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CASE REPORT
Year : 2019  |  Volume : 37  |  Issue : 3  |  Page : 311-313
 

A simplified approach of prosthetic management of posttraumatic nasal obstruction using a custom-made unilateral intranasal stent in 14-year-old child


Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India

Date of Web Publication30-Sep-2019

Correspondence Address:
Dr. Amit Khatri
Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi - 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPPD.JISPPD_232_18

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   Abstract 


Infections, trauma, iatrogenic causes, congenital malformations, or complications of systemic diseases can result in perforation of the nasal septum. An intranasal stent is a removable prosthesis that can be inserted into the nasal cavity to support the form of nose. The stenting can be used for recanalization and nasal valve preservation. This case report presents a method for the fabrication of a customized nasal stent in a 14-year-old female patient with posttraumatic unilateral collapsed nasal vestibule.


Keywords: Intranasal stent, nasal vestibule, prosthetic management


How to cite this article:
Khatri A, Kalra N, Tyagi R, Panwar G, Garg K. A simplified approach of prosthetic management of posttraumatic nasal obstruction using a custom-made unilateral intranasal stent in 14-year-old child. J Indian Soc Pedod Prev Dent 2019;37:311-3

How to cite this URL:
Khatri A, Kalra N, Tyagi R, Panwar G, Garg K. A simplified approach of prosthetic management of posttraumatic nasal obstruction using a custom-made unilateral intranasal stent in 14-year-old child. J Indian Soc Pedod Prev Dent [serial online] 2019 [cited 2019 Oct 23];37:311-3. Available from: http://www.jisppd.com/text.asp?2019/37/3/311/268176





   Introduction Top


The nose is one of the most common anatomical structures of the face to get injured. Trauma to the nose is most often sustained in fights (34%), accidents (28%), and sports (23%). The sequelae of trauma to the nose include nasal deformity and nasal obstruction that can have a long-term negative impact on patient's quality of life.[1] Other complications can also occur because of trauma to nose; these are septal hematoma, esthetic complications such as disfigurement of the nose, and saddling of the nasal bridge; besides these, patients are liable to suffer from lifelong functional problems such as vestibular stenosis – a possible stenosis of the external and internal nasal valves.[2]

Many authors believed that after any type of trauma to nose, it is desirable to prevent the vestibular stenosis, because it is very difficult to treat functional problem, once nasal vestibular stenosis occurs.[3],[4] An intranasal stent is a removable prosthesis that can be inserted into the nasal cavity to support the form of nose.[5],[6] The stenting can be used for recanalization and nasal valve preservation. This clinical report presents a method for fabrication of a customized nasal stent for a patient with posttraumatic unilateral collapsed nasal vestibule.


   Case Report Top


A 14-year-old girl reported to the Department of Pedodontics and Preventive Dentistry of the University College of Medical Sciences and GTB Hospital, Delhi, with the posttraumatic facial injuries. The patient had a history of road traffic accident 2 days before. She had cut injury over the left lateral aspect of nose and had full-thickness alar defect with the collapse of nasal vestibule [Figure 1].
Figure 1: The collapsed nasal vestibule

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The patient was referred from the Department of Plastic Surgery for the prosthetic rehabilitation of collapsed nasal vestibule and constricted internal nasal valve. The patient was not able to breathe from left nostril. On examination, fresh wound was observed with no active bleeding. The use of a rigid, self-cured hollow, intranasal clear acrylic resin stent was considered which could be inserted in collapsed left nasal vestibule. A thin part of the sand paper mandrill was used to make the impression of left nostril along with columella with high viscosity putty impression material (Affinis; Coltene/Whaledent AG, Switzerland) [Figure 2]. Boxing of the impression was done with wax, and it was poured to obtain sectional casts. After rejoining the sectional casts along with impression, they were stabilized with rubber band. The repositioning of stainless steel mandrill was done by indexing using a band orthodontic wire inserted 3 mm into the two part of sectional cast on either side. Autopolymerzing resin was used to join this area to orthodontic wire. The impression was removed and separating media was applied into the mold. Autopolymerzing acrylic resin was poured into this mold. The separable cast part and indices could be used for the exact repositioning of the mandrill [Figure 3]a, [Figure 3]b, [Figure 3]c, [Figure 3]d, [Figure 3]e, [Figure 3]f, [Figure 3]g, [Figure 3]h.
Figure 2: Impression of nasal defect

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Figure 3: (a-h) Technique for the fabrication of the intranasal stent

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After the polymerization, the stent was removed from mold and final finishing and polishing was done. [Figure 4]a and [Figure 4] b. The accuracy and patency of the stent were checked by asking the patient to close his right nostril and breathe forcibly though the left nostril.
Figure 4: (a) Nasal stent, (b) delivered to patient

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The stent was well retained and the patient could perform the inhalation and exhalation process. Instructions were given regarding the use and maintenance of the nasal stent. After 1 month, healing of the lateral nasal cartilages occurs perfectly and the left nasal aperture was almost of normal size. The Department of Plastic Surgery documented that satisfactory results had been achieved by stenting. However, mild internal nasal valve constriction was still present and which could be further improved by serial dilatation of nasal stent. Hence, sequential relining of nasal stent was performed with a soft acrylic relining material, and after 1.5 months, the required opening of left nasal aperture was achieved and constriction of internal nasal valve was resolved [Figure 5].
Figure 5: Normal nasal aperture with excellent healing evident after 1.5 months

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   Discussion Top


The nasal valve is the mobile, airflow-regulating part of the nose that serves as the bridge between the bony skeleton and the nasal tip.[7] This valve is the narrowest part of the nasal airway and poses the greatest resistance to nasal airflow.[2] After the trauma to nose which involves the nasal vestibule and internal and external nasal valves, the patients are at risk of developing vestibular stenosis. Placement of the nasal stent in these patients prevents the sequels, adhesions, contractures, synechia, vestibular stenosis, and fibrosis.

A number of materials have been used for this purpose including nasal airway tubes, endotracheal tubes, and suction catheters.[2] Bilateral, circular stents have been described to avoid contact of raw surfaces,[3] to decrease the risk of vestibular stenosis, leading to functional and esthetic problems.[8],[9] The customized acrylic stent described was a superior alternative to other stenting methods;[10] these customized stents have been used to support collapsed ala nasi to reduce nasal obstruction and improve cosmetic appearance.

In the present case, a transparent acrylic resin was used for esthetic purpose. The use of nasal stents made from acrylic resin is a safe, convenient, and economic treatment for the prevention of contracture and nasal stenosis or nasal valve insufficiency. Since this nasal stent is custom made and individualized for the patient's nostril and retention is good, there is no risk for dislocation and aspiration of the nasal stent.

The risk of night-time breathing disturbances and decrease in nocturnal arterial oxygen partial pressure are, therefore, prevented. The nasal stent inserted in this case was found to be retentive, and there was no need to suture the stent. The technique for fabricating patent nasal stent is simple and straightforward.[11] The stent placement is technically simpler, and it provides support to the external and internal nasal valves and also helps achieve maximal esthetic and functional result.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Corey CL, Most SP. Treatment of nasal obstruction in the posttraumatic nose. Otolaryngol Clin North Am 2009;42:567-78.  Back to cited text no. 1
    
2.
Bassam WA, Bhargava D, Al-Abri R. A novel v- silicone vestibular stent: Preventing vestibular stenosis and preserving nasal valves. Oman Med J 2012;27:60-2.  Back to cited text no. 2
    
3.
Karen M, Chang E, Keen MS. Auricular composite grafting to repair nasal vestibular stenosis. Otolaryngol Head Neck Surg 2000;122:529-32.  Back to cited text no. 3
    
4.
Smith LP, Roy S. Treatment strategy for iatrogenic nasal vestibular stenosis in young children. Int J Pediatr Otorhinolaryngol 2006;70:1369-73.  Back to cited text no. 4
    
5.
The glossary of prosthodontic terms. J Prosthet Dent 2005;94:10-92.  Back to cited text no. 5
    
6.
Seals RR Jr., Bohnenkamp LG, Parel SM. Intranasal prostheses, splints, and stents. J Prosthet Dent 1988;60:595-601.  Back to cited text no. 6
    
7.
Walsh WE, Kern RC. Sinonasal anatomy, function, and evaluation. In: Bailey BJ, Johnson JT, Newlands SD, Editors. Head and Neck Surgery – Otolaryngology. 4th ed., Philadelphia: Lippincott Williams; 2006. p. 307-18.  Back to cited text no. 7
    
8.
Salvado AR, Wang MB. Treatment of complete nasal vestibule stenosis with vestibular stents and mitomycin C. Otolaryngol Head Neck Surg 2008;138:795-6.  Back to cited text no. 8
    
9.
Menger DJ, Lohuis PJ, Kerssemakers S, Nolst Trenité GJ. Postoperative management of nasal vestibular stenosis: The custom-made vestibular device. Arch Facial Plast Surg 2005;7:381-6.  Back to cited text no. 9
    
10.
Pavithran P, Pujary K, Mahesh SG, Parul P, Aziz B. Customised acrylic nasal stents following recanalisation of modified young's procedure. J Laryngol Otol 2010;124:864-7.  Back to cited text no. 10
    
11.
Zaki HS, Myers EN. Prosthetic management of large nasal septal defects. J Prosthet Dent 1997;77:335-8.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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