Invited Discussion on: The Role of the Depressor Nasi Septi Muscle in Nasal Air Flow
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: The Role of the Depressor Nasi Septi Muscle in Nasal Air Flow Ali Totonchi1
Received: 20 April 2020 / Accepted: 21 April 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. In this manuscript, the authors reviewed 29 patients (18 males and 11 females) who underwent open rhinoplasty with or without repair of dermato-cartilaginous ligament (DCL) for external nasal valve competency. All of these patients had dorsal nasal hump deformity with no complaints of nasal obstructions or any need for improvement in the nasal tip; all of the patients were older than 18 years. This study was performed to show the effects of dermatocartilaginous ligament (DCL) repair on the function of the depressor septi nasi muscle for nasal respiration. Only patients who sought nasal hump reduction surgery with no airway issues were selected for this study. Patients with nasal obstruction, acute or chronic sinusitis, nasal polyps, facial paralysis, myopathies, nasal surgery prior to the study, dynamic nasal valve collapse (as determined by detailed nasal endoscopic examination), and static nasal valve collapse (as determined by the modified Cottle maneuver) were excluded from this study. Patients were randomized into DCL-positive (15 patients whose DCL was repaired after cutting during open rhinoplasty) and the DCL-negative (control) groups (14 patients whose DCL was not repaired during open rhinoplasty). All the patient underwent electromyography (EMG) prior to and 6 to 7 months after surgery as well as & Ali Totonchi [email protected] 1
MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA
rhinomanometry (RMM) before and 4 months after surgery. DCL was sutured in 15 patients (10 males and 5 females), and no suturing of the DCL was performed in 14 patients (8 males and 6 females). The depressor septi nasi muscle activity, as determined by EMG, was lower in the DCL-negative group than in the DCL-positive group. As the DCL was cut but not sutured in the DCL-negative group, the strength of the depressor septi nasi muscle was decreased. Furthermore, airflow and nasal resistance during respiration were also measured by RMM, and the results indicated that nasal resistance was increased in the DCL-negative group. Clinically the patients in the DCL-negative group began complaining of nasal obstruction from the second month after surgery. In this study, the authors clearly showed that repairing the DCL and therefore restoring the function of the depressor septi nasi muscle could improve the external valve function using electromyography and nasomanometry data. This finding could be very useful on the patients who are undergoing
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