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How To: Inferior Meatus Augmentation Procedure for Empty Nose Syndrome

by Michael T. Chang, MD, Murray Bartho, BS, Dayoung Kim, BA, Esmond F. Tsai, BS, Angela Yang, BS, Sachi S. Dholakia, BS, Ashoke Khanwalkar, MD, Vidya K. Rao, MD, Andrew Thamboo, MD, Matt Lechner, MD, PhD, and Jayakar V. Nayak, MD, PhD •

The fashioned graft is placed into the inferior meatus submucoper – iosteal pocket (Figure 1). Insertion can be facilitated by retracting the orifice of the pocket during endoscopy, while an assistant advances the half-cylinder implant using forceps. For most patients, the goal is to provide appropriately contoured bulk of the lower nasal airway that projects medially from the inferior meatus sidewall and just underneath any remnant shelf of the IT (if present), while preserving a 1 to 2 mm central nasal airway. In addition, the graft should fit comfortably without excess stretch on the mucoperiosteal flap to prevent flap ischemia or inability to close the incision. Care should be taken to preserve Hasner’s valve during the elevation and implantation to avoid postoperative epiphora. The anterior incision is then closed with interrupted 4-0 Vicryl sutures. Meticulous hemostasis is ensured on the final endoscopic assessment, as typically packing is not placed in the nose.

Results

The patients are discharged home on the day of surgery. Patients are prescribed 10 to 15 oral opioid tablets for pain, as well as two weeks of antibiotics. Patients are also prescribed saline nasal sprays for use two to three times daily, as well as mupirocin ointment to be applied to the anterior nares twice daily. Large-volume rinses are avoided for two weeks.

Patients have their first postoperative visit in the clinic two weeks following surgery. Patients undergo light endoscopic debridement and assessment of the implant sites for tissue dehiscence, cartilage exposure, and graft displacement. Following this visit, patients are typically reassessed at two to three months and six months postoperatively, where graft healing, as well as changes in ENS symptoms using the ENS6Q, are assessed.