From the Department of Otolaryngology-Head and Neck Surgery, and Schulich School of Medicine and Dentistry (M.E.G.), Western University, London, Ontario, Canada.
London Health Sciences Center (M.E.G.), London, Ontario, Canada.
AJNR Am J Neuroradiol. 2019 Mar;40(3):562-567. doi: 10.3174/ajnr.A5980. Epub 2019 Feb 14.
Midnasal stenosis is a poorly defined entity that may be a component of other conditions of nasal obstruction contributing to respiratory distress in infants. We sought to establish whether midnasal vault narrowing is a component of well-defined syndromes of nasal narrowing, such as bilateral choanal atresia and pyriform aperture stenosis, and to characterize the nasal anatomy of patients with syndromic craniosynostosis.
A convenience sample of patients with pyriform aperture stenosis, bilateral choanal atresia, and Apert and Crouzon syndromes with maxillofacial CT scans was identified. Patients with Pierre Robin Sequence were used as controls. Nasal measurements were performed at the pyriform aperture, choana, and defined midnasal points on axial and coronal CT scans. Intra- and interrater reliability was quantified with the intraclass correlation coefficient. tests with Bonferroni adjustment were used to assess differences from controls.
The study included 50 patients: Eleven had pyriform aperture stenosis, 10 had Apert and Crouzon syndromes, 9 had choanal atresia, and 20 were controls. Measurements in patients with pyriform aperture stenosis and Apert and Crouzon syndromes were narrower than those of controls at all measured points ( < .001). Measurements in patients with choanal atresia were only narrow in the posterior half of the nose ( < .001). The intra- and interrater reliability of midnasal and pyriform measurements was very good to excellent (intraclass correlation coefficient > 0.87). The choanal measurement was good (intraclass correlation coefficient = 0.76-0.77).
Pyriform aperture stenosis, Apert and Crouzon patients were narrower at all measured points compared to controls. Bilateral choanal atresia patients were only narrower in the posterior half of the nose. More research is needed to evaluate the clinical implications of these radiographic findings.
中鼻甲狭窄是一种定义不明确的实体，可能是导致婴儿呼吸窘迫的其他鼻腔阻塞的一个组成部分。我们试图确定中鼻甲穹窿狭窄是否是其他明确的鼻腔狭窄综合征的一个组成部分，如双侧后鼻孔闭锁和梨状孔狭窄，并对综合征性颅缝早闭患者的鼻腔解剖结构进行特征描述。
我们选择了方便的一组患有梨状孔狭窄、双侧后鼻孔闭锁和 Apert 及 Crouzon 综合征以及颌面部 CT 扫描的患者。Pierre Robin 序列患者被用作对照组。在轴位和冠状位 CT 扫描上，在梨状孔、后鼻孔和定义的中鼻甲处进行鼻腔测量。使用组内相关系数（intraclass correlation coefficient）来量化组内和组间的可靠性。使用 Bonferroni 调整的 t 检验评估与对照组的差异。
本研究共纳入 50 例患者：11 例患有梨状孔狭窄，10 例患有 Apert 和 Crouzon 综合征，9 例患有后鼻孔闭锁，20 例为对照组。梨状孔狭窄和 Apert 和 Crouzon 综合征患者的测量值在所有测量点均小于对照组（ <.001）。后鼻孔闭锁患者的测量值仅在鼻腔后半部狭窄（ <.001）。中鼻甲和梨状孔测量的组内和组间可靠性非常好至极好（组内相关系数 > 0.87）。后鼻孔测量的可靠性较好（组内相关系数=0.76-0.77）。
与对照组相比，梨状孔狭窄、Apert 和 Crouzon 综合征患者在所有测量点均更狭窄。双侧后鼻孔闭锁患者仅在鼻腔后半部狭窄。需要进一步研究以评估这些影像学发现的临床意义。
