Empty nose syndrome: radiologic findings and treatment outcomes of endonasal microplasty using cartilage implants

To describe the radiologic characteristics of empty nose syndrome (ENS) and to assess outcomes of endonasal microplasty using cartilage implants in patients with ENS.

A retrospective clinical chart review.

We assessed 17 patients diagnosed with ENS who had undergone prior nasal turbinate surgery. The presence of sinus opacity and the nasal mucosal thickening on the lesion side was evaluated with computed tomography in 11 patients and compared with control. To assess the effect of sinusitis on the nasal mucosal thickening, the thickness of lesion-side mucosae in unilateral sinusitis patients were compared with their contralateral mucosae. Twelve patients were managed by submucosal implantation of cartilage at the inferolateral nasal wall, just below the turbinate remnant, to create a neoturbinate. Symptom scores expressed as visual analogue scale (VAS) were compared before and after surgery.

Opacity of the ipsilateral maxillary sinus was observed in seven of 11 patients. All lesion sides of ENS showed mucosal thickening of the nasal cavity, with an average thickness significantly greater than that in controls, whereas mucosal thickening was not found in the lesion-side mucosae of unilateral sinusitis patients. Patients reported significantly improved VAS score in excessive airflow, nasal obstruction, and nasal or facial pain. Complications of surgery included undercorrection in three patients.

Radiologic abnormalities associated with ENS include ipsilateral sinus opacity and nasal mucosal thickening. Endonasal microplasty by submucosal implantation of cartilage may be a useful treatment option in the management of ENS.