{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:52:14Z","timestamp":1788540734740,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T00:00:00Z","timestamp":1553558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the contribution of the nasal floor and hard palate morphology to nasal obstruction for nonresponders to prior intranasal surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective case\u2010control study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary academic center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Institutional review board\u2013approved, retrospective institutional database analysis was obtained of a cohort of 575 patients who presented with nasal obstruction over a 21\u2010year period. Of the patients, 89\u00a0met inclusion criteria: 52 were placed into the experimental group, defined as having persistent nasal obstruction following endoscopic sinus surgery (ESS), septoplasty, nasal valve repair, and\/or turbinoplasty using validated subjective questionnaires, and 37 were placed into the control group, defined as having resolution of subjective nasal obstruction. Computed tomography imaging was presented to 3 blinded experts, who measured numerous nasal airway and hard palate morphology parameters, including anterior nasal floor width, anterior maxillary angle, maxilla width, anterior nasal floor width, and palatal vault height. Standard demographic information, comorbidities, perioperative 22\u2010item Sinonasal Outcome Test (SNOT\u201022), and follow\u2010up time were also assessed. Wilcox rank sum analysis or <jats:italic>t<\/jats:italic> test was performed where appropriate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Follow\u2010up ranged from 2 to 36\u00a0months following surgical intervention. Several skeletal characteristics within the upper airway were significantly associated with persistent nasal obstruction, including acute maxillary angle (<jats:italic>P<\/jats:italic> =. 035), narrow maxillary width (<jats:italic>P<\/jats:italic> =. 006), and high arched palate (<jats:italic>P<\/jats:italic> =. 004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Persistent nasal obstruction may be seen in patients with narrow, high arched hard palate despite prior nasal surgical intervention and may benefit from additional skeletal remodeling procedures such as maxillary expansion.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599819838262","type":"journal-article","created":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T04:25:47Z","timestamp":1553574347000},"page":"171-177","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["The Upper Airway Nasal Complex: Structural Contribution to Persistent Nasal Obstruction"],"prefix":"10.1002","volume":"161","author":[{"given":"Ryan","family":"Williams","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Stanford California USA"},{"name":"Department of Head &amp; Neck Surgery University of California Los Angeles David Geffen School of Medicine Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Feng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Stanford California USA"},{"name":"Department of Oral and Maxillofacial Surgery Kaohsiung Medical University Hospital Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navarat","family":"Tangbumrungtham","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Stanford California USA"},{"name":"Department of Otorhinolaryngology Ramathibodi Hospital Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Thamboo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Stanford California USA"},{"name":"Division of Otolaryngology\u2013Head &amp; Neck Surgery University of British Columbia Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam P.","family":"Most","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayakar V.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley Y. C.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-010-1469-7"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-015-3868-2"},{"key":"e_1_2_9_4_1","first-page":"717419","article-title":"Nasal involvement in obstructive sleep apnea syndrome","volume":"2014","author":"Michels Dde S","year":"2014","journal-title":"Int J Otolaryngol"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2009.03.002"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25343"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599811434256"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2013.07.028"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2015.06.018"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tripleo.2009.09.011"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0b013e31826917ae"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26352"},{"key":"e_1_2_9_13_1","first-page":"391","article-title":"STRIDE\u2014an integrated standards\u2010based translational research informatics platform","volume":"2009","author":"Lowe HJ","year":"2009","journal-title":"AMIA Annu Symp Proc"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2013.344"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2273.2003.00663.x"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcm.2016.02.012"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21488"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21682"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fsc.2016.03.008"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599815582176"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2003.12.004"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1613688"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23615"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21668"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12667"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000003409"},{"key":"e_1_2_9_27_1","first-page":"11","article-title":"Orocraniofacial changes in young subjects with cystic fibrosis [in Italian]","volume":"14","author":"Gola G","year":"1989","journal-title":"Mondo Ortod"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.1978.0001"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/14.2.147"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599817707168"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599819838262","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1177\/0194599819838262","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599819838262","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T13:52:31Z","timestamp":1760968351000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1177\/0194599819838262"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,26]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,7]]}},"alternative-id":["10.1177\/0194599819838262"],"URL":"https:\/\/doi.org\/10.1177\/0194599819838262","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,26]]},"assertion":[{"value":"2018-09-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}