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Current diagnosis relies on clinical assessment and manual computed tomography (CT) measurements of the pyriform aperture width, which may not fully capture obstruction severity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>To evaluate the severity of pyriform aperture stenosis using automatic three-dimensional (3-D) analysis and identify parameters discriminating between conservative and surgical cases.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Materials and methods<\/jats:title>\n            <jats:p>This retrospective study analyzed CT scans of neonatal airways using a novel automated 3-D segmentation algorithm. We collected 22 CT scans (2010\u20132022) of newborns aged 0\u201335 days: 12 controls, four moderate cases treated conservatively, and six severe cases requiring surgery. The algorithm measured pyriform aperture width, nasal volumes, surface area, and cross-sectional areas.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The algorithm achieved high accuracy (Dice coefficient, 0.961\u2009\u00b1\u20090.005) and aligned well with manual measurements of the pyriform aperture (average difference, -0.05\u2009\u00b1\u20090.77 mm, -0.7\u2009\u00b1\u20099.1%). All cases with stenosis showed anterior narrowing, while only severe cases exhibited stenosis along the entire mid-nasal cavity. Mid-nasal cavity volume, surface area, and cross-sectional areas at 50% and 75% of the mid-nasal cavity emerged as potential surgical predictors, with cross-sectional area at 75% being the most discriminating (moderate, 68.6\u2009\u00b1\u20097.5 mm<jats:sup>2<\/jats:sup>; severe, 33.5\u2009\u00b1\u200913.7 mm<jats:sup>2<\/jats:sup>; <jats:italic>P<\/jats:italic>&lt;0.01).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Automated 3-D CT analysis quantifies pyriform aperture stenosis severity by measuring nasal airway dimensions. The study suggests objective parameters that may assist in surgical decisions and highlights the importance of considering the entire 3-D nasal cavity when planning surgical interventions. A multi-center study with a larger cohort is recommended to validate these findings.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00247-025-06282-7","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T11:00:02Z","timestamp":1750762802000},"page":"1702-1712","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Automated three-dimensional computed tomography analysis for surgical decisions in congenital nasal pyriform aperture stenosis"],"prefix":"10.1007","volume":"55","author":[{"given":"Talia","family":"Yeshua","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Ben-Haim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yehuda","family":"Schwarz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Attal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliyahu","family":"Nezri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shlomo","family":"Grinzaig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliel","family":"Ben-David","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"6282_CR1","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1288\/00005537-198901000-00016","volume":"99","author":"OE Brown","year":"1989","unstructured":"Brown OE, Myer CM, Manning SC (1989) Congenital nasal pyriform aperture stenosis. 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