P088 An unusual sequela of long-term continuous non-invasive ventilation(NIV) therapy

Abstract Introduction Non-invasive ventilation (NIV) is a standard treatment for chronic ventilatory failure from various conditions. However, long-term NIV can lead to complications, including structural changes in the facial skeleton. The nasal valve area is particularly susceptible to external pressure. This report presents a rare case of lateral nasal bone loss secondary to prolonged NIV use. Case Description A 42-year-old obese male (350–400 kg) was started on NIV for obesity hypoventilation syndrome (S/T IPAP 35 cm H₂O, EPAP 25 cm H₂O, Ti 1.6, BUR 18/min). His usage increased from 8 hours nightly to up to 20 hours/day between 2019 and 2025. He developed progressive nasal bulging during NIV use. Examination revealed a non-tender bulge near the eye. ENT evaluation confirmed bilateral lateral nasal bone loss. Nasendoscopy showed nasal dryness and nasopharyngeal crusting. Due to his high BMI, CT imaging was not feasible, and surgery posed high risk. A custom nasal prosthesis was fitted. Current management includes daytime mouthpiece ventilation and night-time NIV with a nasal splint. Discussion This case illustrates the challenges of diagnosing and managing nasal bone loss in chronic NIV users. The mechanism likely involves pressure-induced bone resorption, influenced by mask fit and bone fragility. Constant pressure may disrupt bone remodelling, causing resorption and soft tissue deformation. Conclusion Long-term NIV patients require careful monitoring for nasal complications. Regular mask fit assessments and exploring alternative interfaces can reduce risk. Custom solutions like 3D-printed masks may offer personalized care and minimize complications.