Preoperative assessment of airway patency in the planning of corrective cleft nose surgery.

OBJECTIVE: To investigate acoustic assessment of complex structural anomalies in cleft lip and palate associated nasal deformities and its impact on the planning of corrective rhinosurgery.

PATIENTS: Twenty-three consecutive patients with unilateral CL(P) during routine consultations, three of them prior to corrective surgery.

INTERVENTION: Acoustic measurements of the nasal airway crosssectional area were obtained for both nasal cavities. The size of isthmus area and isthmus location as well as the nasal volume and decongestion capacity in various regions of interest were determined.

RESULTS: Obstructions in the area of the nasal valve (< 0.4 cm2) were detected in 85% of the patients on the cleft side, but only 15% on the contralateral side. Severe mucosal hypertrophy was a common finding on the cleft side with a significantly higher capacity of decongestion, especially in the posterior region of the nasal cavity (P < 0.02). A second stenosis located behind the physiological isthmus was found in 16 patients.

CONCLUSION: Acoustic rhinometry is a noninvasive, objective method. It measures the degree and the exact location of airway obstructions. Apart from the equipment, the only prerequisite is a cooperative patient. The measurement has direct therapeutic consequences. If the exact cause and location of airway stenosis are known, it is easier to adapt the corrective surgical procedures to suit the individual patient. The decision in favour of additional therapeutic measures can be made on a more rational basis to prevent residual airway problems postoperatively. Preoperative acoustic rhinometry offers valuable information concerning the severity and location of nasal airway obstructions and thus proves to be a helpful tool in the planning of corrective operative measures.