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Alar Base Surgery
Published in Suleyman Tas, Rhinoplasty in Practice, 2022
The effects of the perinasal muscles, which constitute the dynamic component of the soft tissue anatomy of the alar base, are seen in Bell’s palsy. In addition to innervation loss in all the facial mimetic muscles on that side, the alar base goes down and the nasolabial fold becomes flat. Nostril collapse and inspiration problems also occur due to loss of function in the dilator naris muscle. However, total nostril collapse does not occur on the paralyzed side because the cartilage and ligament systems and static components do not allow this. The piriform ligament, rising from the piriform aperture and lying on the lateral cartilage and alar base, is the most important structure in this ligament system.
Neonatal Nasal Obstruction
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
This abnormality, first described in 1988, is a very rare condition leading to nasal obstruction in the neonate which arises due to bony overgrowth of the nasal process of the maxilla (Figure 23.5).17 The piriform aperture is the narrowest part of the nasal airway and so even minimal reduction in diameter here can cause significant problems. Symptoms similar to bilateral choanal atresia occur and epiphora is also often seen secondary to bony involvement of the nasolacrimal ducts. Diagnosis is suggested by the inability to pass a narrow gauge nasogastric tube or 2.2 mm endoscope through the anterior nasal vestibule due to the bony obstruction. CT scan confirms the diagnosis with an aperture width of less than 11 mm measured on an axial CT at the level of the inferior meatus (in a term neonate). CT can also demonstrate a single central incisor, which exists in some affected individuals. This single central incisor is associated with an absent upper frenulum and arch-shaped lower lip. In this subgroup with a ‘megaincisor’ there is a suggested association with holoprosencepaly, a rare condition in which the developing forebrain fails to divide appropriately to form the cerebral hemispheres, diencephalon, and optic and olfactory bulbs. These patients should undergo further evaluation for central nervous system defects with an MRI and particularly the hypothalamic–pituitary–thyroid axis. There are variable reports on the incidence rates of this condition with piriform aperture stenosis, but a figure of around 50% is generally accepted.18
Alveolar bone grafting in cleft patients
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
Following removal of any excess mucosa, the nasal layer is approximated closing the fistula along its length. A thin sheet of cortical bone is inserted at the level of the piriform aperture reconstructing the nasal floor (Figure 69.17). A biomembrane (Bio-Gide®; Geistlich Pharma, Wolhusen, Switzerland) is placed above the cortical sheet which acts as a barrier to ingress of infection and promotes guided tissue regeneration.
Biomechanical evaluation of maxillary protraction with an orthodontic anchor screw: a three-dimensional finite element analysis
Published in Orthodontic Waves, 2021
Tomohiro Ebisawa, Hidenori Katada, Kenji Sueishi, Yasushi Nishii
In terms of stress distribution, although high stress was observed in the piriform aperture lateral wall at 0°, stress decreased at greater angles. Stress on the alveolar bone increased at greater angles. These findings are similar to the stress distribution results of the dental anchorage model reported by Yan et al [26]. Compared with the stress distribution observed with a plate-type appliance in skeletal anchorage models using the finite element method in previous studies, the patterns we observed are more similar to those of conventional dental anchorage models [13,24,29]. This can be ascribed to the tooth and bone–borne appliance that we used for the skeletal anchorage model, which allowed load to be transferred to the maxilla not only through the anchor screw but also through the teeth.
Swinging inferior turbinate approach to the nasolacrimal duct
Published in Orbit, 2020
David S. Curragh, Craig James, Dinesh Selva
A mucosal incision using monopolar diathermy was made just superior to the insertion of the inferior turbinate on the lateral nasal wall, beginning at the root of the uncinate process, at the junction of its horizontal and vertical portions, continuing onto the frontal process of the maxilla (Figure 2c). The incision was carried forward towards the piriform aperture just anterior to the anterior head of the inferior turbinate and brought inferiorly to the floor of the nose. This incision was made down to the bone to facilitate elevation of the inferior turbinate to expose its attachment to the lateral nasal wall (Figure 2d). The inferior turbinate attaches to the lateral wall on its central portion by three process, the lacrimal, ethmoidal and maxillary processes. The lacrimal process, which forms the medial wall of the nasolacrimal canal, was disinserted and the bone medial to the nasolacrimal duct can then be easily removed (Figure 2e) to expose the entire length of the nasolacrimal duct which was distracted medially from its bony canal, leaving the bony medial wall of the maxillary sinus posterior to the nasolacrimal duct in place (Figure 2f).
Prelacrimal approach for nasolacrimal duct excision in the management of lacrimal system tumours
Published in Orbit, 2019
David S. Curragh, Alkis J. Psaltis, Neil C. Tan, Dinesh Selva
The procedure was performed under general anaesthetic. Two per cent lignocaine with 1:80,000 adrenaline was injected into the nasal septum, inferior turbinate, and lateral nasal wall as local anaesthetic. Neuropatties soaked in 1 mL of 1:1000 adrenaline, 2 mL of 10% cocaine solution, and 3 mL of normal saline were applied to the nasal mucosa for topical vasoconstriction. Via an endoscopic approach, an uncinectomy and middle meatal antrostomy were performed using the well-described “swing door” technique.15 A mucosal incision using monopolar diathermy (15 W) delivered via a Colorado needle (Stryker, St Leonards, NSW, Australia) was made just superior to the insertion of the inferior turbinate on the lateral nasal wall, beginning at the anterior edge of the maxillary antrostomy, onto the frontal process of the maxilla (Figure 3A). The incision was carried forward to just anterior to the head of the inferior turbinate and brought inferiorly to the floor of the nose. This incision was made down to bone to facilitate raising of a mucosal flap to expose the entire bony extent of the anterior inferior turbinate and its attachment to the lateral nasal wall (Figure 3B). Osteotomies were created to remove a wedge of bone of the lateral nasal wall, just posterior to the piriform aperture and anterior to the nasolacrimal duct (Figure 3C). Preserving the piriform aperture reduces the risk of alar notching that can have functional and cosmetic consequences. The remainder of the bone anterior to the nasolacrimal duct can then be easily removed with a Blaksley forceps to expose the entire length of the nasolacrimal duct (Figure 3D). A lacrimal probe was then passed externally through the inferior lacrimal canaliculus down the length of the nasolacrimal duct to identify its opening at Hasner’s valve in the inferior meatus. Monopolar was again used to incise a cuff of tissue around the valve of Hasner (Figure 3E). The lacrimal apparatus was then excised en-bloc. This included the lacrimal bone posterior to the lacrimal sac (Figure 3F). The lateral nasal wall was reconstructed by suturing the mucosa with 4/0 vicryl rapide (Figure 3G).