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Nasal airway device gets thumbs up

The Kotler Nasal Airway (Anthony Products) device, which maintains nasal airway patency in rhinoplasty and nasal reconstruction patients, is safe, well-tolerated and doesn’t increase transcolumellar incisional dehiscence risk, according to a study published September 6 in JAMA Facial Plastic Surgery.

Following completion of nasal procedures, surgeons insert the 12 cm dual tube intranasal airway. The tubes nest on the nasal floor. The external portion of the tubes facilitate cleaning and maintaining patency. The device doesn’t require sutures for fixation and doctors can use it along with postoperative packing materials.

The device is designed to support airflow postoperatively.

The authors, who have no ties to the device and didn’t receive samples or funding from the company that makes it, reviewed the medical records of 300 nasal surgery patients (249 who had rhinoplasty). Surgeons used postoperative packing and inserted the intranasal airway device in all patients and in some cases concurrently placed Doyle-type intranasal splints. The researchers also surveyed 59 of the patients on their first in-office post-op visits when they removed the airway devices to evaluate patient comfort and breathing.

They found 24 patients (7.9% of those studied) removed the device or the device extruded entirely or partially. That, according to the authors, is a device limitation. Four patients had cellulitis and six epistaxis that were not unique to airway insertion. One patient developed dehiscence along the transcolumellar incisions.

The rates of postoperative complications were comparable with what’s accepted according to the literature, the authors write.

On patient surveys, the average breathing score was between good and average; comfort scores averaged between comfortable and average. The average ease of irrigation score was between very easy and easy. More than three-quarters of those surveyed had full patency or partial obstruction. Just under a quarter of survey respondents reported total obstruction.

Patients irrigated the device an average of 3.57 times daily, according to the study’s findings.

The manufacturer suggests irrigating every 4 hours during the day of surgery and once the first night, followed by 2 to 3 times per day thereafter. “We advised patients to irrigate at least that many times but strongly encourage frequent irrigation to clear secretions and blood,” the authors write.

Robert Kotler, M.D., clinical instructor of head and neck surgery at UCLA and inventor of the Kotler Nasal Airway, tells The Aesthetic Channel that plastic and aesthetic surgeons who do open rhinoplasty had expressed concern about whether the device would exert pressure on the horizontal incision. This study, he says, puts the concern to rest.

“Concerns about possible compromised healing of the horizontal, transcolumellar open rhinoplasty incision by the device’s external horizontal bridge were dispelled. That was no surprise to us because we designed it using a very specific shape, such that it puts very little pressure on that incision,” Dr. Kotler says.

While the study’s authors identified one such patient with columellar breakdown, they write that patient had concomitant use of polydioxanone plate with cartilage grafts, which could have predisposed the patient to the complication.

The study suggests the device is safe, useful and can be used along with a variety of commercially available packing materials, the authors conclude. 

The Aesthetic Channel reported on the device earlier this year. Click here for more.