In de loop der jaren hebben we vele artsen ontmoet en met hen gesproken over Empty Nose Syndrome. Aan sommigen van hen hebben we gevraagd om hun statement over ENS en neusschelpen te delen. Met als doel deze te publiceren op deze site.
We zijn deze artsen zeer dankbaar voor de medewerking hieraan.
De onderstaande verklaringen zijn gepubliceerd met toestemming van de genoemde artsen.
Dr. Juan Monreal, Madrid:
"Empty Nose Syndrome (ENS) is a nasal disorder that typically results many years after turbinate reduction surgeries. Much less frequently, it can appear as a result of surgeries performed on the nasal septum or on the middle turbinates. The vast majority of patients with ENS have a history of septoplasties and turbinate reduction performed simultaneously.The precise origin of SNV is unknown, but it is clear that there is probably an interplay of mechanical and functional problems:- Modifications in air flow delivered to the middle and inferior meatus pathways. These modifications come from the turbinate volume reduction itself and from turbinate volume cycling abolition.- Physical and chemical neuro-receptors malfunctioning or damage (or both). Loss of mucosal sensory nerve fibers may play a role.It is unknown why some patients with turbinate reduction surgeries develop ENS while others do not, and why the symptoms are not always correlated with the findings in physical exams.
My interest in ENS began precisely when, years ago, I caused this problem in one of my patients. Fortunately, I had the time and interest to study the case, update my knowledge and treat it appropriately. The teaching was clear: I have never performed turbinectomies of any kind again, and I began to see internal nasal cavities more as a sensory organ than as a “tube” that can be mutilated without consequences.
Unfortunately today there is no curative treatment for ENS. Physicians interested in treating ENS face some difficulties when trying to reconstruct inferior turbinates:- We are unable to in-vivo regenerate the erectile and sensory capacity of the turbinal tissue. - The special anatomy and distribution of the turbinal tissue and its bone support make reconstruction a very complicated task- The added difficulty of working in a "cave" with irregular "walls and recess" difficult to access to.
From my point of view, every attempt should be made to repair the damage with the tools that we currently have.- The loss of volume in the affected turbinates must be repaired by re-volumizing, preferably with cartilage / bone grafts or permanent synthetic materials.- The loss of sensory capacities can be partially ameliorated through the use of fat grafts and SVF injections. Stem cells injections is promising although there are no conclusive studies.- With the arrival of "virtual surgeries" we can probably be somewhat more effective in both preventing and treating ENS. With virtual surgery it may be possible to predict if turbinate or septal surgery will be beneficial for our patients. With virtual surgery the degree of improvement that the patient might experience can be predicted depending on which areas of the turbinates (or the rest of the nasal cavity) receives volume augmentation.
Today, any surgeon performing functional nasal surgeries must bear in mind that this potentially devastating pathology exists and think twice before performing any kind of turbinate surgery."