Inferior Meatus Augmentation Procedure (IMAP) for Treatment of Empty Nose Syndrome

In Response to Inferior Meatus Augmentation Procedure (IMAP) for Treatment of Empty Nose Syndrome

“…In Response to Inferior Meatus Augmentation Procedure (IMAP) for Treatment of Empty Nose Syndrome Dear Editor, We appreciate Dr. Piazza's thoughtful Letter to the Editor regarding our manuscript "Inferior Meatus Augmentation Procedure (IMAP) for Treatment of Empty Nose Syndrome." 1 We agree the term "empty nose syndrome" (ENS) does not encompass the spectrum of complex patients who experience unexpected issues with breathing and discomfort following inferior turbinoplasty. ENS can result from a wide surgical range, including total turbinectomy, inferior turbinate trim, anterior head resection, and radiofrequency ablation.…”

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…A wide variety of biomaterials – including acellular dermis, implants, and xenografts – have been published as bulking options to sites of inferior meatus and IT tissue loss 344–349 . Importantly, a procedure originally reported by Houser, 318 now termed the inferior meatus augmentation procedure (IMAP), where missing turbinate contour is replaced with fashioned rounded rib grafts placed in the anterolateral nasal airway, has accumulated strong evidence for effectively treating ENS 350 . IMAP has yielded statistically significant short 351 and long 352 term reductions in the ENS6Q and the Sinonasal Outcome Test (SNOT)‐22.…”

In Reference to Inferior Meatus Augmentation Procedure (IMAP) for Treatment of Empty Nose Syndrome

“…In Reference to Inferior Meatus Augmentation Procedure (IMAP) for Treatment of Empty Nose Syndrome Dear Editor, I read the interesting paper "Inferior meatus augmentation procedure (IMAP) for treatment of empty nose syndrome" by Chang MT et al 1 and, based on 12 years of experience with cartilage for the treatment of empty nose syndrome, I think some recommendations can be added to optimize the attempt to replace the missing tissue of the inferior turbinate: (1) we should keep in mind that the term empty nose syndrome describes a variety of conditions that can follow total turbinate excision or lesser procedures; therefore, the surgical technique should be individualized and adapted to anatomy of the residual inferior turbinate, degree of atrophy of the mucosal layer, and results of the cotton test; (2) elevating the inferior meatal pocket can be difficult in case of atrophic mucosal layer; in such a case, chemically assisted dissection 2 can help to maintain the correct cleavage plane and to preserve the mucosal layer intact: mesna is administered in the cleavage plane by means of specifically designed dissectors that deliver a 10% mesna solution directly at the tip of the instruments; (3) the cartilage we use is harvested from the costochondral region of young donors whose tissues and organs have been designated for tissue and organ donation 3 ; in our hands, this is an excellent material because of its elasticity that rarely traumatizes the mucosal layer and because of the low extrusion rate (no case of extrusion in the last 100 cases); (4) the procedure can be performed using standard microscope for otologic surgery, with magnification between Â6 and Â10 and 300 mm working distance: this allows to easily insert the fashioned graft in the inferior meatal pocket, without the need for help from the assistant; (5) we commonly prefer to use a series of small cartilage "bricks" with rounded edges instead of half-cylinders, since this improves the integration of the implant material. Typically, every single implant measures 15-25 mm in length, 3-6 mm in height, and 2-5 mm in width.…”