Surgical Treatment for Empty Nose Syndrome Using Autologous Dermal Fat: Evaluation of Symptomatic Improvement

Yu Hosokawa; Takeshi Miyawaki; Kazuhiro Omura; Taisuke Akutsu; Ryohei Kimura; Tetsuo Ikezono; Nobuyoshi Otori

doi:10.1177/01455613221130885

Surgical Treatment for Empty Nose Syndrome Using Autologous Dermal Fat: Evaluation of Symptomatic Improvement

Ear Nose Throat J. 2022 Sep 29:1455613221130885. doi: 10.1177/01455613221130885. Online ahead of print.

Authors

Yu Hosokawa^{1

2

3}, Takeshi Miyawaki^{3

4}, Kazuhiro Omura², Taisuke Akutsu², Ryohei Kimura², Tetsuo Ikezono¹, Nobuyoshi Otori^{2

3}

Affiliations

¹ Department of Otorhinolaryngology, Saitama Medical University, Saitama, Japan.
² Department of Otorhinolaryngology, the Jikei University School of Medicine, Tokyo, Japan.
³ Septorhinoplasty Clinic, Jikei University Hospital, Tokyo, Japan.
⁴ Department of Plastic Surgery, the Jikei University School of Medicine, Tokyo, Japan.

PMID: 36174975
DOI: 10.1177/01455613221130885

Abstract

Background: Empty nose syndrome (ENS) is caused by nasal turbinate surgery. The standard treatment for ENS is an inferior meatus augmentation procedure (IMAP) in which autologous tissue such as auricular cartilage, rib cartilage, or artificial material is transplanted into the nasal cavity. However, some challenges like a very small auricular cartilage are associated with these autologous tissue types. Moreover, since using rib cartilage is a highly invasive technique, the scar on the chest from where the harvesting is done is easily visible, and the artificial material is susceptible to infection. We used autologous dermal fat (ADF) in IMAPs in our study for the following reasons: the quantity of ADF could be increased or reduced as needed, ADF is considered a safer option than rib cartilage because it is harvested from superficial tissue, it is superior in terms of cosmetic appearance to harvested rib cartilage, and it has a lower risk of infection than any artificial material.Objective: The purpose of our study was to investigate the efficacy and safety of IMAPs using ADF.Methods: We included nine patients with ENS who underwent an IMAP using ADF. The patients' backgrounds and responses to the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) were recorded. Changes in each item of the ENS6Q before and after surgery (up to 3 months) were analyzed.Results: The postoperative ENS6Q total score and parameters were significantly better than their preoperative counterparts. Nasal dryness improved slightly less than other symptoms. There were no complications.Conclusions: The IMAP using ADF was effective in improving ENS symptoms; however, some physiological functions were difficult to improve, and dryness persisted. Autologous dermal fat is larger than auricular cartilage, less invasive than rib cartilage, and has a lower risk of infection than artificial material.

Keywords: Empty Nose Syndrome 6-Item Questionnaire; auricular cartilage; autologous dermis fat; cosmetic; dryness; empty nose syndrome; inferior meatus augmentation procedure; inferior turbinate; nasal obstruction; nasal turbinate surgery.