolaryngol. 25: 495, 2000.
Ho, W. K., Yuen, A. P., Tang, K. C., Wei, W. I., and Lam, P. K. Time course in the relief of nasal blockage after septal and turbinate surgery: A prospective study. Arch. Otolaryngol. Head Neck Surg. 130: 324, 2004.
Passali, D., Lauriello, M., De Filippi, A., and Bellussi, L. Comparative study of most recent surgical techniques for the treatment of the hypertrophy of inferior turbinates (in Italian).Acta Otorhinolaryngol. Ital. 15: 219, 1995.
Martinez, S. A., Nissen, A. J., Stock, C. R., and Tesmer, T. Nasal turbinate resection for relief of nasal obstruction. Laryngoscope 93: 871, 1983.
Jackson, L. E., and Koch, R. J. Controversies in the management of inferior turbinate hypertrophy: A comprehensive review. Plast. Reconstr. Surg. 103: 300, 1999.