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Rose AS, Makary CA, Soler ZM, Kimple AJ, Pearlman AN, Ramaswamy US, Setzen M, Gudis DA. American Rhinologic Society Expert Practice Statement: Indications and Recommendations for Septoplasty in Children. Int Forum Allergy Rhinol 2024. [PMID: 38995326 DOI: 10.1002/alr.23397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 07/13/2024]
Abstract
The goal of this American Rhinologic Society Expert Practice Statement (EPS) is to provide recommendations and guidance through evidence-based consensus statements regarding pediatric septoplasty. This EPS was developed following the previously published methodology and approval process. The topics of interest included appropriate indications, safety and efficacy, timing, relevant quality of life instruments, and surgical techniques. Following a modified Delphi approach, six statements were developed, five of which reached consensus and one that did not. These statements and accompanying evidence are summarized along with an assessment of future needs.
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Affiliation(s)
- Austin S Rose
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Chadi A Makary
- Department of Otolaryngology-Head & Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Aaron N Pearlman
- Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Uma S Ramaswamy
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Michael Setzen
- Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - David A Gudis
- Department of Otolaryngology-Head & Neck Surgery, Columbia University School of Medicine, New York, New York, USA
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Abbasoglu B, Basak H, Mete B, Gokalp E, Zaimoglu M, Beton S, Meco C, Kahilogulları G. Effect of endoscopic endonasal skull base approaches on olfactory function and facial development in children. Childs Nerv Syst 2024:10.1007/s00381-024-06446-0. [PMID: 38850294 DOI: 10.1007/s00381-024-06446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/01/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Endoscopic approaches for skull base pathologies are increasingly being performed, and the subsequent complications, especially in the long term, have also been partially clarified. However, there is no information on the effects of endoscopic endonasal skull base surgeries (EESBS) in children on odor and facial development in parallel with long-term development. We conducted this study to investigate postoperative olfactory function and facial development in pediatric patients who underwent skull base surgery using the endoscopic endonasal method. METHODS We evaluated the smell test, sinonasal symptoms, and facial development of pediatric patients who underwent endoscopic endonasal skull base surgery after long-term follow-up. Odor was evaluated using the "Sniffin' Sticks" test kit, which assessed the T (odor threshold), D (odor discrimination), and I (odor identification) parameters. Sinonasal symptoms were evaluated using the SNOT-22 (sinus-nose outcome test) questionnaire. SNA (sella-nasion-A point), SNB (sella-nasion-B point), and ANB (A point-nasion-B point) angles were calculated from maxillofacial tomography and magnetic resonance imaging) to evaluate facial development. Data were compared with those of the healthy control group. RESULTS We included 30 patients comprising 19 (63.3%) boys and 11 (36.7%) girls, with no age difference between case and control groups. The mean follow-up period was 7 years. Odor test data, cephalometric measurements, and SNOT-22 analysis results showed no statistically significant differences between the two groups. CONCLUSION To our knowledge, this is a comprehensive study with the longest follow-up period in terms of evaluation of facial development after EESBS in children to analyze odor using the Sniffin' Sticks test kit and the quality of life using SNOT-22. Olfactory function, facial development, and quality of life remained unaffected after long-term follow-up after EESBS in children. Although this surgical approach is minimally invasive, we recommend considering the possibility of complications, and the procedure should be performed by an experienced surgical team with adequate equipment.
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Affiliation(s)
- Bilal Abbasoglu
- Department of Neurosurgery, Ankara University Medical School, Ankara, Turkey
| | - Hazan Basak
- Department of Otorhinolaryngology - Head and Neck Surgery, Ankara University Medical School, Ankara, Turkey
| | - Bahir Mete
- Department of Neurosurgery, Ankara University Medical School, Ankara, Turkey
| | - Elif Gokalp
- Department of Neurosurgery, Ankara University Medical School, Ankara, Turkey
| | - Murat Zaimoglu
- Department of Neurosurgery, Ankara University Medical School, Ankara, Turkey
| | - Suha Beton
- Department of Otorhinolaryngology - Head and Neck Surgery, Ankara University Medical School, Ankara, Turkey
| | - Cem Meco
- Department of Otorhinolaryngology - Head and Neck Surgery, Ankara University Medical School, Ankara, Turkey
- Department of Otorhinolaryngology - Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
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Howard T, Williams I, Navaratnam A, Haloob N, Stoenchev K, Saleh H. "Should Pediatric Septal Surgery and Septorhinoplasty Be Performed for Nasal Obstruction?"-A Systematic Review of the Literature. Facial Plast Surg 2024; 40:378-393. [PMID: 38035612 DOI: 10.1055/a-2219-9266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Corrective septal surgery for children with nasal obstruction has historically been avoided due to concern about the impact on the growing nose, with disruption of midfacial growth. However, there is a paucity of data evaluating complication and revision rates post-nasal septal surgery in the pediatric population. In addition, there is evidence to suggest that failure to treat nasal obstruction in children may itself result in facial deformity and/or developmental delay. The aim of this systematic review is to evaluate the efficacy and safety of septal surgery in pediatric patients with nasal obstruction. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. MEDLINE, Embase, and the Cochrane Library were searched. Original studies in pediatric patients (<18 years of age) with nasal obstruction were eligible for inclusion. Patients with cleft lip or palate as their primary diagnosis were excluded. Our primary outcomes were patient-reported outcome measures (PROMs), postsurgical complications, and revision rates. Secondary outcomes included surgical technique, anatomical considerations, and anthropometric measurements. Eighteen studies were included (1,080 patients). Patients underwent septoplasty, septorhinoplasty, rhinoplasty, or a combination of procedures for nasal obstruction. Obstruction was commonly reported secondary to trauma, nasal septal deviation, or congenital deformity. The mean age of the patients was 13.04 years with an average follow-up of 41.8 months. In all, 5.6% patients required revision surgery and there was an overall complication rate of 7.8%. Septal surgery for nasal obstruction in children has low revision and complication rates. However, a pediatric-specific outcome measure is yet to be determined. Larger prospective studies with long-term follow-up periods are needed to determine the optimal timing of nasal surgery for nasal obstruction in the pediatric population.
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Affiliation(s)
- Theodore Howard
- Department of Rhinology and Otolaryngology, Charing Cross Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Isabelle Williams
- Department of Rhinology and Otolaryngology, Charing Cross Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Annakan Navaratnam
- Department of Rhinology and Otolaryngology, Charing Cross Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Nora Haloob
- Department of Rhinology and Otolaryngology, Charing Cross Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Kostadin Stoenchev
- Department of Allergy and Clinical Immunology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Hesham Saleh
- Department of Rhinology and Otolaryngology, Charing Cross Hospital, Imperial College NHS Trust, London, United Kingdom
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Lenze NR, Bharadwaj SR, Baldassari CM, Kirkham EM. Surgical Management of Pediatric Obstructive Sleep Apnea Beyond Adenotonsillectomy: The Nose, Nasopharynx, and Palate. Otolaryngol Clin North Am 2024; 57:421-430. [PMID: 38508883 PMCID: PMC11060425 DOI: 10.1016/j.otc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
While adenotonsillectomy is the primary treatment of pediatric obstructive sleep apnea (OSA), persistent OSA after surgery is common and may be due to residual obstruction at the nose, nasopharynx, and/or palate. Comprehensive evaluation for persistent pediatric OSA ideally includes clinical examination (with or without awake nasal endosocpy) as well as drug-induced sleep endoscopy in order to accurately identify sources of residual obstruction. Depending on the site of obstruction, some of the surgical management options include submucous inferior turbinate resection, septoplasty, adenoidectomy, and expansion sphincter pharyngoplasty.
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Affiliation(s)
- Nicholas R Lenze
- Department of Otolaryngology-Head & Neck Surgery, The University of Michigan, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Suhas R Bharadwaj
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA
| | - Christina M Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA
| | - Erin M Kirkham
- Department of Otolaryngology-Head & Neck Surgery, The University of Michigan, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Shave S, Vella J, Chandy B. Pediatric Functional Rhinoplasty. Facial Plast Surg 2023; 39:660-667. [PMID: 37619608 DOI: 10.1055/s-0043-1772576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Surgery on the growing pediatric nose poses many questions regarding the indications and proper timing. Historically, surgeries on the pediatric nose led to facial growth alterations so many urged caution and waiting until skeletal maturity at the age of 18. However, animal studies showed some promise that facial growth may not be affected. Investigations into effects of pediatric sinus surgery and septal surgery on facial growth showed no issues. The external nose is somewhat different in that minor variations potentially can grow to a cosmetic deformity. However, numerous studies on facial growth show, to date, that it is not affected, and that surgery is safe. The caveat that one uses is the techniques of cartilage sparing and preservation, which have been studied and shown to be safe. There are ways to measure the effectiveness of surgery in relieving nasal airway obstruction both objectively and, more recently, subjectively. It is essential to treat pediatric nasal airway obstruction to avoid other facial growth problems, such as mouth breathing, snoring, malocclusion, and obstructive sleep apnea.
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Affiliation(s)
- Samantha Shave
- Department of Otolaryngology/Head and Neck Surgery, Robert Wood Johnson/Rutgers University, New Brunswick, New Jersey
| | - Joseph Vella
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, Robert Wood Johnson/Rutgers University, New Brunswick, New Jersey
| | - Binoy Chandy
- Division of Facial Plastic and Reconstructive Surgery, Division of Complex Pediatric Otolaryngology, Department of Otolaryngology/Head and Neck Surgery, Robert Wood Johnson/Rutgers University, New Brunswick, New Jersey
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Badaoui JN, Choby G, McMillan RA, Goates AJ, Cofer SA. Triple Layer Oronasal Fistula Repair Using Local Endonasal Flaps: Case Series of Three Patients. Cleft Palate Craniofac J 2023; 60:359-366. [PMID: 35244480 DOI: 10.1177/10556656211062040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Oronasal fistula (ONF) is a common complication encountered after palatoplasty. Repair is indicated when symptoms impact speech and swallowing. In spite of the variety of surgical approaches described to repair these defects, recurrence rates remain high. Traditionally, successful closure is said to be achieved in using a double-layered approach due to the three-dimensional aspect of the defect. The extent of the fistula into the nasal cavity has incited an increased curiosity in using local endonasal flaps. In recent years, endonasal reconstructive procedures have seen increased interest and application, from cranial base defect repairs to orbital reconstruction and beyond. The nasoseptal (NSF) and inferior turbinate flaps (ITF) possess a robust arterial supply and an exceptional reach with excellent results demonstrated in large defect repair. However, the use of these flaps in ONF repair is scarcely discussed in the literature, and their effectiveness is relatively undetermined. In this manuscript, we present a series of three patients who underwent a triple layer ONF closure, with the oral portion incorporating a turn-in mucosal flap plus a local palate rotation flap or greater palatine artery pedicled-rotation flap, and a NSF or an ITF for the nasal portion of the defect.
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Affiliation(s)
- Joseph N Badaoui
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Garret Choby
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan A McMillan
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew J Goates
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Shelagh A Cofer
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
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Shah JP, Youn GM, Wei EX, Kandathil C, Most SP. Septoplasty Revision Rates in Pediatric vs Adult Populations. JAMA Otolaryngol Head Neck Surg 2022; 148:1044-1050. [PMID: 36201221 PMCID: PMC9539730 DOI: 10.1001/jamaoto.2022.3041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/20/2022] [Indexed: 12/13/2022]
Abstract
Importance Although septal deviations are highly prevalent in the pediatric population and pediatric septoplasties are garnering more discussion, to date, there are no large-scale studies characterizing pediatric septoplasty revision rates. Objective To identify rates of pediatric septoplasty revision in the US. Design, Setting, and Participants This retrospective, observational cohort study used administrative claims data from the IBM MarketScan Commercial Database (which contains inpatient and outpatient data for millions of patients and dependents covered by employer-sponsored private health insurance in the US) to identify patients undergoing septoplasty between January 1, 2007, and December 31, 2016. Patients 18 years or younger were included in the study as the pediatric cohort, and patients aged 19 to 65 years were included as the adult cohort for comparison. Patients were excluded if the initial surgery included rhinoplasty, nasal vestibular stenosis, or costal cartilage grafts or if the second surgery did not have nasal vestibular stenosis, septoplasty, rhinoplasty, and/or cartilage grafts. Main Outcomes and Measures Outcomes included septoplasty revision rate, septoplasty-to-rhinoplasty conversion rate, and associated risks for revision surgery. Collected data were analyzed between January 1 and July 30, 2022. Results A total of 24 322 pediatric patients (mean [SD] age, 15.7 [2.5] years; 15 121 boys [62.2%]) who underwent an initial septoplasty were identified, of whom 704 (2.9%) received a revision. In the adult cohort of 286 218 patients (mean [SD] age, 41.4 [12.2] years; 162 893 [56.9%] men), 3081 individuals (1.1%) received a revision. Within the pediatric revision group, 66 patients (9.4%) received a rhinoplasty vs 162 (5.3%) in the adult revision group. All pediatric age groups had higher revision rates than the adult population, with the 9- to 13-year-old group having the highest rates of revision (118 of 2763 [4.3%]). Patients in the West and Northeast, along with those with point of service and health maintenance organization health plans, were more likely to receive a revision. Conclusion and Relevance The findings of this cohort study suggest that pediatric patients are more likely to receive a revision surgery than their adult counterparts. Furthermore, pediatric patients are more likely than adults to receive a rhinoplasty as their revision surgery. These findings provide valuable information that may be used to inform clinical decision-making, although further research is needed to better identify the causes for pediatric septoplasty revision.
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Affiliation(s)
- Jay P. Shah
- Stanford University School of Medicine, Stanford, California
| | - Gun Min Youn
- Stanford University School of Medicine, Stanford, California
| | - Eric X. Wei
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Cherian Kandathil
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Sam P. Most
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Benyo S, Moroco AE, Saadi RA, Patel VA, King TS, Wilson MN. Postoperative Outcomes in Pediatric Septoplasty. Ann Otol Rhinol Laryngol 2022:34894221129677. [PMID: 36226335 DOI: 10.1177/00034894221129677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Identify risk factors and perioperative morbidity for pediatric patients undergoing septoplasty. METHODS The American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database was retrospectively queried to identify patients who underwent septoplasty (CPT 30520) for a diagnosis of deviated nasal septum (ICD J34.2) from 2018 to 2019. Outcomes analyzed include patient demographics, medical comorbidities, surgical setting, operative characteristics, length of stay, and postoperative outcomes. RESULTS A total of 729 children were identified. Median age at time of surgery was 15.8 years, with most patients (82.8%) >12 years of age; no significant association was identified between age at time of surgery and adverse surgical outcomes. Overall, postoperative complications were uncommon (0.6%), including readmission (0.4%), septic shock (0.1%), and surgical site infection (0.1%). A history of asthma was found to be a significant risk factor for postoperative complications (P = .035) as well as BMI (P = .028). CONCLUSION The 30-day postoperative complications following pediatric septoplasty in children reported in the NSQIP-P database are infrequent. Special considerations regarding young age, complex sinonasal anatomy, and surgical technique remain important features in considering corrective surgery for the pediatric nose and certainly warrant further investigation in subsequent studies.
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Affiliation(s)
- Sarah Benyo
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Annie E Moroco
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert A Saadi
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Vijay A Patel
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of California San Diego, La Jolla, CA, USA.,Division of Pediatric Otolaryngology, Rady Children's Hospital - San Diego, San Diego, CA, USA
| | - Tonya S King
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Meghan N Wilson
- Department of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Shehan JN, Liu J, LeClair J, Mahoney TF, Levi JR, Ezzat WH. Pediatric septorhinoplasty: Current attitudes and practices by facial plastic and reconstructive surgeons. Am J Otolaryngol 2022; 44:103684. [DOI: 10.1016/j.amjoto.2022.103684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/18/2022] [Indexed: 11/01/2022]
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Ugurlu BN, Celik H, Aslan Felek S, Aktar Ugurlu G, Ciledag N, Kaygusuz H. The Effects of Septorhinoplasty Techniques and Poly-P-Dioxanone Plate Use on Maxillofacial Growth: An Experimental Study. J Craniofac Surg 2021; 32:2892-2895. [PMID: 33674500 DOI: 10.1097/scs.0000000000007607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Since the septum plays a key role in maxillofacial growth, the effect of septorhinoplasty maneuvers and the use of poly-p-dioxanone plate during growth on maxillofacial growth was investigated in our study. Thirty-three New Zealand rabbits each with an age of 8 weeks were included in the study. Maxillofacial computed tomography was performed on all 8-weeks old rabbits. Then, the rabbits were divided into 5 groups randomly. No intervention was done on the rabbits in group 1. Nasal dorsum of the rabbits in the 2nd group were opened, and the mucosae were bilaterally elevated. In the third group underwent limited cartilage resection by preserving the nasal dorsum. Removed cartilage was crushed and placed back between the mucoperichondrial flaps for the rabbits in the 4th group. Crushed cartilage with Poly-P-Dioxanone plate was used for the rabbits in the 5th Group. Maxillofacial computed tomography was performed at the end of the 20th week and growth parameters were investigated. When the group 2 was compared with the control group, the nasal bone length was observed to be significantly shorter (P < 0.05). Group 5 compared with group 4, incisive bone volume remained significantly low (P < 0.05) and malocclusion developed. Nasal bone length was affected negatively in the group that underwent osteotomy and mucosa elevation. Although positive results related to poly-p-dioxanone plate use have been reported for adults, incisive bone development retarded in noses that had not yet reached adult size in our study and the maxillofacial development was affected adversely.
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Affiliation(s)
- Burak Numan Ugurlu
- Department of Otolaryngology, Hitit University Erol Olçok Training and Research Hospital, Corum
| | - Hatice Celik
- Department of Otolaryngology, Health Sciences University Ankara Training and Research Hospital, Ankara
| | - Sevim Aslan Felek
- Department of Otolaryngology, Hitit University Erol Olçok Training and Research Hospital, Corum
| | - Gulay Aktar Ugurlu
- Department of Otolaryngology, Hitit University Erol Olçok Training and Research Hospital, Corum
| | - Nazan Ciledag
- Department of Radiology, Health Sciences University Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hidir Kaygusuz
- Department of Radiology, Health Sciences University Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Bishop R, Sethia R, Allen D, Elmaraghy CA. Pediatric nasal septoplasty outcomes. Transl Pediatr 2021; 10:2883-2887. [PMID: 34976754 PMCID: PMC8649597 DOI: 10.21037/tp-21-359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/14/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Corrective nasal surgery has historically been avoided in the pediatric population out of concerns surrounding the potential disruption of nasal growth centers. There is a paucity of data on the rate of complications or revision surgery following septoplasty in this population. As such, the purpose of this study is to review the long-term outcomes of a large cohort of children who underwent nasal septoplasty and to compare outcomes of septoplasty patients under the age of 14 to those 14 years and older. METHODS A retrospective review was performed on all patients who received nasal septoplasty at our tertiary care pediatric referral center between October 2009 and September 2016. All patients who underwent septoplasty for a deviated nasal septum and were 0-18 years of age at the time of surgery were included in this analysis. Outcomes were compared between patients under the age of 14 to those 14 years and older. Demographic, surgical, and follow-up data were collected including complications and the need for revision surgery. RESULTS A total of 194 pediatric patients were identified as meeting inclusion criteria for the study. Mean age for the total cohort was 14.6 years (0-18 years), with a mean of 15.9 years in the older group and 10.6 years in the younger group. Revision septoplasty was performed more frequently in the younger group. However, no significant difference in the rate of complications was seen between the two groups. CONCLUSIONS To the best of our knowledge, this is the largest retrospective study examining outcomes following septoplasty in pediatric patients. We also specifically examine outcomes of very young septoplasty patients, a population for which limited evidence exists. Further retrospective studies are needed to validate the use of nasal septoplasty in the pediatric population.
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Affiliation(s)
- Ryan Bishop
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Rishabh Sethia
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - David Allen
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Charles A Elmaraghy
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
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Abstract
BACKGROUND/PURPOSE Pediatric septorhinoplasty has sparked controversial debate amongst craniofacial surgeons, particularly due to its potential growth disturbances of the face and nose. The purpose of this study is (1) to conduct a systematic literature review that explores unique considerations and limitations associated with performing rhinoplasty in the pediatric population; (2) to discuss objective indicators for determining craniofacial skeleton maturation; (3) to perform a case series to further understand whether the age of menarche serves as a good proxy for estimating the time of facial growth maturation, and by extension, whether a post-menarchal patient is a suitable candidate for rhinoplasty. METHODS Systematic literature review was performed in order to assess unique considerations and limitations of pediatric rhinoplasty. Retrospective chart review and anthropometric (9 linear, 3 angular, 6 indices) measurements were performed for ten pediatric female patients who underwent open septo-rhinoplasty. Follow-up times ranged from 66 to 103 weeks. Patients were separated into 2 cohorts according to age at the time of menarche. Cohort 1 consisted of patients who had undergone menses for longer than 2 years at the time of rhinoplasty, whereas Cohort 2 comprised of patients who either had menses within 2 years of rhinoplasty or did not have menses at the time of rhinoplasty. Data included demographic factors, procedural variables, revision surgeries, and complications. Measurements were conducted using VECTRA software (Canfield Scientific, Parsippany, NJ). Differences in measurements between the 2 postoperative timepoints were compared. RESULTS Literature review yielded 17 articles, which had conflicting opinions regarding pediatric rhinoplasty and ultimately, highlighting the need for a more objective tool for guiding the decision to perform rhinoplasty.Patients in Cohort 1 had minimal deviations in measurements over time, within the exception of an increase in nasal tip projection and a decrease in nasolabial angle and facial width. Patients in Cohort 2 had decreases in facial height, upper facial height, nasal tip angle, and nasofrontal angle. Nasolabial angle decreased for both cohorts. Of the ten patients, 1 in Cohort 2 underwent revision rhinoplasty. CONCLUSIONS Our case series suggests that anthropometric measurements remain relatively more stable for patients who have undergone menses for more than 2 years, compared to those who have not. Although this study has limitations, further investigation is warranted in order to determine whether age of menarche may serve as a useful tool for craniofacial surgeons in guiding the decision to perform rhinoplasty.
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DİLCİ A, CEVİZCİ R. Septoplasti Yapılan Pediatrik Hastaların Klinik Özelliklerinin Retrospektif Değerlendirilmesi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2021. [DOI: 10.17944/mkutfd.822293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Quick septoplasty in children: Long-term effects on nasal breathing and dentofacial morphology. A prospective cephalometric study. Auris Nasus Larynx 2021; 48:914-921. [PMID: 33685756 DOI: 10.1016/j.anl.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/09/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Many authors have investigated the most appropriate surgical approach to the deviated septum in childhood, considering the obligate mouth-breathing habit a possible cause of malocclusion and disharmonious development of the facial skeleton in growing kids. Nevertheless, controversies still remain about the long-term functional/esthetic results of such procedures, mainly due to the duration of the follow-up and possible confounding factors. METHODS 111 Caucasian children (age range: 6-13 years) were submitted to a personal "Quick" septoplasty surgical technique between 2005 and 2010. Preoperative otorhinolaryngological examination using flexible nasal endoscopy, anterior active rhinomanometry (AAR), Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire, and dentofacial evaluation (including cephalometry) were performed. Postoperative AAR, NOSE questionnaire and cephalometric assessment were carried out in all patients at the age of 18 years. Informed consent was obtained from children's parents as appropriate. RESULTS No surgical complication was recorded. Among our patients, a significant (p <0.001) improvement of nasal breathing resistances at AAR and NOSE questionnaire scores was found after surgery. A significant improvement in cephalometric/dental parameters (gonial angle values, anterior facial height, prevalence of class I occlusion, maxillary intermolar width, and cross-bite frequency) was noticed after the follow-up with respect to preoperative conditions. CONCLUSION The "Quick" septoplasty technique described is a practical and conservative procedure with a low complication rate that offers long-term favourable results for the correction of nasal septum deviations in children. Nasal-breathing restoration may favor a physiological and harmonious development of craniofacial and dental structures in offspring.
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15
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Carroll WW, Farhood Z, White DR, Patel KG. Nasal dorsum reconstruction after pediatric nasal dermoid excision. Int J Pediatr Otorhinolaryngol 2021; 140:110502. [PMID: 33248715 DOI: 10.1016/j.ijporl.2020.110502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND To review our experience with pediatric nasal dermoids, and discuss reconstructive options for the nasal dorsum after pediatric nasal dermoid removal. METHODS Retrospective review of pediatric nasal dermoid cases from January 1 2005 through October 1 2016. RESULTS Twenty-five cases (12 males, 13 females) were identified. Median age at time of surgery was 24 months (7-144). Ten nasal dermoids were superficial; eleven, intraosseous; one, intracranial extradural; three, intracranial intradural. Seven were located on the glabella; fifteen, dorsum; three, nasal tip. Twelve underwent vertical midline incision; ten underwent external rhinoplasty; and three combined approach with craniotomy. There was one recurrence four years postoperatively; which was secondarily resected completely via external rhinoplasty approach. Seven cases utilized endoscopic assistance. Conchal cartilage grafting was utilized in nine cases for dorsal reconstruction. A temporoparietal fascial graft was utilized to reconstruct the soft tissue defect in three patients. Median follow-up was 1.17 years (1 month-10 years). CONCLUSIONS Nasal dermoid is a rare congenital pathology. Recurrence rate is generally low provided that complete surgical excision is achieved. Achieving complete surgical excision means sometimes compromising the upper lateral cartilages and nasal bones. Conchal cartilage grafting is useful in reconstruction for lesions that significantly disrupt the nasal cartilages and/or nasal bones, wherein the defect is significant and osteotomies may not be sufficient. Temporoparietal fascia is a favorable adjunct for reconstructing soft tissue deficits when the skin is thin. Further studies and longer follow up are needed to adequately assess functional and cosmetic outcomes.
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Affiliation(s)
- William W Carroll
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Zachary Farhood
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David R White
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Krishna G Patel
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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16
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Calvo-Henríquez C, Neves JC, Arancibia-Tagle D, Chiesa-Estomba C, Lechien JR, Mayo-Yáñez M, Martinez-Capoccioni G, Martin-Martin C. Does pediatric septoplasty compromise midfacial growth? A systematic review. Eur Arch Otorhinolaryngol 2020; 277:1565-1574. [PMID: 32200434 DOI: 10.1007/s00405-020-05919-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/10/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Septal deviation is an important cause of impaired nasal breathing among pediatric patients. A widespread solution to septal deviation is septoplasty. However, there are certain controversies surrounding the effect of this technique on pediatric patients and its influence on the growth centers of the nose. The objective of this review is to study if there is a strong and valid evidence in the literature that supports a detrimental effect of pediatric septo- and rhinoseptoplasty in facial growth DATA SOURCES: Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database. REVIEW METHODS The outcome assessed was the midfacial growth after pediatric septoplasty. RESULTS Eight publications met the inclusion criteria. None found major disturbances in facial growth. Only minor nasal anomalies were reported by 4 authors. CONCLUSION Septoplasty in pediatric patients does not seem to affect midfacial growth according to available evidence. However, due to their design, the degree of recommendation of these studies was not superior to level C.
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Affiliation(s)
- Christian Calvo-Henríquez
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.
- Service of Otolaryngology, Travesía de Choupana, Hospital Complex of Santiago de Compostela, s/n. 15706, Santiago de Compostela, Spain.
| | - J Carlos Neves
- Department of Facial Plastic Surgery - My Face Clinics and Academy, Lisbon, Portugal
| | - Diego Arancibia-Tagle
- Department of Facial Plastic Surgery - My Face Clinics and Academy, Lisbon, Portugal
| | - Carlos Chiesa-Estomba
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Service of Otolaryngology, Donostia University Hospital, San Sebastian, Spain
| | - Jerome R Lechien
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Foch Hospital, University of Paris Saclay, Paris, France
| | - Miguel Mayo-Yáñez
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Service of Otolaryngology, Hospital Complex of La Coruña, La Coruña, Spain
| | - Gabriel Martinez-Capoccioni
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Service of Otolaryngology, Travesía de Choupana, Hospital Complex of Santiago de Compostela, s/n. 15706, Santiago de Compostela, Spain
| | - Carlos Martin-Martin
- Service of Otolaryngology, Travesía de Choupana, Hospital Complex of Santiago de Compostela, s/n. 15706, Santiago de Compostela, Spain
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17
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Kim YH, Lee JY, Phi JH, Wang KC, Kim SK. Endoscopic endonasal skull base surgery for pediatric brain tumors. Childs Nerv Syst 2019; 35:2081-2090. [PMID: 31377913 DOI: 10.1007/s00381-019-04335-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE The utility of endoscopic endonasal skull base surgery (EES) in various pathologic entities in adults has been published in the literature. However, the role of EES in children has not been clearly elucidated. We evaluated the feasibility of EES in children with brain tumors. METHODS We retrospectively reviewed clinical features, surgical outcomes, and complications in children who underwent EES for intracranial and skull base tumors at a single institution from July 2010 to October 2018. RESULTS A total of 82 patients underwent EESs for 77 intracranial and 5 skull base bony tumors. The mean age at diagnosis was 11.4 years (range 4-18 years), and the mean follow-up period was 46.8 months. The most common tumors were craniopharyngioma in the intracranial tumor and chordoma in the skull base. Gross total resection was the goal of surgery in 55 patients and achieved in 90.9%. The vision was improved in 76.1% of patients with visual impairments. Preoperatively, various endocrinological deficiencies were revealed in 73.7% of 76 patients with hypothalamus-pituitary lesions, and the hyposomatotropism was most common. Endocrinological status was improved only in 10. Aseptic or bacterial meningitis (7.3%) was the most common surgical complication, and the cerebrospinal fluid leakage rate was 2.4%. CONCLUSIONS EES provides favorable neurological outcomes with acceptable risk for children with brain tumors. The high incidence of endocrinological deficits in cases with hypothalamus-pituitary lesions emphasizes the importance of judicious pre- and postoperative evaluation.
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Affiliation(s)
- Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Yeoun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.,Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea.,Department of Anatomy, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.,Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Kyu-Chang Wang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.,Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea. .,Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea.
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18
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Saniasiaya J, Abdullah B. Quality of life in children following nasal septal surgery: A review of its outcome. Pediatr Investig 2019; 3:180-184. [PMID: 32851314 PMCID: PMC7331304 DOI: 10.1002/ped4.12145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/20/2019] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Jeyasakthy Saniasiaya
- Department of OtorhinolaryngologyHospital Tuanku Ja'afarSerembanNegeri SembilanMalaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology‐Head and Neck SurgerySchool of Medical SciencesUniversiti Sains MalaysiaKubang KerianKelantanMalaysia
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19
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Parasher AK, Lerner DK, Glicksman JT, Storm PB, Lee JYK, Vossough A, Brooks S, Palmer JN, Adappa ND. The impact of expanded endonasal skull base surgery on midfacial growth in pediatric patients. Laryngoscope 2019; 130:338-342. [PMID: 31070247 DOI: 10.1002/lary.28063] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/09/2019] [Accepted: 04/22/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Surgical resection of skull base tumors in children is increasingly accomplished through an expanded endonasal approach (EEA). We aim to evaluate the potential effect of the EEA on midfacial growth as a result of iatrogenic damage to nasal growth zones. METHODS We performed a retrospective review of children undergoing craniopharyngioma resection via an open transcranial or EEA. Pre- and postoperative magnetic resonance imaging was evaluated for growth in four midfacial measurements based on established cephalometric landmarks: anterior midface height, posterior midface height, palatal length, and sella-nasion distance. Statistical analysis was conducted using a mixed-effects linear regression model. RESULTS Twenty-two patients underwent an EEA (n = 12) or open transcranial approach (n = 10) for tumor resection with 3 years of imaging follow-up. There was no difference in midfacial growth between groups for each measurement. Compared to the open group, patients undergoing EEA demonstrated relative anterior midface height growth of -0.42 mm (P = 0.880), posterior midface height growth of -0.44 mm (P = 0.839), palatal length growth of 0.35 mm (P = 0.894), and sella-nasion distance growth of -2.16 (P = 0.365). CONCLUSION We found no difference in midfacial growth measurements between patients undergoing craniopharyngioma resection via an EEA and the open transcranial route after 3 years of imaging follow-up. Preliminary results on midfacial growth demonstrate that the EEA is a safe alternative to traditional transcranial approaches for the pediatric population. Further investigation with larger sample size and longer duration of follow-up is warranted to more thoroughly investigate the long-term implications of the EEA to the skull base. LEVEL OF EVIDENCE 3 Laryngoscope, 130:338-342, 2020.
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Affiliation(s)
- Arjun K Parasher
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, U.S.A.,Department of Health Policy and Management, University of South Florida, Tampa, Florida, U.S.A
| | - David K Lerner
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Mount Sinai, New York, New York, U.S.A
| | - Jordan T Glicksman
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,North Shore ENT, Danvers, Massachusetts, U.S.A
| | - Phillip B Storm
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Arastoo Vossough
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Steven Brooks
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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20
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A modified reconstructive technique for paediatric congenital alar rim deformity. Int J Pediatr Otorhinolaryngol 2019; 118:201-205. [PMID: 30654227 DOI: 10.1016/j.ijporl.2018.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/26/2018] [Accepted: 12/27/2018] [Indexed: 01/26/2023]
Abstract
Alar subunit retraction or notching whether acquired or congenital, can be challenging to reconstruct. Congenital cysts and benign lumps involving the nasal alar region can also result in acquired alar deformity once resected. Published reports describe different surgical methods, but we demonstrate a simple and highly satisfying technique. We present four paediatric cases with alar rim defects and demonstrate our modified surgical technique. All patients had an unremarkable recovery. Our outcomes demonstrate a minimal yet effective one-stage technique for correction of alar defects in paediatric patients that results in high patient satisfaction and allows for future secondary surgery if required.
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Abstract
PURPOSE OF REVIEW Most children and adolescents with allergic rhinitis (AR) present extra-nasal multimorbid conditions, including conjunctivitis, asthma, atopic dermatitis, rhinosinusitis, or seromucous otitis. Additionally, they may present nasal obstructive disorders, such as septal deformity, turbinate enlargement, and adenoidal hyperplasia, which worsen nasal symptoms, especially nasal obstruction. This is a narrative review on the current state of the concomitant presence of AR and one or more multimorbidities. RECENT FINDINGS The presence of AR and one or more accompanying multimorbidities is associated to a higher severity and duration of the disease, a negative impact on quality of life, with worse control and lack of improvement with medical treatment. Therefore, AR needs to be managed with a multidisciplinary collaborative approach. Pediatric AR needs to be considered in the context of a systemic disease, which requires a coordinated therapeutic strategy.
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22
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Justicz N, Choi S. When Should Pediatric Septoplasty Be Performed for Nasal Airway Obstruction? Laryngoscope 2018; 129:1489-1490. [PMID: 30515850 DOI: 10.1002/lary.27602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Natalie Justicz
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Sukgi Choi
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
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23
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Lee E, Lee SJ, Kim HJ, Shin JM, Choi JH, Lee JY. Incidence of re-deviated nasal septum after septoplasty in adolescent and adult patients. Acta Otolaryngol 2018; 138:909-912. [PMID: 30016905 DOI: 10.1080/00016489.2018.1484564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Re-deviation of the nasal septum may occur after septoplasty. Because the cartilaginous septum grows until the age of 16-17 years, septoplasty is usually recommended thereafter. However, severely deviated septum may necessitate septoplasty in younger adolescents. OBJECTIVES To compare the incidence of re-deviated nasal septum in patients who underwent septoplasty at ≤18 versus ≥19 years of age. MATERIALS AND METHODS The medical records and endoscopic photographs of patients who underwent septoplasty between 2005 and 2015 were retrospectively reviewed. Re-deviation of the nasal septum was defined as >50% narrowing of one side of the nasal cavity compared to immediately after septoplasty. RESULTS The inclusion criteria were met by 52 adolescent patients and 549 adult patients. Re-deviation of the septum occurred in 11 (21.2%) and 39 (7.1%) patients, respectively; the difference was significant. Most patients had caudal and upper cartilaginous deviations. Four adolescent and 14 adult patients underwent revisional septoplasty. CONCLUSIONS AND SIGNIFICANCE Adolescent patients who underwent septoplasty had a significantly higher incidence of re-deviation of the nasal septum than adult patients. Therefore, when septoplasty is deemed necessary in adolescent patients, they and their parents should be informed about the possibility of re-deviation and the need for revisional septoplasty.
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Affiliation(s)
- Eunsang Lee
- Department of Otorhinolaryngology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Seung Jae Lee
- Department of Otorhinolaryngology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyo Jun Kim
- Department of Otorhinolaryngology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Min Shin
- Department of Otorhinolaryngology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Yong Lee
- Department of Otorhinolaryngology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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24
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Comoglu S, Sen C, Yagci I, Sonmez S, Aydemir L. Percutaneous nasal septal retraction technique for dorsal cartilaginous deviations. Clin Otolaryngol 2018; 44:707-710. [PMID: 30160370 DOI: 10.1111/coa.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 08/02/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Senol Comoglu
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology & Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Comert Sen
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology & Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Ibrahim Yagci
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology & Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Said Sonmez
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology & Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Levent Aydemir
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology & Head and Neck Surgery, Istanbul University, Istanbul, Turkey
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25
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Functional septorhinoplasty in the pediatric and adolescent patient. Int J Pediatr Otorhinolaryngol 2018; 111:97-102. [PMID: 29958624 DOI: 10.1016/j.ijporl.2018.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/28/2018] [Accepted: 06/02/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To describe pediatric and adolescent patients undergoing functional septorhinoplasty and to analyze both subjective and objective outcomes. METHODS Retrospective review of prospective cohort study of patients ≤18 years old undergoing functional septorhinoplasty between 2013 and 2016 at a tertiary care center. Patient demographics, nasal exam, procedure, and pre- and postoperative nasal obstruction symptom evaluation (NOSE) score, EuroQOL 5-dimension (EQ5D), and peak nasal inspiratory flow (PNIF) scores were analyzed. RESULTS 39 patients, 48.7% male, mean age 15.9 years (range 7-18), with nasal obstruction underwent functional septorhinoplasty with mean follow up of 8.5 months. Patients reported a history of allergies (46.5%), nasal fracture (59.0%), and previous nasal surgery (25.6%). Most common exam findings included internal nasal valve narrowing (92.3%), superior/dorsal septal deviation (74.4%), external nasal valve narrowing (43.6%), caudal septal deviation (35.9%), and a narrow middle vault (33.3%). Septal cartilage grafts were placed in 79.5% of patients and PDS plate was used in 28.2%. Most common procedures included spreader grafts (84.6%), columellar strut graft (30.8%), and swinging door (23.1%). Of patients with both baseline and postoperative scores, at last follow up NOSE scores (SD) decreased from 59.0 (23.7) to 21.2 (8.8) (n = 26, p < 0.001), EQ5D VAS scores increased from 76.2 (17.7) to 85.8 (13.5), (n = 19, p = 0.056), and PNIF scores increased from 66.2 (25.3) to 90.8 (46) L/min, (n = 13, p < 0.01); all mean differences met the minimal clinically important difference for each score. 2 patients underwent revision surgery and there was one complication of a nasal abscess. CONCLUSIONS Functional septorhinoplasty is safe and effective in select pediatric and adolescent patients with significant nasal obstruction and results in significant improvements in both subjective and objective outcomes measures.
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26
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Manteghi A, Din H, Bundogji N, Leuin SC. Pediatric septoplasty and functional septorhinoplasty: A quality of life outcome study. Int J Pediatr Otorhinolaryngol 2018; 111:16-20. [PMID: 29958602 DOI: 10.1016/j.ijporl.2018.05.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE This study assessed disease-specific quality-of-life outcomes among pediatric patients undergoing septoplasty or functional septorhinoplasty. The Nasal Obstruction Symptom Evaluation (NOSE) score was obtained pre- and post-operatively. Additional analyses determined whether demographics, nasal trauma, prior nasal surgery, or allergic rhinitis history affected NOSE scores. METHODS Patients undergoing septoplasty or functional septorhinoplasty were evaluated prospectively at a tertiary children's hospital. NOSE scores were assessed pre- and post-operatively. Change in NOSE score was analyzed using the Wilcoxon Signed Rank test, while multiple regression analysis evaluated factors associated with NOSE score change. RESULTS 136 patients (mean age 15.7 ± 2.1 years) were evaluated; 52 (38.2%) underwent septoplasty while 84 (61.8%) underwent functional septorhinoplasty. Mean follow-up was 3.6 ± 5.1 months. There was a statistically significant decrease in NOSE score from pre-operative septoplasty and functional septorhinoplasty: median = 75 to post-operative septoplasty: median = 20 (z = -5.9, p < 0.001) and functional septorhinoplasty: median = 15 (z = -7.9, p < 0.001). Gender, age, nasal trauma, prior nasal surgery, and allergic rhinitis did not have a significant effect on NOSE score change for either group. Additional surgery at the time of procedure was not a confounding variable in the relationship between surgery type and NOSE score. A NOSE Scale reliability analysis demonstrated high internal consistency with Cronbach's α of 0.83 across septoplasty and functional septorhinoplasty patients. CONCLUSION There was significant improvement in disease-specific quality-of-life in pediatric patients undergoing septoplasty or functional septorhinoplasty. Gender, nasal trauma, prior nasal surgery, and allergic rhinitis did not significantly affect NOSE scores in either group.
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Affiliation(s)
- Alexander Manteghi
- Division of Pediatric Otolaryngology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, 9500 Gilman Drive, San Diego, CA 92093, USA.
| | - Hena Din
- Division of Pediatric Otolaryngology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Nour Bundogji
- Division of Pediatric Otolaryngology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Shelby C Leuin
- Division of Pediatric Otolaryngology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, 9500 Gilman Drive, San Diego, CA 92093, USA
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27
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Abstract
Pediatric septorhinoplasty has been an area of controversy because early surgical intervention can prevent normal growth. There are certain conditions where early correction of the nose is indicated, such as in cleft lip nasal deformities, severe traumatic deformities, and congenital nasal lesions. Animal and clinical studies have been helpful in elucidating certain areas of the nose that are potential growth zones that should be left undisturbed when performing nasal surgeries on pediatric patients. We discuss the timing, indications, and surgical technique in pediatric septorhinoplasty.
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Affiliation(s)
- Aditi Bhuskute
- Department of Otolaryngology, University of California, Davis, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Mika Sumiyoshi
- Department of Otolaryngology, University of California, Davis, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Craig Senders
- Department of Otolaryngology, University of California, Davis, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA.
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28
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Lee VS, Gold RM, Parikh SR. Short-term quality of life outcomes following pediatric septoplasty. Acta Otolaryngol 2017; 137:293-296. [PMID: 27642703 DOI: 10.1080/00016489.2016.1229023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSIONS Pediatric septoplasty may be associated with short-term symptomatic benefit. This benefit may be greater in female patients and equally achievable in young patients and using less invasive surgical approaches. OBJECTIVE To determine the short-term effect of pediatric septoplasty, which is not routinely performed, on sinus and nasal-specific quality-of-life. METHODS This study is a retrospective case series of 28 pediatric patients that underwent septoplasty. Pre- and post-septoplasty SN-5 overall (mean of all five items, range = 1-7) and visual analog scale (VAS; range = 0-10) scores were obtained and compared using a Wilcoxon signed-rank test. Comparisons of pre- to post-septoplasty changes by sex (female vs male), age (<13 vs ≥13 years), and surgical approach (open vs closed) were performed using a Mann-Whitney U-test. Median and interquartile range are reported. RESULTS Overall and VAS scores significantly improved from pre- to post-septoplasty (3.5 [2.8, 4.3] to 2.0 [1.4, 2.8], p < .001; 5.0 [4.0, 6.3] to 8.0 [8.0, 10.0], p < .001). Females reported significantly greater overall and VAS score improvements compared to males (-1.8 [-2.6, -1.6] compared to -1.0 [-1.6, -0.2], p = .01; 5.0 [4.0, 5.0] compared to 3.0 [1.5, 4.0], p = .007). Comparisons of changes by age and surgical approach were not significantly different.
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Abstract
Nasal surgery in children, most often performed after trauma, can be performed safely in selected patients with articulate, deliberate, and conscientious operative plan. All nasal surgery in children seeks to avoid disruption of the growth centers, preserving and optimizing nasal growth while improving the form and function of the nose. A solid appreciation of long-term outcomes and effects on growth remain elusive.
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Affiliation(s)
- Matthew D Johnson
- Facial Plastic & Reconstructive Surgery, Division of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, 747 N Rutledge Street, 5th floor, PO box 19649, Springfield, IL 62794-9649, USA.
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Cingi C, Muluk NB, Ulusoy S, Lopatin A, Şahin E, Passali D, Bellussi L, Atilla H, Hanci D, Altıntoprak N, Rusetski Y, Sarafoleanu C, Mladina R, Kalogjera L, Manea C. Septoplasty in children. Am J Rhinol Allergy 2016; 30:e42-7. [PMID: 26980385 DOI: 10.2500/ajra.2016.30.4289] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Physicians have long had concerns about the potential harmful effects of pediatric septoplasties on the nasoseptal growth process because septal cartilage is important for the growth and development of the face. METHODS In this review article, pediatric septoplasty and its indications are discussed, together with a literature survey. In addition, overviews of development of the nasal skeleton from neonate to adult, nasal growth, and cartilaginous septum are presented. Important issues and comments on pediatric septoplasties are provided. RESULTS During septoplasty procedures, elevation of the mucoperichondrium unilaterally or bilaterally does not negatively affect growth of the face. Stabilization of the septum may be easier when mucosal elevation is performed unilaterally. The nasal floor mucosa should not be elevated so to avoid damage to the incisive nerves. Corrections and limited excisions may be done from the cartilaginous septum. Separation of the septal cartilage from the perpendicular plate, especially at the dorsal part, should not be performed because this area is important for the length and height of the nasal septum and nasal dorsum. Incisions or excisions should not be performed through the growing and supporting zones, especially at the sphenoethmoid dorsal zone. CONCLUSION If there are severe breathing problems related to the septal deviation, septoplasty should be performed. In the majority of cases, septal surgery may be conducted in 6-year-old children. However, if necessary, septal surgery may be performed in younger children and even at birth.
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Affiliation(s)
- Cemal Cingi
- Department for ORL Head and Neck Surgery, Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
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Anderson K, Ritchie K, Chorney JM, Bezuhly M, Hong P. The impact of septoplasty on health-related quality of life in paediatric patients. Clin Otolaryngol 2016; 41:144-8. [PMID: 26096043 DOI: 10.1111/coa.12485] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the impact that septoplasty had on health-related quality of life (HRQoL) in paediatric patients and to determine whether there were patient characteristics that predicted better outcomes. DESIGN Retrospective cohort study. SETTING Academic paediatric otolaryngology practice. PARTICIPANTS All paediatric patients who underwent septoplasty during the study period. MAIN OUTCOME MEASURES The current HRQoL was assessed using the Paediatric Quality of Life Inventory (PedsQL). The Glasgow Children's Benefit Inventory (GCBI) was used to evaluate the perceived change in HRQoL following septoplasty. RESULTS A total of 29 patients (16 boys, mean age 13 years) and their caregivers responded (response rate of 72.5%). There was a statistically significant improvement in HRQoL following septoplasty, as demonstrated by the positive mean GCBI subscores and the total GCBI score (35.1, sd = 28.4). The total mean PedsQL score for child self-report was 95.2 (sd = 6.9) and for parent-proxy report was 91.8 (sd = 8.6), which indicated good current HRQoL. The enhancement in HRQoL post-septoplasty was moderately correlated with self-reported degree of nasal obstruction pre-septoplasty (r = 0.621 for total GCBI). Also, there were differences in GCBI scores between the groups of children who wanted to have the surgery versus those who did not want to have the surgery. CONCLUSIONS There was a significant positive change in HRQoL following paediatric septoplasty in our study population. Children who reported more severe nasal obstruction and those who wanted to have the surgery were more likely to experience enhancement of HRQoL following their surgery.
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Affiliation(s)
- K Anderson
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - K Ritchie
- IWK Health Centre, Halifax, NS, Canada
| | - J M Chorney
- Department of Surgery, Dalhousie University, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada
| | - M Bezuhly
- Department of Surgery, Dalhousie University, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada
| | - P Hong
- Department of Surgery, Dalhousie University, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada.,School of Human Communication Disorders, Dalhousie University, Halifax, NS, Canada
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Stenner M, Rudack C. Diseases of the nose and paranasal sinuses in child. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc10. [PMID: 25587370 PMCID: PMC4273171 DOI: 10.3205/cto000113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diseases of the pediatric nose and nasal sinuses as well as neighboring anatomical structures encompass a variety of pathologies, especially of inflammatory nature. Congenital disease, such as malformations and structural deviations of the nasal septum, as well as systemic metabolic pathologies affecting the nose and sinuses, rarely require medical therapy from an Otolaryngologist. The immunological function of the mucosa and genetic factors play a role in the development of disease in the pediatric upper airway tract, especially due to the constantly changing anatomy in this growth phase. Disease description of the nose and nasal sinuses due to mid-facial growth must also take developmental age differences (infant, toddler, preschool, and school age) into account. Epidemiological examinations and evidence based studies are often lacking in the pediatric population. The wide range of inflammatory diseases of the nose and paranasal sinuses, such as the acute and chronic rhinosinusitis, the allergic rhinitis, and adenoid disease, play a role in the susceptibility of a child to infection. The susceptibility to infection depends on the pediatric age structure (infant, young child) and has yet to be well defined. The acute rhinosinusitis in children develops after a viral infection of the upper airways, also referred to as the "common cold" in the literature. It usually spontaneously heals within ten days without any medical therapy. Antibiotic therapy is prudent in complicated episodes of ARS. The antibiotic therapy is reserved for children with complications or associated disease, such as bronchial asthma and/or chronic bronchitis. A chronic rhinosinusitis is defined as the inflammatory change in the nasal mucosa and nasal sinus mucosa, in which the corresponding symptoms persist for over 12 weeks. The indication for CT-imaging of the nasal sinuses is reserved for cases of chronic rhinosinusitis that have been successfully treated with medication. A staged therapeutic concept is followed in CRS based on conservative and surgical methods. Nasal sinus surgery is considered nowadays as effective and safe in children. Based on the assumption that adenoids are a reservoir for bacteria, from which recurrent infections of the nose and nasal sinus originate, the adenoidectomy is still defined as a cleansing procedure in rhinosinusitis. 69.3% of the children had benefit from adenoidectomy. Comorbidities, such as pediatric bronchial asthma, presently play an even more important role in the therapy of rhinosinusitis; therefore, it is often wise to have the support of pediatricians. In western European countries 40% of children presently suffer from allergic rhinitis, in which pronounced nasal obstruction can cause disturbed growth in facial bones. An early therapy with SIT may prevent the development of bronchial asthma and secondary sensitization to other allergens. Therefore, SIT is recommended in treatment of allergic rhinitis whenever, if possible. The assessment of diagnostic tools is for the examiner not often possible due to the lack of evidence. Rhinosurgical approaches are often described in study reports; however, they lack the standard prospective randomized long-term study design required nowadays and can only be evaluated with caution in the literature.
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Affiliation(s)
- Markus Stenner
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster, Germany
| | - Claudia Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster, Germany
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Salturk Z, Inan M, Kumral TL, Atar Y, Yildirim G, Uyar Y. Efficiency of external nasal dilators in pediatric nasal septal deviation. Int J Pediatr Otorhinolaryngol 2014; 78:1522-5. [PMID: 25015772 DOI: 10.1016/j.ijporl.2014.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/13/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
INRODUCTION Nasal septal deviation results from irregular development of the nasomaxillary complex and trauma. Treatment of nasal septal deviation in pediatric patients is one of the biggest challenges in rhinology. Surgery may alter craniofacial growth patterns, and so it may be indicated only in the selected cases. The use of external nasal dilators is a relatively new treatment modality in nasal obstruction. OBJECTIVE This study was performed to assess the efficacy of external nasal dilator in pediatric nasal septal deviation patients. METHODS Seventy-six children who were diagnosed with nasal septal deviation at our outpatient clinic were included in the study. The patients were divided into 2 groups: the external nasal dilator group was composed of 48 children that had used an external nasal dilator for at least 1 month and still been using, while the control group was comprised of 28 children that had not received any treatment and had not used an external nasal dilator. The parents of the children were asked to complete the obstructive sleep apnea 18 questionnaire. In addition, the external nasal dilator group was asked to complete the questionnaire after stopping external nasal dilator use for 2 weeks and the control group also repeated the obstructive sleep apnea 18 questionnaire. RESULTS The obstructive sleep apnea 18 questionnaire results were significantly different between the external nasal dilator group and the control group at the beginning of the study (i.e., when patients in the external nasal dilator group were still using their dilators, P = 0.000). On the other hand, there was no difference between the 2 groups after the patients in the external nasal dilator group had stopped using their external nasal dilator (P = 0.670). CONCLUSION External nasal dilator use relieved nasal septal deviation, which narrows the nasal valve. The results of this study suggest that external nasal dilator could be used in patients that are not candidates for septoplasty.
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Affiliation(s)
- Ziya Salturk
- Okmeydani Training and Research Hospital, ENT Clinic, Istanbul, Turkey.
| | - Muzafer Inan
- Okmeydani Training and Research Hospital, ENT Clinic, Istanbul, Turkey
| | | | - Yavuz Atar
- Okmeydani Training and Research Hospital, ENT Clinic, Istanbul, Turkey
| | - Guven Yildirim
- Okmeydani Training and Research Hospital, ENT Clinic, Istanbul, Turkey
| | - Yavuz Uyar
- Okmeydani Training and Research Hospital, ENT Clinic, Istanbul, Turkey
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Yilmaz MS, Guven M, Akidil O, Kayabasoglu G, Demir D, Mermer H. Does septoplasty improve the quality of life in children? Int J Pediatr Otorhinolaryngol 2014; 78:1274-6. [PMID: 24880925 DOI: 10.1016/j.ijporl.2014.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 05/05/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the outcomes of septoplasty and the effects of septoplasty on the quality of life and to determine postoperative patient satisfaction in children using nose obstruction symptom evaluation (NOSE) and visual analog scale (VAS). METHODS Only pediatric patients who underwent septoplasty were included in the study. Patients who underwent adenoidectomy, endoscopic sinus surgery, or turbinate surgery in addition to septoplasty and total septal reconstruction with open technique septorhinoplasty were excluded from the study. Patients and their parents were inquired about their nasal obstruction symptoms using the NOSE scale before and 3 and 12 months following the surgery. VAS was used to analyze overall satisfaction of the patients and their parents on the outcomes of surgery, at the last follow-up examination 12 months after the surgery. RESULTS Thirty-five patients with a mean age of 13.4 ± 2.8 (8-16) were included in the study. There was a very significant improvement in NOSE score at 3 months after septoplasty. The mean subjective satisfaction score measured with VAS at the 12th month postoperatively was 7.9 ± 2.1. Improvement in NOSE score was correlated with patient satisfaction. CONCLUSION Septoplasty is a very effective and satisfactory treatment for nasal obstruction caused by nasal septal deviation in children. The NOSE scale can be used for the evaluation of nasal obstruction symptoms.
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Affiliation(s)
- Mahmut Sinan Yilmaz
- Sakarya University, Faculty of Medicine, Department of Otorhinolaryngology, Sakarya, Turkey.
| | - Mehmet Guven
- Sakarya University, Faculty of Medicine, Department of Otorhinolaryngology, Sakarya, Turkey
| | - Oznur Akidil
- Sakarya University, Faculty of Medicine, Department of Otorhinolaryngology, Sakarya, Turkey
| | - Gurkan Kayabasoglu
- Sakarya University, Faculty of Medicine, Department of Otorhinolaryngology, Sakarya, Turkey
| | - Deniz Demir
- Sakarya University, Faculty of Medicine, Department of Otorhinolaryngology, Sakarya, Turkey
| | - Hasan Mermer
- Sakarya University, Faculty of Medicine, Department of Otorhinolaryngology, Sakarya, Turkey
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Surgical management of paediatric chronic rhinosinusitis: review of 10 years' experience. The Journal of Laryngology & Otology 2014; 128 Suppl 2:S43-7. [PMID: 24572432 DOI: 10.1017/s0022215114000334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the outcome of children with chronic rhinosinusitis who were managed surgically, over a 10-year study period. METHOD From January 1999 to December 2008 inclusive, 136 children diagnosed with chronic rhinosinusitis underwent surgery following unsuccessful medical treatment. The operations ranged from adenoidectomy to functional endoscopic sinus surgery. RESULTS The surgical procedures performed were: adenoidectomy (n=69), antral washouts (n=54), middle meatal antrostomy (n=82), endoscopic ethmoidectomy (n=66), nasal septal reconstruction (n=10), and inferior turbinate outfracture (n=23) or inferior turbinate reductions (n=55). Follow-up duration ranged from 6 months to 9 years (average 3.2 years). Three patients required revision surgery: adenoidectomy in two patients and adenoidectomy with turbinate reductions in another. CONCLUSION This study demonstrates the benefits of focused surgical treatment for paediatric chronic rhinosinusitis. Surgical treatment can be an appropriate and effective option for children with chronic rhinosinusitis when medical management is unsuccessful.
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Bae JS, Kim ES, Jang YJ. Treatment outcomes of pediatric rhinoplasty: the Asan Medical Center experience. Int J Pediatr Otorhinolaryngol 2013; 77:1701-10. [PMID: 23958392 DOI: 10.1016/j.ijporl.2013.07.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/28/2013] [Accepted: 07/29/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Performing rhinoplasty in children has been an issue of some debate due to concerns about potential harmful effects on nasoseptal growth. However, there is a paucity of evidence describing the outcomes of pediatric rhinoplasty. This study presents our experience of performing this procedure in children of 17 years of age and younger. METHODS The study population consisted of 64 Korean children between 4 and 17 years of age who underwent rhinoplasty between May 2003 and August 2011. Forty-six of the patients were boys and 18 were girls with a mean follow-up period of 59 months. The diagnosis of the patients, the extent of the surgical maneuver performed, and the surgical outcomes were reviewed. Subjective satisfaction of the patients was investigated by telephone interview. Surgical outcomes, which were judged by two independent ENT surgeons, were evaluated by comparing preoperative and postoperative photographs. Satisfaction scores were graded using a visual analog scale (from 1 = satisfied, to 4 = dissatisfied). Anthropometric measurements of nasal parameters were performed preoperatively and postoperatively. RESULTS Rhinoplasty was performed in our patient cohort due to a deviated nose (32.8%), nasal bone fracture (18.8%), flat nose (6.3%), nasal mass (4.7%), hump nose (3.1%), nasal dermoid sinus cyst (1.6%), and additional cosmetic rhinoplasty for planned septoplasty (32.8%). The median patient satisfaction score was 2.09 compared with a median doctor satisfaction score of 1.81. Anthropometric measurements showed statistically significant improvements in nasal tip projection, nasal length, dorsal height, and radix height after rhinoplasty. Seventeen patients (26.6%) experienced esthetic dissatisfaction such as deviation, tip depression, bulbous tip, short nose, and nostril asymmetry. Eight patients (12.5%) experienced postoperative difficulty in nasal breathing, and two patients (3.1%) complained of transient nasal pain after rhinoplasty. Six patients (9.4%) underwent revision surgery, and four patients (6.3%) were seriously considering a revision operation. CONCLUSIONS The outcome analysis in our series reveals that rhinoplasty in children is complicated by a high rate of revision and esthetic dissatisfaction. The results of this study may indicate that surgeons should have a conservative attitude and apply strict indication in selecting pediatric rhinoplasty candidates.
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Affiliation(s)
- Ji Seon Bae
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Songpa-gu, Seoul 138-736, Republic of Korea
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Akbay E, Cokkeser Y, Yilmaz O, Cevik C. The relationship between posterior septum deviation and depth of maxillopalatal arch. Auris Nasus Larynx 2012; 40:286-90. [PMID: 23083624 DOI: 10.1016/j.anl.2012.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/05/2012] [Accepted: 09/25/2012] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Ercan Akbay
- Department of Otorhinolaryngology, Mustafa Kemal University Medical Faculty, Hatay, Turkey.
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Lawrence R. Pediatric septoplasy: a review of the literature. Int J Pediatr Otorhinolaryngol 2012; 76:1078-81. [PMID: 22595463 DOI: 10.1016/j.ijporl.2012.04.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/18/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Controversy has surrounded the procedure of pediatric septoplasty since the 1950s due to concerns over an adverse effect on nasal and facial growth. However, more recent evidence has demonstrated that septoplasty can be safely performed without affecting nasal and facial development in the appropriately selected pediatric patient. The purpose of this article is to establish the impact of pediatric septoplasty on nasal and facial growth and review the clinical indications and evidence for timing of surgery according to the most recent literature. METHODS A structured review of the PubMed, Ovid Medline and Cochrane Collaboration databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews) was undertaken, using the terms: pediatric, childhood, septoplasty, nasal septum, indications, nasal growth and facial growth. RESULTS Three long term follow up studies using anthropometric measurements were identified which concluded that pediatric septoplasty does not interfere with normal nasal or facial development. A further similar study concluded that external septoplasty does not affect most aspects of nasal and facial growth, but may negatively influence growth of the nasal dorsum. Furthermore, one study demonstrated that a group of children with symptomatic uncorrected deviated nasal septum had a statistically significant increased occurrence of facial and dental anomalies compared with age and sex matched controls, therefore supporting a role for septoplasty. CONCLUSIONS Evidence exists to support that pediatric septoplasty can be performed without affecting most aspects of nasal and facial growth. Furthermore, not performing or delaying septoplasty when indicated may adversely affect nasal and facial growth with compounding adverse effects in terms of deformity and asymmetry. Despite the majority advocating the timing of septal surgery to be 6 years and older, more clinical studies are required that may provide further evidence for correction of septal deviations in younger children, perhaps even at birth.
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