Resection of pyriform aperture: a useful adjunct in nasal surgery.

Objective: The aim of this paper is to describe a novel technique of improving the nasal airflow in patients in whom, despite reduction surgery to the inferior turbinates (either alone or with septal surgery), the nasal airways remain compromised because of obstruction occurring anterior to the inferior turbinate, due to a prominent nasal process of the maxilla at the pyriform aperture. Method: We describe a novel approach to resection of the nasal process of the maxilla, a technique performed in 40 patients with either: residual obstructive symptoms following septal surgery with or without turbinate surgery; and significant inspiratory alar collapse. The same technique was also used in two patients to improve the intranasal approach to the medial and anterior maxilla during endoscopic medial maxillectomy for recurrent inverted papilloma. Results: Patients reported a subjective improvement in their nasal airways, with resolution of inspiratory alar collapse. This technique significantly improved intranasal access in the two patients with inverted papilloma. Conclusion: This technique confers significant subjective improvement of nasal airways patency in selected patients, and improves endoscopic surgical access to clear inverted papilloma.