Postoperative management of nasal vestibular stenosis: the custom-made vestibular device.

摘要

OBJECTIVE: To evaluate the effect of a custom-made postoperative vestibular device on the occurrence and severity of restenosis. DESIGN: This was a retrospective study conducted at the Department of Otorhinolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery of the Academic Medical Center. In this tertiary care center between January 1994 and December 2000, 52 patients treated for nasal vestibular stenosis received a vestibular device directly postoperatively, with the intention to decrease the risk of restenosis. The vestibular device was composed of thermoplastic acrylic material and had a lumen to facilitate breathing. The shape of the device was custom-made within 1 week after surgery and was subsequently worn by the patient for 12 weeks (6 weeks continuously and 6 weeks only during the night). After this period, the occurrence and severity of restenosis of the nasal vestibule were evaluated and the necessity for a potential adjuvant operation was assessed. RESULTS: Preoperatively, of the 52 patients, 38 (73%) had severe stenosis, 13 (25%) had moderate stenosis, and 1 (2%) had mild stenosis. Postoperatively, 15 (29%) of the patients had mild restenosis, 1 had a case of moderate stenosis, and 1 had a case of severe stenosis. Only the latter patient required a subsequent revision. Functional improvement was noticed in 51 (98%) of the patients, whereas 49 (94%) of the patients showed aesthetic improvement after the initial procedure. CONCLUSIONS: In case of surgical treatment of vestibular stenosis, the use of a custom-made vestibular device may help prevent restenosis. In addition to functional improvement, the device may also improve the aesthetic result. The device does not seem to have any negative adverse effects, was easy to make, and was comfortable for the patient to wear.