A                 B                C

Caption:

Protection of the Inferior Nasal Passage.

Legends:
A. The general flow of air passes through the lower nasal passageway (Southern type of nasal aerodynamics).

B.The creation of the cross connection between the anterior end of the inferior, turbinate and nasal septum.

C. The general flow of air passes through the middle nasal passageway (Northern type of nasal aerodynamics).

 

NASAL AERODYNAMICS and RHINOSINUSITISES

PRIMARY VALVE OF THE NOSE - IT'S HIS CAVERNOUS BODIES

Relationship between two parallel respiratory structures in the nose

The main cause of the night snoring is violations of the nasal aerodynamics

The functionality of the small ostiums of the nasal sinuses

The functionality of the small ostiums of the nasal sinuses

Critical comparison of opposite opinions about the function of the nasal sinuses using Occam's Razor

The real significance of the limen nasi

NASAL AERODYNAMICS

VARIANTS OF NASAL AERODYNAMICS

NORMOGRAM OF NASAL AERODYNAMICS

PHYSIOLOGICAL BRIDGE REPRESENTED BY THE NASAL VALUE

SURGICAL RECONSTRUCTION OF NASAL AERODYNAMICS

SEPTOPLASRY UNDER CONTROL OF NASAL AERODYNAMICS

CONTRAINDICATION TO SEPTOPLASTY

PROTECTION OF THE LOWER MEATUS FROM INSPIRATION

THE INSIDIOUSNESS OF THE UNILATERAL "SOUTHERN" NASAL AERODYNAMICS.

SNORING WHEN NASAL RESPIRATION IS SAVED

Individual defence against infection by Severe Acute Respiratory Syndrome - SARS

 
 
 
 

A                         B

Caption: Cartilaginous implant - 8 in the field of doorstep of nasal bottom.


 

Protection of the Inferior Nasal Passage from Inspiration.

(Uliyanov Y.P. Abstract is pablished in J. Otolaryngology-Head and Neck Surgery. /Abstract/ Otolaryngology-Head and Neck Surgery ,   
August 1999: V.121, N 2, 204-205.)

INTRODUCTION:


It is well-known, that the lower(inferior) nasal passage actively participates  in respiratory  function of a nose, however it participates in protective function of a nose in the least degree, as only in medial and upper nasal passages open all paranasals sinuses in which air at an inspiration is humidified and warmed.  Research of a nasal aerodynamics especially precisely confirm such dependence.  This dependence of a status of respiratory ways mucosas on moving air flow in a nose and appropriate to stability of this people to catch a cold are quite proved and understandable, as well as it is caused by significant redistributions of airstreams between medial and lower nasal passages from 80 (CU) - 204,8 Pa up to 20 (CU) - 51,2 Pa. However, not understandable there was a sharp reduction of stability of the patients to catch a cold  (twice per a cold season) at it would seem insignificant (on 10 (CU) - 25,5 Pa) redistribution of airstreams from a medial nasal passage to lower (in group 50 /50 CU - 128,0 Pa.), when on a background of the minimal phenomenon subatrophic of a mucosas (+) in a nose, pharynx and larynx,  phenomenon vasomotor rhinitis became the most often (+++), have appeared  sinusitis (++) and otitis (+). This group achieved almost 1/3 (28 %) among of the persons with regularly catch a cold (Tab.1).   
  
  

Table 1. Variants of distribution of airstream among nasal passages at inspiration

 

Nasal passages  1,000 persons with  
seasonal  catch a cold. 
300 practically  
healthy  persons.
Olfactory area (Pascal) 25 25  25 25 25 25 25
Middle meatus (Pa.) 50  75  100  125  150  175  200 
Inferior meatus (Pa.) 200  175  150  125  100  75  50 

Clinical manifestations

 

Annual occurrence  
rate of catch a colds 
1-2  2-4  2-3  1-2  Catch a cold  
once for 4-5 years 
Otitis  + + 
Sinusitis  + +  + + +  + + 
Vasomotor rhinitis.  + +  + + +  + + + 
Subatrophic mucosa of SRW  + + +  + + +  + + 
Atrophic mucosa of SRW  + + 
Tracheobronchitis + + +  + + 
Laryngospasms 
Bronchial asthma  + + 
Pneumonia  + + 
Ozena  + + 
  

MATERIAL and METHOD  

We investigated 1000 patients, which regularly suffered from seasonal common  cold and 300 practically healthy persons, which suffered by common cold not more often, than once in 4 - 5 years. The age of the patients was from 2 till 86 years, of the men and women were approximately fifty-fifty (Tab. 1).  This table shows, that from the group with uniform distribution of air flows (50/50 CU) to in extreme groups with moving of  the main airstream to lower nasal passages up to 70 (CU) - 179,2 Pa. and  80 (CU) 204,8 Pa. the protective properties of a nose are gradually reduced and more aggressive display of catch a cold with its consequences (complications). As the distribution of air flows on an inspiration depends from property of the "physiological bridges", also moving of an air flow to a lower nasal passages is depends on changes in this area. For specification of these data we had carried the analysis of a status "physiological bridges" at these patients. We in addition surveyed 280 patients with uniform distribution of airstream  on inspiration (50/50 CU) between medial and lower nasal passages and their age was from 20 till 48 years, from them of the men were  212.  At an anterior rhinoscopy in this group of the patients  "physiological bridges" is kept, as well as at all practically healthy persons. However, the subsequent moving of airstream to lower nasal passage was already accompanied by appreciable  infringements in area of the nasal valve as well a slippage of the inferior turbinate with increase of a clearance connecting medial and lower nasal passages, that resulted in disappearance of the "physiological bridges". And the inferior turbinate bone on so much has decreased, that looked atrophic and corresponds to a "Southern type" of nasal aerodynamics. Hence, in process of a slippage of the inferior turbinate bone, the "physiological  bridges" gradually disappears and accordingly the protective properties of nasal aerodynamics loses. But in group of (50/50 CU), where these protective properties also decrease, visually to find out a slippage of the inferior turbinate bone it is not obviously possible. Therefore we continued to search for others, more latent of the reasons of such sharp downturn of protective properties of a nose to catch a cold. First of all, we have paid special attention to the lower nasal passage, as to most defenceless. It is quite obvious, that the mucosa of the lower nasal passage in the greatest degree suffers from an overload because it practically is unprotected from "harsh" air at inspiration. Only at expiration the warm and damp air way, as though tries to compensate this overload ( removes an irritation of a mucosa from an inspiration). But this indemnification is enough effective only in the summer period, and with a seasonal cold it is already unsufficient.  And as results in an overload of mucosa reaching a trauma of the lower nasal passage expressing in acute seasonal rhinitis. Hence, the lower nasal passages are programmed to be as a starting reason of development seasonal rhinitis.  And consequently, even the insignificant  displacement of an air flow on 10 (CU) in a lower nasal passage already becomes an overload for it. herefore, the regular seasonal catch a colds irrespective of the impression of complete differentiation of the lower and medial nasal passages with presence of the "physiological bridges", specify an overload of the lower passages as a result of infringements of a nasal aerodynamics. The similar patients we observed and in groups with more expressed displacement of an air flow in a lower nasal passages up to 20 and 30 (CU). To reveal such infringements in a nose at an anterior  rhinoscopy rather difficultly and only careful analysis of the mechanism of infringement of a nasal aerodynamics  allows to select for these patients the effective help. Such patients were 83 in the age of from 20 - till 50 years, of the men were 65. It more often (in 47 cases) we observed at a high position an inferior turbinate, when despite of division the lower and medial nasal passages, the main airstream at inspiration can not jump in a medial nasal passage and it as though fall down in a lower nasal passage (Fig. 1-1,2).   (Fig. 1-1,2).  

                                                           Fig. 1


                          1                                    2                                    3
 

In 30 cases of a high position an inferior turbinate we cracked a bone basis of its anterior department and then it displaced to bottom on so much (Fig. 1-2,3.), that the main airstream at inspiration has elevated in a medial nasal passage.  
In 19 of these cases the sizes of the inferior turbinate had appeared smaller and consequently after its displacement to bottom it simultaneously was removed from a nasal septum on so many that destroyed the "physiological bridges" (Fig. 2 - 1,2.). 

                                             Fig. 2                    Fig. 3

 

For a of restoration of the "physiological bridges" it was required in addition increase tissues in this area. With this purpose in 12 cases we had generated the new bridges (two-layers flap) between inferior turbinate and nasal septum - (Patent 2090156 - Fig. 2 - 1,7.), and in 7 cases we increased volume of inferior turbinate on a way  (Zain U. Kadri MD, Anaheim CA. "Reconstruction of inferior Turbinate" J. Otolaryng. H. N. S. 1998, p. 154-155), by an implantation in a mucosal "pocket"  of inferior turbinate a cartilage fragment of an auricle (Fig. 3 - 1,8.).  
The similar situation occurs and at a low position of a bottom (fundus) of a nasal vestibule  (absence a limen nasi - nasal riffle), when the main airstream at inspiration also fall down in the lower nasal passage. (Fig. 4- 1,2.),resulting to its overload.
 
It we observed in 36 cases at a medial position of the inferior turbinate. In 27 cases at a low position of a bottom of a nasal vestibule we carried out an implantation of a cartilage of an auricle in a mucosal "pocket" on bottom of a nasal vestibule (Patent 95110077), that allowed to generate a new limen nasi (nasal riffle) and with its help to lift an airstream at inspiration. It provided moving of an airstream in a medial nasal passage (Fig. 4 - 1,2,8).  
 
 

                                                          Fig. 4.

 
              In 5 cases it was necessary to use combined surgical plastic from an cartilage  implantant in the bottom of a nasal  vestibule and displacement  "physiological bridges " (inferior turbinate) to bottom. In this group of the patients only in two cases the additional increase of an inferior turbinate with the help of a cartilage implantation was required. The basic criterion of efficiency of these plastic operations was moving the main airstream at inspiration in a medial nasal passage (on 10-20 CU). This checked during operation and in two weeks after operation, when postoperational inflammation of tissues disappeared. Clinical results through 3 - 4 months at all were good, as the phenomena subatrophy of nasopharynx disappeared and mucosa of lower nasal passages and pharynxes became damp and juicy.  The subsequent supervision during 2-3 years (40 % of patients) have confirmed efficiency of results, as catch a cold these persons already practically did not suffer.  

                 Conclusions:  

               1. Appearance of regular seasonal rhinitis, despite the presence of the physiological bridge", is indicative of impaired protective function of nasal   aerodynamics.  

               2. The even small  (10 CU - 25,5 Pa.) distribution of airstream in the inferior nasal passages at inspiration can lifts sensitivity below nasal passage to  
overloads in fall and winter, thus programming to be as a starting reason of  
development seasonal rhinitis.  

               3.  The excessively high position of the "physiological bridge" causes the "down-fall" of the airstream at inspiration into the lower nasal passage, which results in its overload and seasonal rhinitis. In such cases, to protect the inferior nasal passage from overloads, surgical shift is indicated of the inferior turbinate bone downwards with supplementary correction of the "physiological bridge" until the main airstream at inspiration is shifted to the medial nasal passage.  

               4. The extremely low position of the fundus of the nasal vestibule, even when the "physiological bridge" is present, causes the "down-fall" of the air flow at inspiration into the lower nasal passage, which results in its overload and seasonal rhinitis. In such cases, to protect the inferior nasal passage from overloads, surgical elevating is indicated of the fundus of the nasal vestibule until the main air flow is shifted into the medial nasal passage.  

              5. In fact it is necessary to recognize that the inferior nasal passage needs protection from the main airstream at inspiration, i.e. protection from inspiration.