Using the maxillary-nasal angle to evaluate congenital nasal pyriform aperture stenosis.
OBJECTIVE
Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of nasal airway obstruction in newborns. The decision to operate is made clinically. Although pyriform aperture width is used for diagnosing CNPAS, it does not fully characterize stenosis of the nasal cavity.


OBJECTIVE
To determine the utility of additional metrics for evaluating CNPAS.


METHODS
The medical records of 13 patients with CNPAS treated from 2007 through 2012 at a single tertiary pediatric facility were retrospectively examined. Data on patient demographic characteristics, known genetic abnormalities, and hospital courses were extracted. Computed tomographic images were evaluated for pyriform aperture width; maxillary-nasal angle (MNA), defined as the angle between the anterior maxilla and anterior-posterior nasal axis; and choanal width.


METHODS
Medical management and surgical management.


METHODS
Pyriform aperture width, MNA, and choanal width.


RESULTS
Six of 13 patients underwent medical management, and 7 patients underwent surgical treatment. For patients who were managed medically as compared with those managed surgically, the evaluation revealed a larger pyriform aperture width (median [interquartile range {IQR}], 5.6 [5.4-6.1] vs 4.6 [4.5-4.7] mm; P = .03) and MNA (median [IQR], 70° [63°-73°] vs 59° [59°-64°]; P = .048) but no significant difference in choanal width (median [IQR], 11.0 [9.6-12.2] vs 11.9 [10.3-11.9] mm; P = .76).


CONCLUSIONS
The MNA, when used in conjunction with pyriform aperture width, provides additional pertinent information to supplement clinical decision making in the evaluation of patients with CNPAS. These measurements may be helpful in identifying patients who should undergo surgical intervention, although additional studies would be required to allow predictive use of the MNA.
Department of Otolaryngology-Head & Neck Surgery, Ohio State University Wexner Medical Center, Columbus.
Jigar B
JB
Sitapara
Center for Surgical Outcomes Research, Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
Justin B
JB
Mahida
Department of Otolaryngology-Head & Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio.
Timothy P
TP
McEvoy
Department of Otolaryngology-Head & Neck Surgery, Ohio State University Wexner Medical Center, Columbus4Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio.
Charles A
CA
Elmaraghy
Center for Surgical Outcomes Research, Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
Katherine J
KJ
Deans
Center for Surgical Outcomes Research, Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
Peter C
PC
Minneci
Department of Otolaryngology-Head & Neck Surgery, Ohio State University Wexner Medical Center, Columbus4Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio.
Jonathan M
JM
Grischkan
D002754:Choanal Atresia / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D003251:Constriction, Pathologic / Q000150:complications / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008437:Maxilla / Q000000981:diagnostic imaging*; D015508:Nasal Obstruction / Q000151:congenital* / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D009666:Nose / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D056144:Pyriform Sinus / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed