With the help of personalized nasal dilation surgery, we can correct abnormal nasal structures, open sinuses symmetrically, increase effective nasal ventilation volume, reduce nasal resistance, relieve upper airway obstruction, increase respiratory tidal volume during sleep, improve the aerobic metabolism level, reduce the rate of pharyngeal surgery, which is important for reducing and controlling the incidence of cardiovascular diseases, metabolic disorders in the elderly and other major diseases. It is important to reduce and control the incidence of major diseases such as cardiovascular and cerebrovascular diseases and metabolic disorders. The core purpose is to expand the effective ventilation volume of the nasal cavity, which means to reduce the upper airway prevalent resistance, correct and improve the collapse of the pharyngeal cavity, and restore the normal ventilation function during sleep. It includes a series of surgeries such as nasal septum trilinear subtraction angioplasty, middle turbinate internal transfer fixation, bilateral middle nasal sinus symmetric opening and inferior turbinate external transfer fixation.
1.Three lines of nasal septum reduction surgery The surgery follows the principle of preserving or maintaining cartilage and bony stent as much as possible. By dissecting the three curves of the deviated septum (caused by abnormal tension during the growth of the embryonic growth point), the biomechanical support of the septum is restored and subsequent nasal dorsal collapse is avoided. The maxillary palatal eminence and palatal nasal crest are removed, and the square cartilage is preserved (for obvious deviation, a grid-shaped scratch can be performed on the concave side to reduce the tension); the vertical plate of the septum with high and severe deviation can be clamped with scissors or biting forceps to keep the fracture in the midline position without removal (Han et al., 2009). This procedure can maintain the thickness and stiffness of the nasal septum, avoid compliant nasal collapse, reduce septal flapping during breathing, increase the total nasal ventilation volume, and reduce the occurrence of septal perforation (Wang et al., 2010).
2.Intranasal turbinate fixation Abnormalities of middle turbinate morphology such as vesicular middle turbinate, middle turbinate retrusion and middle turbinate hypertrophy can directly affect middle nasal tract ventilation and sinus drainage. Internal fixation of the middle turbinate can simplify the management of these problems, including widening of the middle nasal tract for ventilation while reducing the mucosal inflammatory state. Endoscopically, the middle turbinate is moved inward with pressure from the root using a stripper to widen the middle nasal passage. The operation is simple, well tolerated by the patient, and the effect is remarkable.
3.Symmetric opening of bilateral middle nasal tract sinuses Chronic inflammation stimulates local mucosal edema and aggravates nasal obstruction. The study of nasal fluid dynamics found that the effective ventilation space of the nasal cavity is mainly located in the common nasal tract and middle nasal tract, so symmetric opening of the sinuses in the middle nasal tract bilaterally is an important part of nasal dilation. Intraoperative resection of the hooked process, symmetrical opening of the sieve bubble and anterior and posterior groups of sieve sinuses, enlargement of the middle nasal tract increase the effective ventilation volume of the nasal cavity and improve the function of nasal humidification and warming. The need to enlarge the maxillary sinus opening will facilitate the NO molecules in the maxillary sinus to reach the lower airway.
4.External fixation of inferior turbinate A variety of factors can cause hyperplasia and hypertrophy of the inferior turbinate, affecting the ventilation of the common nasal tract. The nasal threshold is the narrowest part of the entire upper airway, and the anterior inferior turbinate is one of the important structures constituting the nasal threshold, and its small changes can affect the changes in the resistance of the entire upper airway. Inferior turbinate hypertrophy is an important factor contributing to elevated nasal resistance. External fixation of the inferior turbinate not only relieves the narrowing of the nasal threshold to a certain extent, but also meets the requirement of functional nasal endoscopic surgery to preserve the normal nasal mucosa and avoid the appearance of empty nose syndrome. The procedure is performed by placing a round blunt stripper through the common nasal passage to compress the anterior inferior inferior turbinate, fracturing the root of the inferior turbinate from anterior to posterior, displacing the lateral wall of the nasal cavity and opening the common nasal passage. This procedure has the advantages of simple method, small trauma and obvious efficacy.