Northern Variant of nasal Aerodynamics (NVA)

When the main air flow comes through the nasal sinuses, even at 20 degrees below zero, the air is warming to + 25

     
 

Southern Variant of nasal Aerodynamics (SVA)

When the main air flow comes through the reserve nasal breathing way, the inferior nasal passage is so cool, with temperatures below zero, that the cold air enters in the nasopharynx, the season ACUTE RESPIRATORY DISEASE (ARD) programming and often leads to the SNORING during of the Night Sleeping

              

NASAL AERODYNAMICS and RHINOSINUSITISES

PRIMARY VALVE OF THE NOSE - IT'S HIS CAVERNOUS BODIES

Relationship between two parallel respiratory structures in the nose

The main cause of the night snoring is violations of the nasal aerodynamics

The functionality of the small ostiums of the nasal sinuses

Critical comparison of opposite opinions about the function of the nasal sinuses using Occam's Razor

The real significance of the limen nasi

NASAL AERODYNAMICS

VARIANTS OF NASAL AERODYNAMICS

NORMOGRAM OF NASAL AERODYNAMICS

PHYSIOLOGICAL BRIDGE REPRESENTED BY THE NASAL VALUE

SURGICAL RECONSTRUCTION OF NASAL AERODYNAMICS

SEPTOPLASRY UNDER CONTROL OF NASAL AERODYNAMICS

CONTRAINDICATION TO SEPTOPLASTY

PROTECTION OF THE INFERIOR NASAL PASSAGE FROM INSPIRATION

THE INSIDIOUSNESS OF THE UNILATERAL "SOUTHERN" NASAL AERODYNAMICS.

SNORING WHEN NASAL RESPIRATION IS SAVED.

Individual defence against infection by Severe Acute Respiratory Syndrome - SARS

     
 
 

ABSTRACT

 

This textbook «NASAL AERODYNAMICS and RHINOSINUSITISES» is recommended by Educational-methodical Association on Medical and Pharmaceutical derivation of universities in Russia as the Manual textbook for experts in ENT illnesses professional skillss improvement as a good application and in polyclinical conditions (outpatience practice).

In the given textbook, with the help of the author's technique was the first to research airflows in nasal passages, that has allowed to conduct the deep pathophysiological analysis of features nasal aerodynamics, which plays a leading role in the development of seasonal ACUTE RESPIRATORY DISEASE (ARD), with stagnant sinusitises, by the way RHINOSINUSITISES (RS).

The proposed rapid method of determining violations of a nasal aerodynamics considerably accelerates their diagnostics, facilitates the selection of pathogenetic therapy and helps develop pathogenesis-based preventive care (prophylaxis).

Designed as therapeutic ways of seasonal protection from violations of nasal aerodynamics and surgical ways of renovation of protective properties of aerodynamics of a nose, the application which one allows more successfully to treat and to notify seasonal ARD with RS.

The new techniques are protected by the Russian patents.

 
 

The Main Findings:

 

1. Relevance of nasal aerodinamics violations as a cause of seasonal ACUTE RESPIRATORY DISEASE (ARD) with RHINOSINUSITISES (RS) especially evident due to the rise in the World of a global epidemic of non-communicable respiratory diseases because even in the years expressed influenza epidemics reach at least 60%;

2. Basic protection from of the seasonal ARD with RS is the mucociliary protective mechanism of nasal mucous membrane, which consists of the mucociliary transport on helium film and the mucociliary clearance beneath the helium film, which successfully complement each other ;

3. The protective properties of nasal aerodynamics are playing a leading role among the nasal protective mechanisms that aim to preserve the activity of the mucociliary protective mechanism;

4. The nasal aerodynamics consists of two parallel respiratory structures, as form of the middle and superior nasal passages together with nasal sinuses, which perform the basic respiratory and protective function of the nose, and inferior nasal passage together with common nasal passage, which perform the reserve respiratory functions, that is activated when the bandwidth of the basic respiratory nasal airways is not enought for nasal respiration;

5. When the main air stream passes through the basic respiratory nasal airways (nasal sinuses), the air is warming to plus 25oC even at minus 20oC outside, that successfully protects against seasonal ARD with the RS and therefore, such type of the nasal aerodynamics is regarded as the Northern Variant of the nasal Aerodynamics (NVA), which corresponds normogramme of nasal aerodynamic;

6. A distinctive feature of the NVA is a distance between the anterior end of the inferior turbinate and the nasal septum within 2 mm and therefore an air column in the gleam of such width in fact blocking the inferior nasal passage and directs the main air flow in the middle and superior nasal passages with nasal sinuses, actually performing the role of “physiological jumper”;

7. When the main air stream passes through the reserve respiratory nasal airways, during cold temperature season the inferior nasal passage and nasopharynx on so much cool, that programming seasonal ADR, so such variant of the nasal aerodynamics is more suitable to a warm climate of Southern latitudes, due to the what he regarded as the Southern Version of nasal Aerodynamics (SVA);

8. The distinctive feature of SVA is not only the width of a lumen more than 2 mm between the anterior end of the inferior turbinate and the nasal septum, which leading to seasonal ARD, but also stagnant inflammatory process in the middle and superior nasal passages with the nasal sinuses, forming stagnant RS which is manifested in the form of seasonal ARD with the RS;

9. Overlapping of the reserve respiratory nasal airways programmed with the help of the physiological oedema his cavernous bodies, especially during sleep that is directing the main air stream of the nose passes through the nasal sinuses, in order to acieve maximum protective properties of a nose during sleep from ARD, but when a person is awake the bandwidth of the main nasal respiratory way becomes not enough, physiological oedema is receding and opening the reserve respiratory nasal airways that no longer threatens the ARD development due to sufficient activation the protective properties of the waking organism;

10. Additional overlap of the inferior nasal passage with the help of the limen nasi, anterior synechiae, spikes and curvatures of the nasal septum, promote the diversion of the main nasal air flow in the middle and superior nasal passages with nasal sinuses which activates the protective properties of the nasal aerodynamics;

11. Exceptionally only small ostiums of the nasal cellular system and nasal sinuses, working like a spray mechanism of the H.L.Bergson (1859–1941), provide their extremely active ventilation;

12. The protective properties of the nasal aerodynamics is also evident during expiration when warm and moist air stream helps to restore the nasal mucous membrane injured during inspiration, especially for the SVA ;

13. The unilateral SVA is the most aggressive, because it leads to a double overload of the inferior nasal passage, which working for both halves of the nose, that is typical for a deviated septum, so during septoplasty the NVA reconstruction from the SVA is needed;

14. Pathogenetic therapy of seasonal ARD with the RS in SVA, should be directed as at the treatment of acute post-traumatic inflammation of the reserve nasal respiratory airways, as well at the treatment of stagnant chronic inflammation in the middle and superior nasal passages with nasal sinuses;

15. Methods of therapeutic protection from violations of the SVA as well as surgical reconstruction of the NVA from of the SVA should be recognized as pathogenetic grounded prophylaxis of the seasonal ARD with the RS;

16. Since the main cause of the night snoring is blocking of the reserve respiratory nasal airway at SVA because of chronic congestive MS, physiological edema cavernous bodies and protective rhinedema of the inferior nasal passage, which leads to the mouth breathing, pathogenetic treatments snoring during sleep should be recognized as forced airing sinuses or surgical reconstruction the NVA from the SVA.

 
 
 
 

The real significance of the limen nasi


Ulyanov Y.P., Sadyev H.D., Sadyev T.H.

 
 

Department of Otorhinolaryngology for postgraduate professional education of the First Moscow State Medical University of Sechenov.  

 
 

Theses of the report - 2011 year

Since the pathophysiologic analysis of structural and functional features of the nasal aerodynamics has identified two parallel respiratory structures (2011), which pose a major respiratory path consisting of the middle and superior nasal passages with nasal sinuses and the backup respiratory path consisting of the inferior nasal passages with common nasal passages, special attention should be paid to ways of overlapping of the backup respiratory structures that are guiding the flow of air through the major respiratory path in nasal sinuses providing the basic protective function of the nose by warming and humidifying inhaled air.
Among the known cases of overlapping backup inferior nasal passages, such as the large size of the inferior turbinate, spikes and curvature of nasal septum, adhesions and physiological oedema of them corpus cavernosum, special attention should be paid to the threshold of the nose - limen nasi, which today is clearly underestimated, because as limen nasi by is mistakenly considered the ledge of the superior edge of the large cartilage wing of the nose.
For example: "the vestibule of a nose - vestibulum nasi is separated from the nasal cavity - cavum nasi, by the ledge on the superior edge of the large cartilage wing of the nose; this ledge takes the name of the limen nasi. "
Although this ledge clearly does not relate to the bone structure of the pyriform aperture - apertura piriformis, which really separates the nasal vestibule - vestibulum nasi from cavum nasi and this ledge on the superior edge of the large cartilage wing of the nose has no relation to the overlapping of the inferior nasal passages.
This error has already been stated on the Internet referring to the work for F.S. Bockstein of "Endonasal surgery" (1956) (www.medvvman.ru/nos/01.htm:) and we cannot be with this not agree.
F.S. Bockstein notes that " apertura piriformis is the entrance to the nasal bone cavities, much smaller section of the cavity. This is due to the displacement of these nasal bones, medial deviation of the frontal processes of the superior jaw, as well as the deflexion of the inside edges of the apertura piriformis. "
"As a result of the bend or lift the bottom edge of the apertura piriformis is a more or less high "threshold"of the nose, so that the bottom of the nasal cavity is lower than the internal entrance in the nose. Expressed by the lateral edges of the bends, especially at the bottom, creating a general narrowing of the entrance and that has made it difficult to endonasal intervention."
Thus, it is this bone inferior emboss, pyriform opening - apertura piriformis, which closes in the bottom by spina nasalis anterior (nasal Crest) and forms the nasal threshold - limen nasi, that clearly represented in the drawings of F.S. Bockstein and many renowned guides.
This interpretation of the nasal threshold - limen nasi by F.S. Bockstein, as a spina nasalis anterior is the most true, since in the dictionary of Russian language S.I.Ozhegov: "Threshold is a cross bar closing the aperture between the door and the floor".
The explanatory dictionary of V. Dal: "Threshold of the door is a bar under the door for sealing, barrier, escarpment, step"; By dictionary of D. N. Ushakov: "A wooden beam on the floor under the door, cross elevation"; In the new dictionary of T. Ephraimova: "Beam is usually wooden - on the floor at the bottom of the door opening"; The Bible. Encyclopedic dictionary: "in the ordinary household under the threshold of course wooden bar placed on the floor, under doors, through which entering the House should cross."
Therefore, such a common erroneous designation of the limen nasi as the ledge on the superior edge of the large cartilage wing of the nose (which would be called with the lateral part of the frame of the entrance in the nose, because it is on the side of the entrance to the nose and not the bottom of the nasal threshold) should be considered erroneous.
This confirms the Universal Russian-English Dictionary. Academician. 2011. Medicine: nostril sill, referring to Article M. S. Irwin, M. A. p. Milling (The morphology of the nostril sill-1995), in which the ledge on the superior edge of the large cartilage wing of the nose, located on the lateral side of the entrance into the nasal cavity is regarded as a threshold or limen nostril (nostril sill), and authors emphasize that: "The nostril sill is a structure which has been overlooked in both anatomical and surgical texts. An understanding of the normal anatomy will help in reconstruction of the nostril both in congenital and acquired conditions, including cleft lip."
That is also the opinion of a famous plastic surgeon Prof. K.P. Psenisnov.(2000), which the ledge on the superior edge of the lateral leg of the wing of the nose cartilage (of the large cartilage wing of the nose,) called nostrils threshold.- limen nostril.
Today, it is especially important because the threshold of nose limen nasi should be seen as an additional protective mechanism of dual-nose to not only protect the lower nasal passage from the trauma of cold and dry air to breath, but also guide the air flow in the upper nasal passages for the warming and moistening of the paranasal sinuses of nose, ensuring the protection of the upper nasal passages and the respiratory tractthat contributes to the formation of the Northern version of the aerodynamics of the nose that protects us from the seasonal ACUTE RESPIRATORY DISEASES (ARD) with RHINOSINUSITIS (RS).
However, the absence of lime nasi so extends and deepens the clearance of the nasal passage, the main stream of air breathing goes right through it in the nasopharynx, overloading and injuring the lining that programs the seasonal ARD with RS, that is consistent with the violations of the southern type of nasal aerodynamics, which already structurally-funkcilonal programs the seasonal ARD with a RS that are difficult to conservative treatment and regularly repeated each year.
Therefore, in such cases, only the reconstruction of the lime nasi, for example, by using submucosal implant at the inferior edge of the apertura piriformis is pathogenetically grounded and effective, that we successfully used more than a dozen years and recommended for use.