Citations

Disturbance of the normal relationship between the caudal border of the upper lateral cartilage and the cephalic margin of the lobular cartilage—the so‐called “cul‐de‐sac” area—can result in alar collapse and nasal airway obstruction. This may be caused by either the aging process or trauma, both surgical and nonsurgical. Rhinolift is a surgical procedure that was developed for the treatment of the aging ptotic nasal tip. We have applied this technique to patients with nasal airway obstruction resulting from alar collapse. Elevation of the cephalic margin of the lobular cartilage to a position superficial to the upper lateral cartilage restores the normal relationship between these two structures. The upper lateral cartilage then assists in stenting the vestibule open, and thereby improves nasal breathing. Over the past 10 years, 20 patients have had rhinolifts at our institution for the relief of nasal airway obstruction. Concomitant surgery included nasal septal reconstruction in 12 patients, polypectomy in one patient, and placement of a silicone rubber septal prosthesis for closure of a large septal perforation in three patients. Rhinolift was the sole procedure used for the correction of valvular pathology in 10 patients. The other 10 patients had modifications made in their upper lateral cartilage along with the rhinolift. Five patients described restoration of normal nasal breathing, while 14 patients showed partial symptomatic improvement. One patient reported no improvement in nasal breathing. Rhinolift is a safe effective surgical technique for functional improvement of nasal breathing in patients with alar collapse resulting from inadequate cartilaginous support.

A new computerized technique for the assessment of human nasal ciliary beat frequency is described. Thirty normal volunteers underwent nasal cytologic brushing to obtain ciliary samples. In each subject, 150 ciliary beats were analyzed from each of 50 separate ciliated cell clusters. The ciliary beat frequency for each area was determined with fast Fourier transformation. The results were plotted on a histogram to determine the ciliary beat distribution. The mean frequency for these samples was 11.29 Hz, with a standard deviation of 0.96 Hz. The median frequency for these samples was 11.25 Hz. These results show a marked improvement over hand‐counting microphotometry techniques because of the much larger sampling size and elimination of much human error. We believe this method of ciliary analysis represents a significant advancement in the evaluation of ciliary function and should assist in the diagnosis of patients with congenital and acquired forms of ciliary dysmotility.

The development of valid objective measurements of vocal cord vibration during phonation is a goal of current research in laryngeal physiology. An excised canine larynx was used to study the effects of vocal cord tension, air flow rate, and glottic width on glottographic parameters. The electroglottographic and photoglottographic waveforms were simultaneously recorded as the vocal cord tension, glottic width, and air flow rate were systematically varied. These glottographic waveforms were analyzed to determine the open quotient and speed quotient. Multiple regression analysis of the data obtained from 10 larynges showed the open quotient to be directly related to vocal fold tension (p< 0.001), glottic width (p < 0.01), and fundamental frequency (p < 0.001). Speed quotient was inversely related to glottic width and subglottic pressure (p < 0.05). Regression analysis also showed frequency of vibration to be directly related to tension (p < 0.001) and inversely related to glottic width (p < 0.001), with different combinations of glottic tension and width capable of producing the same frequency. The open and speed quotients thus reflect the changes in the vibratory patterns of the vocal folds produced by alterations in tension and width. The clinical implications of these results will be discussed, with emphasis on glottography as an objective assessment of the various laryngeal framework procedures being performed.