Using the Maxillary-Nasal Angle to Evaluate Congenital Nasal Pyriform Aperture Stenosis

Abstract

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.

Sublabial Approach for Repair of Congenital Nasal Pyriform Aperture Stenosis: How I Do It

“…In almost all of the cases, the anterior–posterior depth of the overgrown maxillary bone was thicker than expected. This observation aligns with the idea that narrowing of the nasal pyriform aperture extends deep into the nasal cavity and can be measured by a narrowed maxillary‐nasal angle 4 . Before using a drill to remove the bone, it was helpful to feel the depth of the pyriform aperture with an angled round knife to understand how deep to carry the dissection.…”

“…Surgical management of CNPAS involves a sublabial approach with postoperative stenting. 2,3 The severity of clinical symptoms, pyriform aperture width, and maxillary-nasal angle 4 can help determine whether to manage a patient medically or surgically. For outpatients, we monitored weight gain and respiratory symptoms every few weeks upon CNPAS diagnosis.…”

Modeling congenital nasal pyriform aperture stenosis using computational fluid dynamics

“…Belden, et al, reported a PA width of < 11 mm to be diagnostic of CNPAS [2]. However, this criterion has been questioned as more recent case series have found most symptomatic patients have PA width much lower than 11 mm [5, 8, 22]. While most cases can be accurately diagnosed on the grounds of clinical suspicion along with imaging showing clear evidence of maxillary overgrowth, there is no consistent objective finding diagnostic of CNPAS.…”

“…This has been recognized in the literature. Multiple studies have attempted to use measurements other than the PA width to characterize the airway [8, 22]. Use of 3-D CT scans to characterize the airway has also been reported [24].…”

“…Those who fail conservative airway management, indicated by continued respiratory difficulty and poor weight gain, may require interventions such as endotracheal intubation, feeding tubes, or more aggressive interventions such as surgery [6, 7]. While the decision to proceed to more aggressive treatment is clinical, previous studies have attempted to identify the patients more likely to require surgical treatment by using CT-measured nasal cavity dimensions such as PA width or maxillary-nasal angle as predictors [5, 8]. However, the correlation between nasal cavity dimensions and clinical symptoms is unclear [9].…”