How septum deformations in newborns occur

Is there a relationship of nasal septum deviation with pharyngeal airway dimension and craniocervical posture?

OBJECTIVE

This study aimed to evaluate the effects of nasal septum deviation on the pharyngeal airway and craniocervical posture measurements using cone beam computed tomography (CBCT).

METHODS

This retrospective study analyzed the CBCTs of 25 patients with and without nasal septum deviation. Various parameters defining the pharyngeal airway and craniocervical and facial skeletal morphology were measured and compared between the groups after confirming intra-examiner reliability.

RESULTS

Compared to the control group, the group with nasal septum deviation had a statistically significantly shorter nasopharyngeal length (p < 0.001), longer vertical airway length (p < 0.002), and larger cervical column curvature angle (p < 0.006).

CONCLUSION

Children with a nasal septum deviation of 4 mm or more on their CBCT scan are susceptible to unfavorable pharyngeal airway and craniocervical postural changes.

Objective and Subjective Analysis for Efficaciousness of Nasal Airway in Patients Undergoing Conventional and Endoscopic Septoplasty: A Comparative Study

Deviated nasal septum is the most common cause of nasal obstruction and is one of the common problems encountered by otolaryngologists. Although there are different methods to surgically correct a deviated nasal septum which can give qualitative relief to the patient, less emphasis is put on the quantitative assessment of airway after a septal correction surgery. Institution based Case Control study was undertaken at Medical College and Hospital Kolkata between January 2019 to March 2020 to subjectively and objectively assess and compare the nasal airway status preoperatively and postoperatively in patients undergoing conventional and endoscopic septoplasty. A total of 250 patients were taken in this study and divided into two groups A and B. Group A consisted of patients undergoing Conventional Septoplasty (Control arm) and Group B consisted of patients undergoing Endoscopic Septoplasty (Case arm). Patients were followed up and the readings of NOSE score and PNIF value were recorded at the end of 6 weeks and 6 months (24 weeks). The Mean NOSE score post operatively at the end of 6 weeks was 36.32 in GROUP A (Control arm) and 33.08 in GROUP B (Case arm). t-Test revealed insignificant results with a p-value of 0.08. The mean NOSE score post operatively at the end of 6 months was 29.96 in GROUP A (Control arm) and 22.16 in GROUP B (Case arm). t-Test revealed significant results with a p-value of 0.00. Similarly, Mean PNIF value post operatively at the end of 6 weeks was 57.24 in GROUP A (Control arm) and 73.88 in GROUP B (Case arm). t-Test revealed significant results with p-value of 0.00. The mean PNIF value post-operatively at the end of 6 months was 59.44 in GROUP A (Control arm) and 80.08 in GROUP B (Case arm). t-Test revealed significant results with p-value of 0.00. Endoscopic Septoplasty is a very effective way to treat septal deviations especially with deviations based on the posterior aspect of the septum. It provides a superior edge in terms of nasal airway improvement as compared to conventional method of septoplasty.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03120-2.

Nasal Septal Deviation After Surgically Assisted Rapid Maxillary Expansion

Background and Aim

Surgically assisted rapid maxillary expansion (SARME) is a surgical technique widely used to correct deficiency of the transverse maxillary dimension. Although some studies investigated the effect of SARME on nasal and facial alterations, there is no evidence that correlates nasal septal deviation (NSD) to SARME as a possible postoperative sequel. The aim of this study is to address and quantify possible variations in the position of the nasal bony septum after SARME and identify any NSD as a postoperative outcome of this surgical technique.

Patients and Methods

This is a retrospective study, conducted at the Department of Oral and Maxillofacial Surgery of the University Hospital of Araraquara (Unesp, faculty of dentistry), SP, Brazil. Twenty-nine patients who underwent SARME were studied; every patient was evaluated by cone-beam computerized tomography (CBCT) before (T0) and six months after surgery (T1), and we collected the variation of nasal septal position by measuring the distance between the bony septum and the nasal lateral wall. Our measurements were carried out at the level of the head, midpoint and tail of the inferior turbinate.

Results

A mean NSD ranging from 0.4 to 1.2 mm was measured, and it is more pronounced at the anterior part of the bony septum. Twenty-seven patients (93.1%) presented minor changes in bony septum position; in 2 cases (6.8%), a significant NSD was found (p < 0.05).

Conclusion

A variation of bony nasal septum position can be expected in any direction after SARME, and it is more pronounced at anterior portion.

Associations between the severity of nasal septal deviation and nasopharynx volume in different ages and sexes: a cone-beam computed tomography study

Background

Nasal septum deviation (NSD) can cause serious anatomical and clinical complications. It can change the breathing pattern and thus alter the anatomy of the airway structures. Despite its importance, the association between NSD with the nasopharynx volume (NPV) has not been assessed before. Therefore, we aimed to investigate it for the first time.

Methods

Archival CBCTs of 202 patients older than 17 years and without any history of trauma or pathology of the nasopharynx and without any orthodontic/orthognathic treatments were evaluated (129 women, 73 men, mean age: 36.24 ± 14.61 years). All included CBCTs must have been taken with a 12 × 8 field of view and fully covered the nasopharynx areas. The extent of NSD (°) and NPV (mm³) were measured. NSDs were categorized as mild (NSD ˂ 9°), moderate (9 ≤ NSD ≤ 15°), and severe (NSD ˃ 15°). Associations between sex, age, NSD, and nasopharynx volume were assessed using independent-samples t test, chi-square, one-way ANOVA, Tamhane post hoc test, Pearson and point-biserial correlation coefficients, and multiple linear regressions (α = 0.05).

Results

Mean NSDs were 11.27 ± 4.69° (range 1–19.5), 11.58 ± 4.63°, and 10.70 ± 4.76° in the sample, females, and males, respectively (P > 0.05). Of females, 27.9%, 40.3%, and 31.8% had mild, moderate, and severe NSDs. These were 35.6%, 39.7%, and 24.7% in males (P > 0.05). Mean NPVs were 4.88 ± 1.49, 4.80 ± 1.43, and 5.04 ± 1.60 mm³ in the sample, females, and males, respectively (P > 0.05). Mean NPVs were 6.41 ± 1.21, 4.87 ± 0.73, and 3.30 ± 0.65 mm³ in mild, moderate, and severe NSD groups (all P values = 0.000). Mean ages were 27.06 ± 6.49, 29.80 ± 9.64, and 54.73 ± 8.45 years in mild, moderate, and severe NSD groups (severe group being older than the other two groups, P = 0.000). NSD was strongly, negatively correlated with NPV (R = − 0.793, P = 0.000). Sex was not correlated with NPV or NSD (P ≥ 0.189). Age was negatively and positively correlated with NPV and NSD, respectively (P = 0.000). Modeling NSD (β = −0.776, P = 0.000) as a predictor for NPV rendered age effect insignificant (P > 0.05).

Conclusions

It was found, for the first time, that the more deviated the nasal septum, the smaller the nasopharynx volume. Aging might increase NSD and through it, reduce the nasopharynx volume. Sex might not affect NSD or NPV.

Position of lips and tongue in rest in newborns with and without ankyloglossia

PURPOSE

Verify the position of lips and tongue at rest in newborns with and without ankyloglossia.

METHODS

Cross-sectional study, carried out with 130 newborns in University Hospital. Data collection was performed by the researcher and speech-language pathologists from the Hospital. Information on gestational age, sex, weight, height and days of life was collected. The position of the lips and tongue at rest was evaluated through visual inspection with the newborns asleep. After the newborns were awakened, Neonatal Screening of the validated Protocol for the evaluation of the lingual frenulum for infants was performed to detect the alteration of the lingual frenulum. The data obtained were described and submitted to statistical analysis using the Chi-Square test to verify the association between the position of the lips with the tongue and to compare the position of the lips and tongue with and without ankyloglossia. The Mann-Whitney test was used to verify the behavior of the variables the differed between newborns with and without ankyloglossia. The significance level of 5% was adopted.

RESULTS

When comparing the data, a significant difference was found between: weight and height with and without ankyloglossia; position of lips and tongue. An association between the position of the tongue and lips with and without ankyloglossia was also found.

CONCLUSION

Newborns without alteration of the lingual frenulum have a tendency to remain with their lips closed and their tongue elevated during rest and newborns with ankyloglossia have a tendency to keep their lips parted and their tongue low during rest.

Evaluation of the nasal septum and depth of palatal arch in different facial vertical patterns: A Cone-Beam Computed Tomography Study

OBJECTIVE

The purpose of this study was to evaluate the nasal septum and the depth of posterior palatal arch in the different facial vertical patterns using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

A total of 143 CBCTs were analysed (53 normodivergents, 26 hypodivergents, and 64 hyperdivergents) using the software Real Scan 2.2. On the coronal view, the following measurements were taken, palatal interalveolar length (PIL), palatal arch depth (PAD), maxillopalatal arch angle (MPAA), septal vertical length (SVL), deviated septal length (DSL), and deviated septal curve angle (DSCA). Using the program Stata v16.0, we obtained the mean, standard deviation and median values. The identification of significant differences between facial biotypes was performed using the one-way ANOVA test and H of Kruskal-Wallis test, considering a significance level of 0.05.

RESULTS

The hypodivergent group got the highest PIL and MPAA (49.6mm and 118.1° respectively), with statistically significant differences (P<0.05) between this group and the hyperdivergent group. Statistically significant differences were found by gender for the SNMeGo, PFH, AFH, and the relationship between the facial heights, where the males had the highest values. Additionally, PIL and SVL also had the highest values for males (48.8mm and 63.6mm respectively).

CONCLUSIONS

Patients presenting with greater hyperdivergence have shorter interalveolar distances and smaller maxillopalatal arch angles.

Quality of life in children following nasal septal surgery: A review of its outcome

Nasal septal surgery among children remains controversial because of its adverse effect on craniofacial development. Recent studies, however, have demonstrated that early nasal septal correction prevents the midfacial and nasal growth deformity that is the inevitable consequence of nasal septal abnormality. Nasal septal surgery in children has been reported to lead to significant improvement in quality of life. We reviewed the existing literature to evaluate the outcomes of pediatric nasal septal surgery.

Risk factors for intraoperative saddle nose deformity in septoplasty patients

INTRODUCTION

Septoplasty is one of the most common otolaryngologic procedures. Previous studies have reported that the overall rate of significant change in cosmetic appearance of the nose after septoplasty ranged from 0.4 to 3.4%, and saddle nose was the most commonly cited deformity. In this study, we evaluated the risk factors for intraoperative saddle nose in a group of septoplasty patients.

METHODS

This case-control study (1:2 case:control) was conducted based on retrospective chart review. Intraoperative saddle nose was observed in 108 (5.1%) of 2106 patients who underwent septoplasty in our center between January 2008 and December 2017. The control group consisted of 216 randomly selected, hospital-matched septoplasty patients who had no intraoperative saddle nose deformity in the same period. The demographic data, preoperative endoscopic findings, and surgical procedures of the two groups were analyzed to identify possible risk factors of intraoperative saddle nose deformity.

RESULTS

The mean ages of the two groups were 34.8 years (saddle group) and 33.2 years (control group). In multivariate logistic regression analysis, clinical risk factors associated with intraoperative saddle nose were female gender (OR 3.39; 95% CI 1.76-6.54; p < 0.01), severe caudal septal deviation (OR 2.22; 95% CI 1.30-3.79; p = 0.003), and intraoperative finding of septal cartilage fracture (OR 3.96; 95% CI 1.92-8.19; p < 0.01).

CONCLUSIONS

Severe caudal septal deviation, intraoperative fracture of septal cartilage, and female gender were risk factors for intraoperative saddle nose deformity in our study population.

Validation of a septoplasty deformity grading system for the evaluation of nasal obstruction

OBJECTIVES/HYPOTHESIS

We developed and validated a septal deformity grading (SDG) system that accounts for anatomic location and grading of deformity severity.

STUDY DESIGN

Retrospective cohort study.

METHODS

Subjects were patients with nasal obstruction presenting to University of California, Irvine Medical Center. Subjects were given pre- and postoperative Nasal Obstruction Symptom Evaluation (NOSE) questionnaires and were evaluated by a facial plastic surgeon using our septal deformity grading (SDG) system. Validity and reliability analyses were conducted on the SDG results. Statistical analyses were conducted on SDG and NOSE data to assess and compare instruments, and to validate the SDG instrument using the NOSE instrument.

RESULTS

One hundred thirty-five patients met inclusion criteria. Cronbach's α was ≥ 0.7 for SDG and pre- and postoperative NOSE scores. There was a significant difference in pre- and postoperative NOSE scores (Z score = -7.21, P < .001). Correlations between postoperative NOSE and SDG scores were significant (P = .014), and convergent construct validity was achieved. There was a significant difference in SDG scores between primary versus revision operations (P < .001), history versus no history of nasal trauma, and nasal/septal surgery (P = .025, P = .003, respectively). The odds of having a revision operation were 2.3 times higher for high SDG scores (P < .001), of having a history of nasal trauma were 1.33 times higher for high SDG scores (P = .014), and of having a history of nasal/septal surgery were 2.9 times higher for low SDG scores.

CONCLUSIONS

Our SDG system addresses the challenge of providing objective anatomic information on the severity of nasal septal deformities, and may be valuable when used in conjunction with subjective data gathered from the NOSE questionnaire.

LEVEL OF EVIDENCE

4 Laryngoscope, 129:586-593, 2019.

Neonatal nasal septal deviation: Two cases of successful early surgical intervention

Neonatal nasal septal deviations can occur as a result of trauma in utero or during birth. They are associated with significant clinical implications, including respiratory distress and failure to thrive. The incidence and classification of these deformities are varied in the otolaryngology literature. Some authors advocate conservative observation, but no consensus on management has been reached. We present 2 cases of neonatal septal deviation that occurred during difficult deliveries. We repaired the defects with closed reduction in the operating room within the first 2 weeks of life to good effect.

Immediate Correction of Nasal Septum Dislocation in Newborns: Long-Term Results

Background

The authors present the results of a long-term follow-up after an immediate reduction of nasal septum luxation in newborn infants.

Methods

Forty-nine children, who underwent a treatment for septal dislocation within 48 hours after birth, were reexamined in 2002 at a mean age of 13.2 years (range, 10–17 years). The examination was performed through inspection of the nasal pyramid, anterior rhinoscopy, nasal endoscopy, rhinomanometry, and acoustic rhinometry.

Results

Anatomic and functional findings showed satisfactory results for all children affected by septal dislocation. Three patients presenting irreplaceable septal-pyramidal deformity had no spontaneous reduction at 7-, 10-, and 11-year follow-ups and thus required surgical intervention.

Conclusions

Considering the simplicity and the safety of the reduction maneuver, the importance of early detection and treatment of neonatal septal dislocations is stressed. This is the longest follow-up study reported in international literature to date.

Nasal Septal Deformity in Relation to the Mode of Delivery

OBJECTIVE

The aim of this study was to find the relation between mode of delivery and the types of septal deviation.

MATERIALS AND METHODS

Records of patients treated for a deviated nasal septum from March 2003 to October 2015 were reviewed. Those with previous facial trauma were excluded. Information retrieved included basic demographic data, mode of delivery, sibling birthing order, type and date of surgery, and postoperational outcomes.

RESULTS

A total of 130 records were recovered. According to Guyuron's classification of nasal septal deviation, we found that type 5 was the most common type for patients delivered normally, whereas type 2 was the most common type for those who were delivered by cesarean section.

CONCLUSION

Mode of delivery may be related to a certain type of deviation. However, studies with larger samples are required to support the finding in our study.

Paediatric orbital cellulitis and the relationship to underlying sinonasal anatomy on computed tomography

OBJECTIVE

To assess if there is an association between sinonasal anatomical variants and the risk of developing orbital cellulitis and associated complications, in children.

METHODS

A retrospective case-control series was conducted, examining computed tomography confirmed sinonasal anatomical variants of septal deviation and concha bullosa in children who presented with periorbital cellulitis who went on to develop orbital cellulitis and abscesses.

RESULTS

Thirty children had a Chandler score of 2 or greater on computed tomography. Mean age was seven years and there was relatively equal sex distribution. There was no association between presence of concha bullosa and side of disease (odds ratio = 1), and no statistically significant difference between septal deviation and ipsilateral orbital infection (p = 0.125).

CONCLUSION

There was no statistical correlation between any sinonasal bony or cartilaginous anatomical variants on computed tomography and orbital complications of acute rhinosinusitis in our paediatric cohort. The findings do not support the theory that these anatomical variants predispose to orbital cellulitis occurring in these children, nor complications thereof.

Open versus endoscopic septoplasty techniques: A systematic review and meta-analysis

BACKGROUND

Septal deviation is a condition of high prevalence, which ranges from 22% in newborns to 90% in adults. Surgical intervention is frequently considered in the management of patients with symptoms. Although many surgeons prefer either the endoscopic or the open approach to septoplasty, there is an ongoing debate regarding comparative outcomes between the two approaches.

OBJECTIVE

The purpose of this study was to systematically review the literature and provide pooled summary estimates to evaluate the efficacy and safety of open versus endoscopic septoplasty techniques.

METHODS

This study was registered with PROSPERO (CRD42014010730). MEDLINE, EMBASE, Google Scholar, CINAHL, Web of Science, and The Cochrane Central Registry for Randomized Trials were searched for relevant studies by using the following keywords in varying combinations: "nasal septum," "nasal obstruction," "nasal cartilages," "nose," "nose diseases," "surgery," "nasal/septal deviation," and "septoplasty." All the studies that compared open versus endoscopic septoplasty techniques for the management of symptomatic septal deviation were considered. Two reviewers independently extracted data by using a preestablished extraction form and performed quality assessment by using the Jadad and Newcastle Ottawa Scales. Weighted pooled estimates were calculated and reported, along with relative risks and 95% confidence intervals.

RESULTS

Fourteen studies met our inclusion criteria. When comparing open versus endoscopic septoplasty techniques, there was significant improvement in postoperative symptoms (i.e., nasal obstruction, headaches) (p < 0.05) in the endoscopic septoplasty group. There also were significantly fewer complications associated with the endoscopic septoplasty technique (p < 0.05). Based on the quality assessment, included studies were deemed at a moderate-to-high risk of bias.

CONCLUSION

Our analysis indicated that endoscopic septoplasty may have some advantages over open septoplasty. However, our findings should be taken with caution given the poor quality of included studies.

Nasal septal deviation with obstructive symptoms: Association found with asthma but not with other general health problems

BACKGROUND

Nasal septal deviation (NSD) is a very common deformity. Because it may induce chronic upper airway obstruction in the nose, clinicians encounter some patients who have concerns about whether this can be a risk factor for general health. However, the influence of NSD on general health has rarely been studied.

OBJECTIVE

To determine associations between NSD, especially NSD with nasal obstructive symptom, and general health problems in an adult Korean population.

METHODS

This nationwide study analyzed data from the Korea National Health and Nutritional Examination Survey, 2008-2009. NSD was evaluated by using a nasal endoscope, and a nasal obstructive symptom was assessed via individual interviews. The survey also investigated general health problems, such as medical comorbidity, mental health status, and quality of life. Medical conditions included neurocardiovascular, respiratory, metabolic, musculoskeletal, gastrointestinal, and malignant diseases. To eliminate the effect of combined nasal problems in otorhinolaryngology, subjects with rhinosinusitis and allergic rhinitis were excluded. This study focused on obstructive NSD, which is defined as an anatomic NSD with a chronic nasal obstructive symptom.

RESULTS

We enrolled 8865 participants, and the prevalence of NSD was 44.8%. No general health problems showed a significant association with NSD. However, the prevalence of NSD with an obstructive symptom was 2.1%. Obstructive NSD had no association with all the general health problems, except asthma. A significant association was found between obstructive NSD and asthma (odds ratio 2.648 [95% confidence interval, 1.211-5.791]).

CONCLUSION

Among various general health problems, our study found that NSD was associated with asthma only when NSD was accompanied by a chronic nasal obstructive symptom.

Effect of non-surgical maxillary expansion on the nasal septum deviation: a systematic review

Nasal breathing is a requirement for proper growth and development of the craniofacial complex. Inadequacy of the nasal airway from obstruction such as from nasal septal deviation (NSD) can affect craniofacial development. Further investigation of the possibility of rapid maxillary expansion (RME) correcting NSD would be valuable, considering the undesirable sequelae of NSD on nasal breathing, which can consequently affect craniofacial development. A systematic review of the effect of RME treatment on NSD was conducted. Electronic database searches were conducted until April 2015 using MEDLINE, EMBASE, Web of Science, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CCTR), Cochrane Methodology Register (CMR), Database of Abstracts of Reviews of Effects (DARE), American College of Physicians Journal Club (ACP Journal Club), Health Technology Assessments (HTA), and NHS Economic Evaluation Database (NHSEED). MeSH terms used in database searches were ‘nasal septum,’ ‘palatal expansion,’ and ‘maxillary expansion,’ ‘orthodontic device,’ and ‘palatal expansion technique.’ The methodological quality of studies was reviewed using methodological index for non-randomized studies (MINORS). Only two studies were finally selected and reviewed. Both studies had significant methodological limitations. One study reported a significant straightening of the nasal septum in the middle and the inferior third of nasal cavity from RME in children aged 5 to 9 years. The other study reported no positional change in the nasal septum from RME in adolescent orthodontic patients. Thus far, the limited available (moderate risk of bias) evidence suggests a potentially positive effect on the nasal septum asymmetry during childhood, but no significant change in adolescence from RME in patients with NSD. The clinical significance of reported changes could be considered questionable.

Measurement tools for the diagnosis of nasal septal deviation: a systematic review

Objective

To perform a systematic review of measurement tools utilized for the diagnosis of nasal septal deviation (NSD).

Methods

Electronic database searches were performed using MEDLINE (from 1966 to second week of August 2013), EMBASE (from 1966 to second week of August 2013), Web of Science (from 1945 to second week of August 2013) and all Evidence Based Medicine Reviews Files (EBMR); Cochrane Database of Systematic Review (CDSR), Cochrane Central Register of Controlled Trials (CCTR), Cochrane Methodology Register (CMR), Database of Abstracts of Reviews of Effects (DARE), American College of Physicians Journal Club (ACP Journal Club), Health Technology Assessments (HTA), NHS Economic Evaluation Database (NHSEED) till the second quarter of 2013. The search terms used in database searches were ‘nasal septum’, ‘deviation’, ‘diagnosis’, ‘nose deformities’ and ‘nose malformation’. The studies were reviewed using the updated Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.

Results

Online searches resulted in 23 abstracts after removal of duplicates that resulted from overlap of studies between the electronic databases. An additional 15 abstracts were excluded due to lack of relevance. A total of 8 studies were systematically reviewed.

Conclusions

Diagnostic modalities such as acoustic rhinometry, rhinomanometry and nasal spectral sound analysis may be useful in identifying NSD in anterior region of the nasal cavity, but these tests in isolation are of limited utility. Compared to anterior rhinoscopy, nasal endoscopy, and imaging the above mentioned index tests lack sensitivity and specificity in identifying the presence, location, and severity of NSD.

The relationship between posterior septum deviation and depth of maxillopalatal arch

OBJECTIVE

To investigate the relationship between depth of maxillopalatal arch and deviation of posterior septum.

METHODS

This study is based on paranasal sinus CT (PNSCT) scan in the coronal plane evaluation, and sinus paranasal scans were obtained from the database. One-hundred and fifty PNSCT scans were randomly chosen among the PNSCT scans which belong to adult (18 and older) patients. All scans were divided to three different groups. The first group constituted by those patients who had more convex deviation. The second group had those patients with either crest or spur deviations. The last group (control group) had no septum deviation. The data collected from each group were statistically compared.

EXCLUSION CRITERIA

CT imaging which has a chronic sinusitis, nasal cavity mass, and nasal polyps.

MAIN OUTCOME MEASURES

angle and distance measures were taken on maxillopalatal arch and posterior nasal septum.

RESULTS

Strongly positive correlation between posterior septum deviation and depth of maxillopalatal arch was determined (r=0.479, p=0.001).

CONCLUSION

These findings suggest that posterior septum deviations are considered as a result of increase in maxillopalatal depth.

Nasal septal deviation in a mediaeval population

In modern populations, there is evidence that nasal septal deviation (NSD) may be associated with maxillary sinusitis, and that those with NSD may differ in craniofacial morphology from those without or with less severe NSD. Whether these associations hold true for earlier populations has yet to be investigated. The current work is a step toward remedying this. The study group comes from a mediaeval English archaeological site. NSD was quantified using image analysis. Maxillary sinusitis was identified from new bone formation in the antrum. Cranial morphology was assessed using standard craniometric measurements. The results provided no evidence for a relationship between NSD and maxillary sinus disease. NSD was associated with reduced measures of upper facial height, suggesting decoupling of growth in vertical height of the nasal septum and the bony structures surrounding it.

Nasal growth after pediatric septoplasty at long-term follow-up

BACKGROUND

Septoplasty in children is still a matter of open discussion, because it is thought that a surgical procedure on a developing structure might produce some adverse effects on normal nasal growth. The goal of this retrospective study is to evaluate the effects of pediatric nasal septum surgery in a long-term follow-up by anthropometry.

METHODS

Forty-four Italian patients, 25 male patients and 19 female patients, who had undergone septoplasty during childhood using the endonasal approach, were reassessed after a mean follow-up of 12.2 years. Anthropometric recordings were used to identify any growth retardation due to the operation by a comparison with previously published age-specific normative data of North American white subjects. Nasal measurements consisted of five linear parameters, three angular parameters, and three proportional index.

RESULTS

There were no significant differences in any of the measures between the sample and controls (p > 0.1) with regard to gender, with the exception of the nasolabial angle measurement. Indeed, the nasolabial angle of the female patients was significantly reduced compared with controls (p = 0.04), whereas that of the male patients was reduced compared with controls (p = 0.08). This measurement seems to be influenced by the type of operation, because it has been noted that the nasolabial angle of patients treated surgically by extracorporeal septoplasty were significantly lower than those of patients treated surgically by conservative septoplasty.

CONCLUSION

Pediatric septoplasty may be indicated in selected cases of obstructing nasal septum deformities. The operation, performed via endonasal approach, does not interfere with the normal growing nasal process.

Nasal septal deviation in the pediatric and adult populations

A significant proportion of the population has nasal septal deviation of varying degrees. Recent reports of such deviation occurring at younger ages suggest a congenital etiology. To the best of our knowledge, no previous clinical studies have compared the septal deviation of adult and pediatric populations with a uniform measure that focuses on the degree of deviation. We retrospectively analyzed computed tomography (CT) and magnetic resonance imaging (MRI) scans obtained from 81 patients who had undergone head and neck imaging for a variety of reasons. These subjects were divided into four age groups: younger than 4 months; 4 months to less than 5 years; 5 to 15 years; and more than 15 years. We used a measure of tortuosity to examine and compare nasal septal deviation among the different age groups. The tortuosity of the septum was measured at four precise points along the length of the septum on thin-section sinus CT and MRI. Tortuosity was defined as the ratio of the "actual" length of the septum to the "ideal" length of the septum, which was defined as the length of a straight line drawn from the superior to the inferior aspect of the septum. We found that subjects younger than 5 years of age exhibited significantly less tortuosity (p ≤ 0.017459) than did the older children and the adults. Therefore, we conclude that nasal septal deviation occurs at a higher frequency in older children and in adults when calculations of tortuosity are used as a measure. Our data may suggest that a noncongenital etiology is responsible for nasal septal deviation. However, given that the growth of the septum continues throughout childhood, our results do not preclude the possibility of a genetic predisposition to the later development of a deviated nasal septum.

Deviated nasal septum in the newborn-A 1-year study

A prospective study of 200 newborn babies was done at Silchar Medical College Hospital from September 2002 to August 2003. The babies aged from 0 to 4 days were taken in the study. They were examined for any signs of nasal obstruction, birth trauma, prolonged labour, mode of delivery (forceps/vaginal/caeserian section), intrauterine malposition, postmaturity, birthweight, cephalopelvic disproportion, parity of the mother and gestational period. The diagnosis was done by clinical examination, rhinometry, struts and applying cotton wool. In the study, the incidence was found to be 14.5% (29 cases). It was found that high-birth weight babies, delivered by vaginal route (55%), to a primi mother are more likely to have DNS after birth. Moreover, intrauterine malposition particularly breech (45%) and prolonged labour seemed to play a role in newborn DNS. More importantly, the present study seems to indicate that since a good percentage of such deformity originate at the gestational period, early detection at the neonatal age is vital to manage and also to prevent complications and sequelae in adult life. Therefore, a policy of routine screening in view of early correction is advocated to decrease the morbidity associated with nasal septal deviation in newborns.

The prevalence of nasal septal deviation in children from Kahramanmaras, Turkey

OBJECTIVE

The aim of this study was to determine the prevalence of nasal septal deformities among Turkish school children, in the city of Kahramanmaras in Turkey.

METHODS

Study included 1234 Caucasian children attending pre-school, primary and secondary schools. All of the children underwent nasal examinations. Pathological septal deformities were grouped into seven types by using Mladina's classification. The differences among the types of nasal septal deformity (NSD) and between sexes were tested by chi(2)-test for independent samples.

RESULTS

The overall prevalence of NSD has been found to be 34.9%. For the age groups, the prevalence of NSD was 16.5% in pre-school children, 38.7% in primary school children and 39.9% in secondary school children. Type 1 NSD was the most commonly seen deformity among all age groups. Anterior deformities (types 1 and 2) were the most commonly encountered types in pre-school children, but the occurrences of the posterior deformities (types 3-5) was relatively increased as the age increased. Neither the distribution of NSD types nor the overall prevalence showed any statistically significant difference between both sexes.

CONCLUSION

We found that the prevalence of NSD and the occurrence of the posterior deformities was relatively increased as the age increased. Our study may reflect the prevalence of septal deviation in Turkish children in Kahramanmaras, an eastern Mediterranean city of Turkey. However, further studies throughout the country are needed.

[Neonatal nasal obstruction]

Because neonates are obligate nose breathers, neonatal nasal obstruction may have serious consequences. Prompt diagnosis and appropriate treatment are essential to avoid severe hypoxia. The most common cause of neonatal nasal obstruction is rhinitis. However, it is essential to first rule out anatomical causes such as choanal atresia and stenosis, pyriform aperture stenosis, traumatic deformation or tumors, as these conditions may be life-threatening and require prompt surgical treatment.