Congenital nasal pyriform aperture stenosis: diagnosis and treatment

Congenital nasal pyriform aperture stenosis is an unusual form of nasal airway obstruction in the neonate. Pediatric plastic surgeons are often involved in the management of these children and should recognize this condition and know the treatment options. Fifteen cases of children with congenital nasal pyriform aperture stenosis were reviewed for presentation of the disorder, management, and effectiveness of treatment, making it the largest series to date. There were nine male patients and six female patients in the series. They all experienced varying degrees of nasal obstruction at birth and were managed on the basis of the severity of their symptoms. Twelve patients were treated surgically in the first year of life, with a mean age at operation of 97 days (range, 3 to 362 days). Two patients required surgical intervention during their teenage years (age, 14 and 18 years) because of persistent symptoms, and one patient (age, 2 years) with mild symptoms was managed medically. Associated craniofacial anomalies were present in six cases (40 percent). Surgical enlargement of the pyriform aperture was successfully performed through an upper buccal sulcus incision in 14 patients. Preoperative symptoms of upper airway obstruction were improved in all patients at an average follow-up of 2.4 years (range, 1 month to 5 years). Congenital nasal pyriform aperture stenosis varies in presentation and severity, occurring either as an isolated congenital anomaly or in association with developmental craniofacial anomalies. It can be effectively managed by surgical enlargement of the pyriform aperture without significant recurrence or long-term morbidity.     

Climatic influence on the skeletal nasal aperture

Abstract Climate is thought to be one of the factors affecting the distribution of nasal form as represented by the breadth and height of the skeletal nasal aperture. A model of nasal function is developed to predict influences on the skeletal nasal dimensions by selection acting upon the external nasal passage and aperture. Cranial series from Alaska and Australia, each series representing a climatic continuum from warmer and moister conditions to cooler and drier conditions, verify the predictions. These data suggest conditions for testing hypotheses about human variation.     

Congenital nasal anomalies: a classification scheme

The purpose of this work was to develop a simple yet comprehensive classification scheme dedicated to congenital nasal anomalies. To date, no such classification system has been proposed and widely used. A 22-year retrospective review was performed. Two hundred sixty-one patients with congenital nasal anomalies were identified. From this extensive database, a systematic morphogenic classification system was devised. Congenital nasal deformities were classified into four categories. Type I, hypoplasia and atrophy, represents paucity, atrophy, or underdevelopments of skin, subcutaneous tissue, muscle, cartilage, and/or bone. Type II, hyperplasia and duplications, representing anomalies of excess tissue, ranging from duplications of parts to complete multiples, are categorized here. In the type III category, clefts, the comprehensive and widely utilized Tessier classification of craniofacial clefts is applied. Type IV deformities consist of neoplasms and vascular anomalies. Both benign and malignant neoplasms are found in this category.     

Congenital aortic stenosis: follow-up of surgical management

We have reviewed the cases operated upon for correction of congenital aortic stenosis at l''Hôpital Ste-Justine between 1959 and 1969.Twenty-five of the 26 patients were readmitted for complete clinical, radiological and hemodynamic investigation. Fourteen had a valvular stenosis, eight a diaphragmatic subvalvular lesion, and three had mixed lesions.The results lead us to believe that the surgical treatment of this malformation is justified. The indications for surgery must take into account all available clinical, radiological, electrocardiographic and hemodynamic data.     

The paradox of a wide nasal aperture in cold-adapted Neandertals: a causal assessment

Neandertals have been characterized as possessing features indicative of cold-climate adaptation largely based on ecogeographical morphological patterning found in recent humans. Interestingly, one character that deviates from this pattern is a relatively wide nasal aperture. The ecogeographical patterning of the nasal aperture in recent humans would predict instead that Neandertals should exhibit reduced nasal breadth dimensions. To explain this apparent anomaly it has been argued that a reduction in Neandertal nasal breadth was not possible due to dentognathic constraints on their midfaces via large anterior palatal breadth dimensions, especially large intercanine distances. A complicating factor in understanding the relationship between anterior palate breadth and nasal breadth is that both measurements are also correlated with facial prognathism. It is, therefore, unknown to what degree the relationship between anterior palate breadth and nasal breadth in Neandertals is a function of the pleisiomorphic retention of a prognathic facial skeleton. We used path analysis to test for a causal relationship between intercanine breadth and nasal breadth taking into account the potential effect of facial projection and facial prognathism (i.e., basion-nasion length and basion-prosthion length) using a large sample of geographically diverse recent and fossil Homo. Additionally, we examined the ontogenetic relationship between nasal breadth and intercanine breadth using a longitudinal human growth series to determine whether these variables exhibit similar growth trajectories. The results of these analyses indicate a weaker association between intercanine breadth and nasal breadth than expected, and that more variation in nasal breadth can be explained through basion-prosthion length rather than anterior palatal breadth dimensions. Moreover, the ontogenetic development of anterior palate breadth does not correspond to the growth trajectory of the breadth of the nose. These results explain the apparent paradox of wide piriform apertures in generally cooler climate-adapted Neandertals without resorting to dentognathic constraints, and provide additional insight into both the adaptive and nonadaptive (i.e., neutral) basis for Neandertal facial evolution.     

Congenital tracheal stenosis in lambs induced by maternal ingestion of Veratrum californicum

Seven of nine lambs born to six ewes gavaged with Veratum californicum root and rhizome material on days 31, 32 and 33 of gestation died from asphyxia within 5 minutes after birth. Five of the seven were autopsied and found to have severe stenosis of the trachea. None of the 12 lambs born to seven control ewes had tracheal stenosis. The defect was characterized by lateral flattening of the trachea throughout its entire length. Cartilaginous tracheal rings were reduced in number, nonuniform in size and shape, irregularly spaced, and with abnormal orientation. The rings were thinner than those of control tracheas, and had zones of chondrogenesis on outer and inner surfaces which were of equal width, rather than of unequal width as in controls. The smaller size and relatively noncurved shape of the cartilaginous rings of the stenotic trachea resulted in a nondistended lumen.