nasal septum deformity in children - PowerPoint Presentation

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nasal septum deformity in childrenDr. Sayed Mostafa HashemiSlide3

Figure 1: (a) Facial profile of a child (1.5 years of age) and (b) his father (37 years).

Proportional differences in facial and

brain skull

of the father and son

.

The infant face shows smaller vertical dimensions, less frontal projection of the nose and a

largernasolabial

angle.Slide4

Evidence for timing of pediatric septoplastyBe´ jar et al. concluded from their study in the 1990s that they would encourage children with mild nasal obstruction to wait for surgery until after the nasal growth process is complete [16

].

They considered

this to be age 16 years for boys and age 14 years

for girls.Slide5

Consequences of conservative managementA recent study by D’Ascanio et al. performed a cephalometric study to compare 98 children (mean age 8.8 years, age range 7–12 years)

children (due to nasal septum deviations)

demonstrate facial

and dental anomalies in comparison to

nose-breathing controls

[4

].

most

septal deformities are bound to

worsen

after

the growth

of the nose and thus can cause or

increase sinusitis

and infections

of the upper airways and middle

ear and obstructive

sleep

apnea.Slide6

Figure 8: (a) 5-year-old girl with minimal deviation of the nose due to nasal trauma 1 year previously; (b) progressive deformity at the age of 8 years and (c) 15 years.Slide7

Growth of the nasal septumGrowth of the nasal septum occurs in two phases, with the cartilaginous septum reaching adult size by the time the child is 2 years old, and further enlargement due to growth of the bony septum.16Slide8
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Figure 3: Radiographs of three anatomic specimens: 10 (a), 17 (b) and 30 (c) years of age. (A) septum cartilageSlide10

prevalence of nasal septum deformity in childrenThe overall prevalence of nasal septum deformity in children ranges from 0.93 to 55% and varies according to age and different types of nasal septum deformity classifications.1Slide11

EtiologyThe increase in age is associated with an increased rate of nasal septum deformities, probably because of the greater likelihood of suffering traumatic events.2passing through the birth canal can produce a traumatic event to the nasal septum. In fact,

Kawalski

and

Spiewak

found a 22.2% rate of septum deformity in children born by spontaneous birth, whereas this rate was reduced to only 3.9% in children born by caesarean birth.

For this reason, the importance of an

early diagnosis

of septum deformity in newborns has been underlined to enable immediate treatment and avoid possible worsening of respiratory function in adult age.4Slide12

Appropriate surgery base on animal studyin vitro studies appreciated the importance of the muco perichondrium on the survival of underlying septal cartilage and its contribution to skeletal growth

Bernstein showed that

submucous

resection of cartilage with preservation of a

muco

perichondrial

flap in young pups did not result in any growth disturbances

.

Functional

septoplasty

with

mucoperichondrium

preservation in ferrets also showed no differences in facial growth on

cephalometric

analysisSlide13

Clinical studies of pediatric septoplastyResults from animal studies provided clinicians with the confidence to perform septal surgery in children An

appreciation for

preservation of the mucoperichondrium appeared to

be paramount

for all surgeons performing this type of surgery

.

no wide cartilaginous resections must be made,

the areas

of contact between the septum, the

vomer

, and

the perpendicular

lamina of the

ethmoid

must be reconstituted,

and finally

, the remodeled cartilage must be repositioned.Slide14

warning Avoid incisions through the growing and supporting zones, in particular of the (spheno)ethmoido-dorsal zone

.

Posterior

chondrotomy

or separation of the

septum cartilage

from the perpendicular plate (in

particular the

dorsal part) should be avoided as this area is

of paramount

importance for support and

further growth

(length and height) of the nasal septum

and nasal

dorsum;Slide15
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Effects of different technique on anthropometryAfter separating the patients into two groups, those treated by removing and repositioning of the quadrangular cartilage (external approach/extracorporeal septoplasty)

those treated by minimal septal resections (conservative

endonasal

approach),

it was noted that in both sexes the

nasolabial

angle of patients undergoing the extracorporeal

septoplasty

was significantly lower than that of patients undergoing conservative

septoplasty

therefore concluded that

septoplasty

performed by the

endonasal

approach does not interfere with the normal nasal growing process Slide17
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Absolute and relative indications for pediatric septoplasty [3].Slide19

advocating the timing of septalDespite 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.

However, before

considering pediatric nasal septal surgery, a

thorough clinical

examination must be performed to ensure the

correct diagnosis

has been

madeSlide20

septal deviations at birthA long term follow up study by Sooknundun et al. supported closed reduction of nasal septal deviations at birth [23]. Results of this study revealed no untoward effects such as

nasofacial

disproportion

or retardation of facial growth

.

The authors

reported that

uncorrected septal deviation is accompanied by

statistically valid

symptoms such as upper respiratory tract infections, ear

pain and

discharge and that surgical correction of septal deviations

at birth

can prevent the need for

septoplasty

surgery at a later date

in addition

to preventing a number of airway related conditionsSlide21

4. ConclusionNumerous long term follow up studies have provided evidence that pediatric septoplasty can be performed without affecting nasal and facial growth.

Studies have also shown that

conservative management

of deviations of the nasal septum can lead to

facial 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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