Septoplasty in children

Assessing volume growth of paranasal sinuses and nasal cavity in children using three-dimensional imaging software

OBJECTIVE

To investigate the accurate volume changes in the paranasal sinus and nasal cavity with age development, using three-dimensional (3D) imaging software METHODS: Paranasal sinus and nasal cavity volumes from computed tomography (CT) images in patients aged 0-24 years were measured using a 3D model to examine age-related changes. Paranasal sinus and nasal cavity growth were compared between age groups. Additionally, the correlation between body height and paranasal sinus growth was examined.

RESULTS

A total of 139 CT scans from 137 patients were analyzed. Volume growth of maxillary, ethmoidal, sphenoid, frontal sinuses, and nasal cavity was observed until 18, 16, 20, 20, and 22 years, respectively. Maxillary sinus rapidly grew at 2-8 and 9-12 years, ethmoid sinus 2-8 and 13-16 years, sphenoid sinus 5-8 years, frontal sinus 2-10 years, and nasal cavity 7-12 years. The median volume after growth completion for maxillary, ethmoidal, sphenoid, frontal sinuses, and nasal cavities was 21,937 mm³, 4868 mm³, 5870 mm³, 3172 mm³, and 15,555 mm³, respectively. The left-right difference in the nasal cavity volume increased with age. Sinus and nasal cavity growth completion was delayed by 2-4 years compared to general height growth.

CONCLUSION

Growth of the ethmoid, maxillary, sphenoid, frontal sinus, and nasal cavity was completed in approximately 20 years. Compared to the results shown in reports based primarily on 2D measurements, the ethmoid and sphenoid sinuses and nasal cavity were found to continue to grow until older age than previously thought.

American Rhinologic Society Expert Practice Statement: Indications and Recommendations for Septoplasty in Children

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.

"Should Pediatric Septal Surgery and Septorhinoplasty Be Performed for Nasal Obstruction?"-A Systematic Review of the Literature

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.

Surgical Management of Pediatric Obstructive Sleep Apnea Beyond Adenotonsillectomy: The Nose, Nasopharynx, and Palate

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.

Pediatric Functional Rhinoplasty

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.

Effective Local Anesthetic Use in Nasal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Studies

Intraoperative nerve blocks have shown promise in managing pain after nasal surgery. The purpose of this systematic review and meta-analysis was to analyze existing level I and II evidence on intraoperative nerve blocks in nasal surgery to optimize postoperative recovery.

Methods

The primary outcome of this systematic review and meta-analysis was postoperative pain scores; secondary outcomes included perioperative opioid requirements, patient satisfaction scores, and time to first analgesic requirement. PubMed, Embase, and MEDLINE databases were searched, and two independent reviewers conducted article screening. Methodological quality assessment of studies utilized the Jadad instrument, and interrater reliability was assessed using Cohen kappa. An inverse-variance, fixed-effects model was used for meta-analysis with Cohen d used to normalize effect size between studies. I2 and Q statistics were used to assess interstudy variability.

Results

Four studies were included for meta-analysis, totaling 265 randomized patients. The nerve blocks assessed included infraorbital nerve, sphenopalatine ganglion, external nasal nerve, central facial nerve blocks, and total nerve blocks. All demonstrated significantly reduced postoperative pain compared with controls, with a large effect size (P < 0.001). Opioid requirements were lower in the nerve block groups (P < 0.001), and patient satisfaction scores were higher (P < 0.001). Supplemental meta-analyses showed a longer time to first analgesic requirement for patients who received a nerve block (P < 0.001).

Conclusions

These findings support the efficacy of nerve blocks in providing postoperative pain relief and enhancing patient satisfaction with pain management. Perioperative nerve blocks, in combination with general anesthesia, should be considered for postoperative pain control.

Maxillary sinus volume and mucosal thickening according to the septal deviation angle and age of the children

We examined the relationship between nasal septal deviation (SD) angle and maxillary sinus volumes by examining the paranasal sinus computed tomography (PNSCT) images in children. In this retrospective study, PNSCT images of 106 children with one-sided nasal SD were included. According to the SD angle, two groups were identified: Group 1 (n = 54): SD angle ≤ 11°, Group 2 (n = 52): SD angle > 11°. There were 23 children between 9 and 14 years and 83 children between 15 and 17 years. Maxillary sinus volume and mucosal thickening were evaluated. In 15- to 17-year age group, maxillary sinus volumes of males were higher than females bilaterally. For each of the males and females, ipsilateral maxillary sinus volume was significantly lower than the contralateral side in all children and in 15- to 17-year age group. In each of the SD angle values (≤11 or >11) separately, ipsilateral maxillary sinus volume was lower; and in the SD angle > 11° group, maxillary sinus mucosal thickening values were higher than those of the contralateral side. In young children in 9- to 14-year age group, bilateral maxillary sinus volumes decreased, in this group maxillary sinus volume was not affected according to the SD. However, in 15- to 17-year age groups, maxillary sinus volume was lower on the ipsilateral SD side; and ipsilateral and contralateral maxillary sinus volumes of the males were significantly higher than those in the females. SD should be treated at an appropriate time to prevent SD-related maxillary sinus volume shrinkage and rhinosinusitis.

OUTCOMES OF SEPTOPLASTY IN CHILDREN

OBJECTIVE

Aim: The aim of the study was to present the experience of a local hospital surgical department where septoplasty is performed on children suffering from its degeneration.

PATIENTS AND METHODS

Materials and methods: A retrospective cohort study with 100 patients aged between 3 and 18 years were taken. Both males and females out of 100 patients were followed up for 7 years. The patients were treated with using septoplasty as well as the related clinical procedures such as cauterization of the inferior turbinate. We performed clinical evaluation and nasal endoscopy of the cases in the postoperative period. The longest observation period was 7 years.

RESULTS

Results: The male and female child enrolled in the study were 60 (60%) and 40 (40%), respectively. Out of this number of patients, 92 (92%) had inferior turbinate cauterization. In all the 100 cases, we did not notice any intraoperative complication. Also, all the cases were evaluated in 15th, 30th, and 60th days of observation.

CONCLUSION

Conclusions: When performed correctly, septoplasty in children is a good clinical intervention as it allows the right growth and development of the crani-ofacial region and prevents abnormalities in psychic and somatic components in young patients. Moreover, this study confirms the previous studies that have demystified the point of view, that the setoplasty should only be recommended when the patients reach the ages of 17 and 18.

An Evaluation of Health-Related Quality of Life in Children with Nasal Septum Deviation

Background: From the 1950s, the quality of life criterion came to be studied in earnest, originally forming a part of measurement of human development in Western Europe and the USA. The present study aims to compare the health-related quality of life (HRQL) between children with nasal septum deviation and healthy children controls. Materials and Methods: Subjects were children suffering from nasal septum deviation, one of the commonest chronic diseases of the upper respiratory tract. Controls were randomly recruited from kindergarten, primary and secondary schools (junior high school & high school). All schools and subjects were randomly selected. The CHQ-PF50 questionnaire was used and outcome scores were calculated by an algorithm for the 13 tested HRQL variables. Results: Means for all outcome scores in the test subjects (i.e., children with deviated nasal septums) varied between 3.65–89.27 with a standard deviation between 0.83–25.66 and a median between 3.4–100 (n = 101). Those for the controls (n = 102) were 3.78–97.11, 0.86–14.21 and 4.40–100, respectively. Test subjects showed significant scoring declines in Physical Fitness, Role/Social–Emotional/Behavioral, Role/Social–Physical, Mental Health, Self-esteem, General Health Perceptions, Parental Impact Emotional and Time and Family Limitations in Activities. Conclusions: 1. The well-being of children with nasal septum deviation was found to be chiefly limited by their physical fitness, effects of physical condition on social behavior/interaction and how health is perceived. 2. Parents considered their children’s health to be paramount, as demonstrated by assessing the HRQL.

Septoplasty Revision Rates in Pediatric vs Adult Populations

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.

Postoperative Outcomes in Pediatric Septoplasty

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.

Cleft Rhinoplasty: Does Timing and Utilization of Cartilage Grafts Affect Perioperative Outcomes?

BACKGROUND

The purpose of this study was to evaluate the epidemiology and perioperative complications of different reconstructive strategies to correct cleft nasal deformity, with particular attention paid to type and timing of cartilage grafting.

METHODS

Retrospective cohort study was conducted of cleft rhinoplasty performed between 2012 and 2017 in North America utilizing the American College of Surgeons National Surgical Quality Improvement Program- Pediatric hospital network. Medical/surgical complications, reoperations, and readmissions within 30 days postoperatively were analyzed with appropriate statistics.

RESULTS

During the study interval, 3317 pediatric patients underwent cleft rhinoplasty, with 8.0% involving the use of cartilage grafts. Ear cartilage was significantly more commonly used for intermediate repair, whereas rib cartilage was more commonly used for late repair (P=0.006). Overall, rhinoplasties with ear cartilage grafts had shorter procedure durations than those without cartilage grafts (P=0.005), whereas those with rib cartilage grafts had increased procedure duration (P<0.001). The use of cartilage grafts was not associated with increased complications in either intermediate or late cleft rhinoplasty. Patients with bilateral clefts were more likely to undergo rhinoplasty with cartilage grafts overall (P=0.047) and with cartilage grafts for late reconstruction (P=0.039).

CONCLUSIONS

Ear cartilage is most frequently utilized for intermediate repair, whereas rib cartilage is most frequently utilized for late repair during cleft rhinoplasty. Ear cartilage grafts are associated with significantly decreased procedure duration, whereas rib cartilage grafts are associated with significantly increased procedure duration. Not surprisingly, cleft rhinoplasty is relatively safe, with a 2% overall short-term complication rate.

Innovations in the Treatment of Pediatric Obstructive Sleep Apnea

Obstructive sleep apnea affects a large proportion of otherwise healthy children in the context of interactions between craniofacial elements, adenotonsillar hypertrophy and other anatomical factors, and neuromuscular reflexes of the upper airway. In light of the adverse consequences of sleep apnea, it is important not only to proceed with early diagnosis but also to implement adequate treatment that is guided by the pathophysiological determinants of the disease in each child. Here, we will describe the current standard of care approaches to the treatment of pediatric obstructive sleep apnea, and will also explore novel management strategies that should enable more personalized therapy in the near future.

The Effects of Septorhinoplasty Techniques and Poly-P-Dioxanone Plate Use on Maxillofacial Growth: An Experimental Study

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.

Pediatric nasal septoplasty outcomes

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.

Effect of septal deviation on nasomaxillary shape: A geometric morphometric study

Nasal cavities in their primitive stage communicate with the oral cavity until the 8th week of intrauterine life where the posterior palate initiates its development. Hence, starting from the initial growth phases, a significant connection lays between the nasal structures and the maxillary bone and witnessing key functional roles, among which the respiration. Proper nasal breathing has been proven to be a crucial factor for the maturity of the craniofacial complex, and obstruction of the respiratory airway due to nasal septum deviation can generate clinically significant reduction of the nasal airflow. This situation will imply irreversible repercussions that hinders the harmonious development of the craniofacial complex. In order to understand such potential impacts of septal deviation, our first objective was to materialize the relation between septum deviation, and both nasal cavity and maxillary structures. For the second objective, we used Procrustes analysis to assess the shape variation of these two anatomical regions, the bivariate plots of Principal Components to evaluate their shape space, and a two-block Partial Least Square (PLS) to explore their covariation. We analysed, in this cross-sectional study, 62 posteroanterior cephalometric radiographs of adult subjects from both sexes (23 males, 39 females; mean age 25.3 years) collected from the database of the Department of Orthodontics at Lebanese University. Landmarks were plotted and variables were calculated and divided into nasal septum, nasal cavity and maxillary ones. The sample was further divided into two groups based on septal deviation severity (a septal deviation is considered minor if <6). The results suggested that nasal septum deviation was correlated to reduced nasal cavity area and a reduced maxillary area. Moreover, the comparison of the two groups concluded that the difference between all variables was statistically significant with higher scores in the minor septal deviation group. These findings were corroborated with the shape analysis where the mean centroid size of nasal cavity and that of the maxilla in the group of reduced septal deviation were significantly greater than those of the group with increased angle of deviation. Results of PLS analysis concluded to a strong covariation between nasal septum and nasomaxillary complex. These conclusions support the early septoplasty in growing patients as a solution to redirect the normal course of growth and re-establish a good function of the nasomaxillary complex.

Rapid Maxillary Expansion Has a Beneficial Effect on the Ventilation in Children With Nasal Septal Deviation: A Computational Fluid Dynamics Study

Nasal septal deviation (NSD) is one of the most common nasal diseases. Different from common clinical examination methods, computational fluid dynamics (CFD) can provide visual flow information of the nasal cavity. The dimension and volume of the nasal cavity are easily affected by rapid maxillary expansion (RME). The purpose of this study was to use CFD to evaluate the effect of RME on the aerodynamics of the nasal cavity in children with maxillary transverse deficiency and NSD. Computational fluid dynamics was implemented after 3D reconstruction based on the CBCT of 15 children who have completed RME treatment. After treatment, the volume increases in the nasal cavity, nasopharynx, oropharynx, and pharynx were not statistically significant. The wall shear stress of the nasal cavity after RME, 1.749 ± 0.673 Pa, was significantly lower than that before RME, 2.684 ± 0.919 Pa. Meanwhile, the maximal negative pressure in the pharyngeal airway during inspiration was smaller after RME (-31.058 Pa) than before (-48.204 Pa). This study suggests that RME has a beneficial effect on nasal ventilation. The nasal airflow became more symmetrical in the bilateral nasal cavity after RME. Pharyngeal resistance decreased with the reduction in nasal resistance and the increase in the volume of oropharynx after RME.

Influence of Pediatric Endoscopic Endonasal Skull Base Resections on Midface and Skull Base Development

OBJECTIVE

The purpose of this study is to use imaging data to determine if endoscopic endonasal surgery (EES) for skull base tumor resection interrupts skull base growth and development, resulting in an atrophic midface skeletal structure, compared to matched normal controls.

METHODS

Data were collected by a retrospective chart review done on children aged 16 years and below who underwent endoscopic tumor resection and had pre- and postoperative magnetic resonance imaging with relevant midface anatomy. 121 normal controls were matched to 20 EES patients by age and gender. Three measurements related to midface anatomy were taken from 1 sagittal T1 slice and 1 axial T2 slice of each scan. Statistical analysis was used to compare growth measures between cases and controls.

RESULTS

Twenty patients who underwent EES between November 2015 and April 2018 met our inclusion criteria. The mean age of the patients, 11 males and 9 females, was 10 years, and 8 patients (38%) were aged 7 years or younger. Six patients who had a high-flow CSF leak obtained a nasoseptal flap. A student T test and multivariate regression analysis found that EES did not affect midface and skull base growth. Among the variables assessed, age appears to be the only driver of growth.

CONCLUSION

There were no identified differences in craniofacial growth in pediatric patients undergoing EES for skull base tumor resection as compared to the control group. EES does not appear to significantly interfere with midface/skull base development and is a good surgical option for pediatric patients.

Comparing autologous versus allogenic rib grafting in pediatric cleft rhinoplasty

BACKGROUND

Patients with cleft lip with or without cleft palate suffer from varying degrees of nasal deformity, often requiring nasal reconstruction to provide improved form and function. Rib cartilage is an excellent source of grafting material for nasal reconstruction and is available either as an autologous or allogenic graft. There is a paucity of literature comparing outcomes of autologous and allogenic rib grafts in pediatric cleft rhinoplasty.

METHODS

A retrospective chart review was performed on patients who underwent cleft rhinoplasty with autologous or allogenic rib grafting at a tertiary pediatric hospital between January 1, 2003 and December 31, 2017. Outcome data were gathered over a 6-month postoperative period.

RESULTS

There were 23 cleft rhinoplasties performed with rib graft, 12 with autologous rib and 11 with allogenic rib. Those in the autologous group tended to be older than those in the allogeneic group (15.6 ± 4.4 v 12.4 ± 5.2 years, p = 0.13). The most common types of grafts used were columellar strut (20/23), shield graft (9/23), and unilateral or bilateral batten grafts (7/23). Length of stay was significantly longer for patients who underwent autologous rib grafting compared with those with allogenic rib grafting (25.8 ± 4.7 v 11.9 ± 7.2 h, p < 0.05). Each group reported one complication.

CONCLUSION

Autologous and allogenic rib grafts are safe and effective in pediatric rhinoplasty. The most common grafts used in this sample were columellar strut, batten, and shield grafts. Autologous rib grafts were more likely to be used in older patients and require longer hospital stay compared to allogenic grafts.

Multimorbidities of Pediatric Allergic Rhinitis

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.

Pediatric Rhinoplasty: A national surgical quality improvement program analysis

OBJECTIVES

Rhinoplasty is commonly performed in children with congenital anomalies and resultant nasal deformity causing airway obstruction. Little is known regarding patient factors or perioperative sequelae. We define demographic characteristics and perioperative complications for children undergoing rhinoplasty within a large national cohort.

STUDY DESIGN

Retrospective cohort study of children aged ≤ 18 years undergoing rhinoplasty utilizing data from the 2012 to 2015 American College of Surgeons National Surgery Quality Improvement Program-Pediatric public use file.

METHODS

All children who underwent rhinoplasty were identified. Postoperative complications were defined as 30-day postoperative infection, unplanned readmission and reoperation, and death. Multivariate logistic regression was used to identify predictors of complications. Subgroup analysis was performed based on child age (age < 5 years vs. 5-13 years vs. ≥ 14 years).

RESULTS

Of 1,378 children undergoing rhinoplasty, 21(1.52%) children experienced complications, with the most common being unplanned readmission. Younger children were more likely to experience complications (3.79% aged < 5 years vs. 0.66% aged ≥ 14 years; P = 0.001). Using multivariate logistic regression analysis, we observed a 61% decreased odds of complication with each age group (odds ratio 0.39, 95% confidence interval 0.19, 0.77; P = 0.007). Younger children were more likely to be male (56.2% male aged < 5 years vs. 46.6% male aged ≥ 14 years; P = 0.011), have developmental delay (11.7% aged < 5 years vs. 3.65% aged ≥ 14 years; P < 0.001), and have craniofacial abnormalities (73.2% aged < 5 years vs. 42.1% aged ≥ 14 years; P < 0.001).

CONCLUSION

Children undergoing rhinoplasty experience few major complications, with the most common being unplanned readmission. Younger children are at greater risk and are more likely to be male with craniofacial abnormalities.

LEVEL OF EVIDENCE

4 Laryngoscope, 129:494-499, 2019.

Functional septorhinoplasty in the pediatric and adolescent patient

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.

Pediatric nasal surgery: timing and technique

PURPOSE OF REVIEW

Timing of pediatric nasal surgery has always been a controversial topic. Concern over disrupting growing parts of the face and causing permanent facial deformity has led to a primarily conservative approach. Many surgeons feel that it is prudent to wait until the patient has completed nasal growth after puberty to pursue nasal surgery.

RECENT FINDINGS

Recently, this attitude has been challenged with evidence that not only is nasal surgery in the pediatric age group not a detriment to facial growth, but failure to correct significant nasal deformity may actually cause dysmorphic facial growth secondary to obligate mouth breathing. Because of this, recent studies have focused on determining safe surgical techniques for pediatric nasal surgery, including inferior turbinate reduction, septoplasty and rhinoplasty. Research focus on this topic has also been expanded to include quality-of-life measures after nasal surgery.

SUMMARY

Pediatric nasal surgery prior to puberty is not only safe, but may prevent facial deformity in certain patients.