[Surgical treatment of unilateral atrophic rhinitis with total obstruction of the opposite nasal fossa].
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The aetiology of primary atrophic rhinitis is still unknown. Treatment of this disease is conservative in the first place. Surgery is indicated if the medical treatment fails. The aim of surgery is either to narrow the nasal cavity or in special cases to close the nostril. Closure of the nostril (Young's operation), is achieved by raising a circular skin flap. Raising the skin flap is difficult, the suture line may break down and an excessive scar tissue may form resulting in vestibular stenosis. We therefore developed a septal mucoperichondrial flap to close the nostril. This new and easy technique has been used to treat 17 patients with excellent results. The description of this technique and the results of surgery will be discussed.
Atrophic rhinitis is caused by toxigenic Pasteurella multocida strains. The infection is supported by Bordetella bronchiseptica and other widespread agents and by non-infectious factors damaging the nasal epithelium. The term "infectious multifactorial disease" means in German, that ubiquitous low-virulent agents cause disease when intensified by non-infectious factors. Atrophic rhinitis does not belong to this group but is an infectious disease, caused by a specific agent and influenced by several factors.
OBJECTIVE: To improve the treatment effect of atrophic rhinitis. METHOD: Twenty-one cases (thirty-one sides) of atrophic rhinitis were treated by implantation of complex tissue flap to narrow the nasal cavity. RESULT: Short-term effective treatment results were 100% (21/21), long-term effective treatment results were 90.5% (19/21). CONCLUSION: Implantation of complex tissue flap offers a simple and effective way and can be recommended for the treatment of atrophic rhinitis.
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BACKGROUND: Atrophic rhinitis is a distressing and socially crippling disease. Surgical treatment has been used for patients with severe disease that is unresponsive to medical therapy. METHODS: Eight patients with primary atrophic rhinitis were treated surgically by narrowing of the nasal fossae with implantation of 2 Plastipore plates per affected side into submucosal pockets into the floor of the nose and septum, thus reducing the volume of the nasal fossae. RESULTS: Excellent results were obtained in 6 patients, with complete resolution of symptoms and good results and only minor crusting in 2 patients. One implant was extruded spontaneously 18 months after implantation and was reimplanted. Results in this patient before and after reimplantation were excellent. There were no cases of infection and no other complications. CONCLUSION: We implanted Plastipore, a high-density polyethylene sponge with micropores, which enables tissue ingrowth, anchoring the implants to the surrounding tissue. The surgical technique is performed with the patient under local anesthesia and is relatively easy and avoids complicated flap procedures, allogeneic bone harvesting, and the discomfort of nostril closure for prolonged periods.
The spontaneous occurrence of atrophic rhinitis in 12 of 49 goat herds in one area of Norway is described. The clinical signs included nose bleeding, nasal discharge, sneezing and tender noses. Pathologically, the macroscopic and histological findings resembled those found in pigs with atrophic rhinitis. Bacteriological investigation of nasal swabs in five of the herds revealed toxigenic strains of Pasteurella multocida in three of them. In four of the herds the clinical signs were seen in two or more consecutive years. No specific source of the infection was discovered. Atrophic rhinitis was induced experimentally in kids by the nasal inoculation of toxigenic strains of P multocida and atrophic rhinitis toxin.
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