Total Nasal Airway Procedure (TNAP)

What is the total nasal airway procedure (TNAP)?

TNAP is an all-inclusive procedure designed to improve nasal breathing by addressing the four main components of the nasal airway. Nasal breathing is a complex multifactorial process that results in airflow from the nostrils to the lungs.

While the process seems simple, there are actually multiple layers and complications that can occur. When we breathe in many physiologic changes occur to the air that help us improve oxygen flow through our tissues (see The Science of Breathing below). 

The Layers of Nasal Breathing

Lower Lateral Cartilage: The lower lateral cartilage can sometimes be collapsed and soft. During inspiration, they can collapse and cause stenosis of the nasal airway. Some people are born with weak cartilage or a stenosis at rest. TNAP addresses this by strengthening the cartilage and opening the stenotic valve.

Upper Lateral Cartilage: In some, the upper lateral cartilage can collapse during inspiration which causes decreased airflow. This is often the reason for the use of breathe right strips. TNAP can address this issue with dissolvable implants that act to create rigidity to the ULC and act as permanent breathe right strips.

Nasal Septum: The nasal septum acts to help direct airflow through the nose. Many people are born with, or acquire through trauma, a deviated septum. This can cause a number of problems including obstruction, inflammation or turbulent airflow. TNAP provides a minimally invasive solution to the deviated nasal septum to help improve airflow.

Inferior Turbinates: The inferior turbinates help direct airflow and provide sensation when breathing. The inferior turbinate is the first area in the nose to sense airflow and direct its flow. Enlarged turbinates can cause turbulent airflow and blockage leading to nasal congestion and obstructed breathing. TNAP addresses the turbinates by reducing their size while sparing the mucosal surface and keeping the sensory aspects intact. 

The Science of Breathing.

New research in the journal *Proceedings of the National Academy of Sciences* (*PNAS*) by cardiologist Jonathan Stamler, a professor of medicine at Case Western Reserve University School of Medicine, and his colleagues indicate that nitric oxide is an essential part of delivering oxygen to your cells and tissues that need it.

The findings show that nitric oxide is a gas that opens and supplies oxygen from red blood cells into the tissues that require it. According to Stamler, the blood flow to tissues can be more crucial than oxygen carried by hemoglobin making the respiratory cycle a three-gas system: oxygen, carbon dioxide and nitric oxide.

Hemoglobin delivers nitric oxide along with oxygen. It turns out that blood flow to tissues is usually more important than oxygen carried by hemoglobin.

Where exercising, breathing through the nose releases nitric oxide and allows more oxygen to get to the active tissues. It turns out nitric oxide is necessary to increase carbon dioxide in the blood and, subsequently, releases oxygen.

Rhinomanometry

Rhinomanometry is a diagnostic tool that measures nasal pressure and airflow in and out of the nose and evaluates its respiratory function. It is the standard method for appraising the potency of the nose, including measuring the resistance of nasal airway.

There are three types of rhinomanometry, anterior, posterior, and postnasal, used to make pre- and post-treatment assessments of medical or surgical therapy and other issues. It can evaluate symptoms of nasal obstruction and patients with sleep apnea as well as testing such as allergy.

Acoustic rhinometry is a technique based on the analysis of sound waves that assesses the geometry of the nasal cavity and nasopharynx and measures the volume of the nasal passage. Optical rhinometry uses a detector and an emitter at opposite sides of the nose to recognize changes in nasal congestion.

Who is TNAP for?

TNAP is a procedure that is designed to improve breathing through the nose. Many people suffer from nasal obstruction causing difficulty exercising, snoring, trouble falling asleep or staying asleep, sleep apnea, and a general frustration throughout the day.

TNAP is also designed to help improve athletic performance and improve breathing exercises for things like meditation and yoga. By opening the nasal valve and stiffening the upper and lower lateral cartilages, TNAP allows better airflow through the nose. Straightening the septum and lateralizing the turbinates also allows improved airflow once air has passed through the internal nasal valve.

TNAP vs surgery?

In some patients, surgery may be necessary to improve nasal airflow. TNAP is not a replacement for surgery but it does give a distinct advantage in many ways. First, patients can have the procedure done in an hour without undergoing general anesthesia. Secondly, there is very little downtime (2-5 days). It is often less painful than surgery and carries less risk. TNAP is a minimally invasive procedure that can improve nasal airflow comparable to surgery.

- Less downtime,
- Back to life faster
- Less pain
- Local anesthesia

https://www.laent.com/procedures/nose-sinus/tnap/