Pyriform Aperture Expansion: An Adjunct Technique to Functional Nasal Surgery

Functional nasal surgery is commonly performed to correct obstructed nasal airflow, and our institution implements pyriform aperture expansion (PAE) as an adjunct to surgical correction. The aim of this study was primarily to describe the surgical technique of PAE and demonstrate its safety and feasibility in functional nasal surgery.

A retrospective review of patients who underwent functional nasal surgery including PAE from April 2022 to May 2023 was conducted. Demographic, intraoperative, postoperative complication, and outcome data were collected. The endonasal surgical technique is described and videography is provided.

One hundred patients were included. In addition to PAE, patients underwent concurrent septoplasty (92%), septal cartilage harvest (61%), turbinate reduction (94%), nasal valve repair (87%), open reduction and internal fixation of nasal bones (44%), or endoscopic sinus surgery (5%). Complications included epistaxis (7%), septal hematoma (3%), nasal cellulitis (2%), nasal tip numbness (1%), adhesions (1%), and persistent or recurrent pyriform aperture narrowing (4%). Eighty-one percent of patients reported improvement in obstructive nasal symptoms (P < .001). Postoperative examination demonstrated adequate pyriform aperture expansion in 96% of patients.

This study describes an endonasal approach to PAE, which utilizes an ultrasonic bone aspirator for maxillary reduction. It demonstrates that PAE is a safe and feasible adjunct to functional nasal surgery. With adequate surgical technique, PAE can be performed with relative ease in a timely fashion.