Empty Nose Syndrome


Pathology: 

This is described as a rare, late complication of nasal turbinate resection surgery. The commonest clinical symptoms include paradoxical nasal obstruction, nasal dryness and crusting and a feeling of breathing difficulty.

The symptoms usually present 1-5 years after intranasal surgery for breathing difficulty. The procedures usually involve resection of the inferior turbinates and possibly a sub mucous resection of the nasal septum.

The turbinates, 3 on each side, function to warm and filter the air as we breathe. The inferior turbinate is the largest and most important. It has been suggested that removal of this would lead to greater volumes of air transiting the nasal passage and assist in respiration/breathing. However whilst this may be true in the first instance the nerves of the structure suffer a neuropathic injury on removal and thereafter the nerve cells are damaged and send the wrong signals back to the brain giving rise to the perception that the nose is blocked.

Surgeons in the past have tried to re-create the nasal architecture by placing implants or grafts unsuccessfully. Essentially it is the nerves that are damaged. What nerves are involved? Generally it is the long sphenoplalatine nerve and anterior branches of the maxillary nerve. This is a branch of the Trigeminal nerve.

This type of neuropathic pain is analogous to the well described “phantom limb pain”. In this condition the person may have lost a leg or arm but still feels pain in the absent limb. It is thus the nerve endings at the severed end of the limb and and brain that cannot process the sensory inputs properly. Thus the treatment is aimed at trying to re-establish repair to the severed and damaged neurones. In the head and neck region we see the same concepts in refractive or LASIK surgery.

This injury occurs from neuropathic damage to the tiny nerve fibres relaying the sensory area of the outermost layer of the cornea. Why these nerve suffer an injury is only understood to the extent that a cut anywhere in the body is going to interrupt the nervous impulse and function of the neurone or nerve cell. The concept of stem cells is that stem cells are neurotrophic and encourage the growth and repair of nerve cells, thus limiting neuropathic injury.

The very nature of the aetiology of empty nose syndrome (ENS) dictates the appropriate treatment. For instance if the ENS is as a result of inferior turbinate resection surgery we would recommend injection of stem cells close to the branches of the maxillary division of the Trigeminal nerve and to the long sphenopalatine nerve combined with hyperbaric oxygen (HBOT) to try to encourage new cells to repair the damaged nerves on the nasal walls. 

Surgeons at eurostemcell.life are trained in craniomaxillofacial surgery and know exactly where these nerves are and how they should be approached. No other commercial stem cell laboratory would have craniomaxillofacial surgeons on staff to administer these stem cell injections in these special areas.

Of course the use of combined hyperbaric therapy (HBOT) and stem cells is recommended to encourage the stem cells to differentiate better into neurones. The stem cells work best in an oxygen rich environment. 

SUMMARY

Empty nose syndrome can be an irritating and debilitating side effect of nasal surgery encompassing turbinate resection. There are no easy surgical cures. The use of stem cells and hyperbaric therapy is a relatively low risk procedure that may or may not have results. Ideally for ENS the earlier the stem cell treatment and HBOT the better, multiple treatments may be required. Professor Vickers and his team are ready to assist.

At Eurostemcell.life we pride ourselves on ensuring patients know the team diagnosing and conducting their stem cell therapy. Professor Russell Vickers is the lead specialist, working within a team of specialist surgeons and doctors.

Important questions that patients should ask of any treating clinicians and facility:

  • Are my treating doctors specialist surgeons/doctors and stem cell experts?
  • How many publications and research based studies have they published in peer reviewed journals?
  • Can they augment stem cell therapy with the known benefits of adjunctive therapy?

Eurostemcell.life is Europes premier stem cell organisation guided by evidence based medicine and clinical research.

Our founding director, Professor Russell Vickers PhD, MDsc, M Med, MA, FFPM (ANZCA) is an Australian and New Zealand board registered surgeon with over 100 publications, books and thousands of invited lectures and presentations on stem cells, pain, peptide synthesis and biochemistry. Professor Vickers is the leader of a family team of surgeons assisting him including Dr Peter Vickers, MD, FRCS (Edinburgh), FRACDS, Dr Richard Vickers, MD, FRCS (England, Glasgow, Ireland), FRACDS (OMS) and Dr Jessica Vickers, MD, MCOM, BA/BN as co-ordinator.

This medical summary has been written by Professor Vickers and his family team of specialist consultants.

It has been written by medically qualified writers.

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