Nasal cavity ventilation expansion techniques

Abstract

Nasal cavity ventilation expansion surgery has been progressively developed alongside an advanced understanding of the pathophysiological mechanisms of sleep-disordered breathing and the maturation of endoscopic surgery techniques. Nasal cavity ventilation expansion surgery could increase the ventilation volume of the nasal cavity effectively and decrease the nasal resistance, relieve the upper airway obstruction, and finally remove the original obstructive factor in the upper airway obstruction. The major significance of these procedures is to decrease the pre-ventilation resistance of the upper airway, to relieve pharyngeal collapse, to recover normal ventilatory function, to promote physical recovery, to re-establish normal metabolic functions, and to restore sleep structure. Nasal cavity ventilation expansion surgery includes a series of procedures and to open nasal sinuses symmetrically could decrease the nasal resistance, relieve the upper airway obstruction, and finally remove the original obstructive factor in the upper airway obstruction. The application of endoscopic surgery to obstructive sleep apnea (OSA) enhances the ventilation volume and symmetry of nasal cavity ventilation and has expanded the range of indications for which functional endoscopic sinus surgery (FESS) is effective. Combined with H-uvulopalatopharyngoplasty (H-UPPP), the outcome of surgical treatment on ventilation disorders of the upper airway obstruction and the symptoms of OSA will both be improved.

Reoperation on patients with obstructive sleep apnea–hypopnea syndrome after failed uvulopalatopharyngoplasty

“…Due to the presence of bone or cartilage in the nasal and nasopharyngeal area, endoscopy and CT scan for morphological evaluation of this area are sufficient for preliminary confirmation or exclusion of nasal and nasopharyngeal obstruction [12]. In contrast, the oropharyngeal and glossopharyngeal area does not contain bone or cartilage, and endoscopy, CT and other morphological evaluation methods alone cannot accurately determine the site of obstruction [17].…”

“…Evaluation of the nasal cavity-nasopharynx was primarily based on nasal endoscopy and CT scan results. Those with an obvious deviated nasal septum, turbinate hypertrophy, new growth in the nasal cavity or adenoid hypertrophy were considered to have nasal cavity-nasopharyngeal obstruction and appropriate surgical treatments were performed [12]. Evaluations of the oropharyngeal and glossopharyngeal areas were mainly based on NPT-PSG results.…”

Evaluation of the subjective efficacy of nasal surgery

“…It can significantly improve OSAHS patient QoL. 3 In this study, patients with OSAHS and simple snoring who complained of nasal blockage and snoring during sleep underwent nasal surgery. Subjective symptoms were compared at baseline and approximately six months after surgery.…”

The Pneumatization and Adjacent Structure of the Posterior Superior Maxillary Sinus and Its Effect on Nasal Cavity Morphology

“…In addition, residual lesions in the anterior ethmoidal sinus and posterior ethmoidal sinus after ESS have been reported widely during revision functional endoscopic sinus surgery [ 6 ]. The common anatomic factor associated with primary surgery failure was incomplete anterior ethmoidectomy (64%), and incomplete posterior ethmoidectomy (41%) [ 7 ], which may be related to the lack of awareness of the anatomical variations between PSMS and posterior ethmoidal cells [ 5 ]. However, there is little literature that focuses on anatomical variations.…”

“…It is well known that the anatomic width of the nasal cavity is related to the nasal ventilation function. Nasal cavity ventilation expansion surgery has become one of the effective methods for the treatment of obstructive sleep apnea syndrome (OSAS) for patients with nasal obstruction [ 7 , 8 ]. There are many considerations in the operation of the nasal cavity ventilation expansion including septoplasty, medial displacement and fixation of the middle turbinate (MT), and lateral displacement and fixation of the inferior turbinate (IT).…”