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

Association between nasal septum deviation and transverse maxillary development: A retrospective cross-sectional study

INTRODUCTION

The few studies investigating the relationship between nasal septum deviation (NSD) and maxillary development, using different assessment methods and the age of subjects, reported contradicting results.

METHODS

The association between NSD and transverse maxillary parameters was analyzed using 141 preorthodontic full-skull cone-beam computed tomography scans (mean age, 27.4 ± 9.01 years). Six maxillary, 2 nasal, and 3 dentoalveolar landmarks were measured. The intraclass correlation coefficient was used to assess intrarater and interrater reliability. The correlation between NSD and transverse maxillary parameters was analyzed using the Pearson correlation coefficient. Each transverse maxillary parameter was compared among 3 groups of different degrees of severity using the analysis of variance test. Transverse maxillary parameters were also compared between the more and less deviated nasal septum sides using the independent t test.

RESULTS

A correlation between deviated septal width and palatal arch depth (r = 0.2, P <0.013) and significant differences in palatal arch depth (P <0.05) among 3 NSD severity groups classified with deviated septal width was noted. There was no correlation between septal deviated angle and transverse maxillary parameters and no significant difference for transverse maxillary parameters among the 3 groups of NSD severity classified by septal deviated angle. No significant difference in transverse maxillary parameters was found when comparing the more and the less deviated sides.

CONCLUSIONS

This study suggests that NSD can affect palatal vault morphology. The magnitude of NSD may be a factor associated with transverse maxillary growth disturbance.

Mitomycin-C in Post-endoscopic Septoplasty Synechiae: Does it Really Helps?

Endoscopic septoplasty has advantage of magnified image and access to posterior part of the septum. Synechiae formation is a common complication of this procedure. The incidence of adhesions rises particularly in cases of submucosal flap tears which is sometimes unavoidable during spurectomy. Various procedures like septal splints, nasal packings have been tried to reduce the incidence of adhesions. Recently mitomycin-C is being tried to decrease post operative adhesions after Functional Endoscopic Sinus Surgery, endoscopic Dacrocystorhinostomy, with varying degree of success. Mitomycin-C has got anti fibroblastic activity, which inhibits the fibroblasts without hampering epithelization. Eighty (80) Patients undergoing septoplasty and spurectomy were observed for any submucosal flap tear, and those developing flap tear were included in the study. The patients were divided into 2 groups of 40 each. In group-1 topical mitomycin (0.4 mg/ml) was applied at the raw area for 5 min, similarly normal saline was applied in group-2 (control).The aim of study was to evaluate the role of mitomycin-C in preventing post operative adhesions in Endoscopic septoplasty. Adhesion rate was calculated at 1 month, and compared using Chi square test. P value < 0.05 was considered significant. The adhesion rate at 1 month was 17.5% in group-1 and 45% in group-2 (P = 0.008). Incidence of adhesion decreased significantly in mitomycin-C treated group. Mitomycin-C can routinely be used in septoplasty to prevent post op adhesions, particularly in cases of submucosal flap tears/concurrent turbinate reduction procedures.

Association between congenital nasolacrimal duct obstruction and mode of delivery at birth

PURPOSE

To investigate the association between mode of delivery, incidence of congenital nasolacrimal duct obstruction (CNLDO), and treatment outcomes.

METHODS

The medical records of children diagnosed with CNLDO at a tertiary referral center between 2012 and 2017 were analyzed retrospectively. Patient demographics, pregnancy and birth history, clinical characteristics of CNLDO, and treatment outcomes were compared in patients delivered via Cesarean section (CS) versus vaginal delivery (VD). The rates of CS, as well as full-term and premature births, were also compared to Miami-Dade County normative values to eliminate the confounding effects of prematurity.

RESULTS

A total of 104 patients were included. A significantly higher percentage of patients with CNLDO (61%) were delivered via CS (P < 0.0001). Among full-term babies, there was 55% greater risk (OR = 1.55; 95% CI, 0.98-2.43; P = 0.067) of CNLDO for CS birth compared to all other babies. Among preterm babies, there were no significantly greater odds of CNLDO for CS compared to VD births (P = 0.575). CNLDO did not resolve spontaneously in 50 patients, including 37 CS (74%) and 13 VD (26%) patients (P = 0.007). Among those patients who failed first-line probing, 86.2% were born via CS, whereas 13.8% were born via VD (P = 0.0009).

CONCLUSIONS

CS is a risk factor for CNLDO, independent of gestational age. Children born via CS also tend to have a more complicated clinical course requiring additional surgical interventions.

Nasal Septal Deformity in Relation to the Mode of Delivery

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Management of Pediatric Nasal Surgery (Rhinoplasty)

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.

Endoscopic vs Conventional Septoplasty: A Comparative Study

Objective

Traditional surgeries of the nasal septum improve the nasal airway but recent developments of endoscopic techniques have brought focus over several aspects of possible advantages over traditional techniques. These are due to better visualization and illumination, better accessibility and evaluation of exact pathology, lesser need of unnecessary manipulation, resection and overexposure of the septal framework and improving the scope for a revision surgery if required later.

Materials and methods

Sixty cases of deviated nasal septum (DNS) refractory to conservative medical treatment were divided into two groups of 30 patients and underwent correction surgery for nasal septal deformity using both endoscopic and conventional techniques.

Results

The postoperative follow-up was done at 1, 2, 4 weeks and 3 months. The clinical results of endoscopic septoplasty were found better as compared to conventional techniques with lesser complications and lesser period of hospitalization. However, the statistical analysis did not show a difference between the two groups.

Conclusion

The use of endoscopic techniques offers lesser complications and lesser period of hospitalization. However, this study of limited series needs further extensive evaluation to statistically establish the proposed results in future.

How to cite this article

Kaushik S, Vashistha S, Jain NK. Endoscopic vs Conventional Septoplasty: A Comparative Study. Clin Rhinol An Int J 2013;6(2):84-87.

Prevalence of Nasal Septal Deviation in New-borns and Its Precipitating Factors: A Cross-Sectional Study

To estimate the prevalence of neonatal nasal septal deviation and to identify the precipitating factors. 250 neonates were examined on the 2nd day using Gray's struts for the presence of deviated nasal septum. Struts passing up to the 4 cm mark was taken to be normal, while struts getting stuck before the 4 cm mark was diagnosed to have deviated septum on that particular side. Out of 250 neonates, 49 had nasal septal deviation. There was significantly higher number of deviations in neonates of primiparas, emergency LSCS and in high birth weight babies. Neonatal septal deviation is quite common, being present in approximately 20% of all newborns. Greater amount of birth trauma increases its incidence further.

Nasal birth trauma: a review of appropriate treatment

The aetiology of nasal deformity has frequently included birth trauma. There is no consensus in the literature as to whether nasal surgery, in the form of closed reduction, is indicated in neonates. The majority of studies in the literature that advocate intervention have inadequate followup periods and there is a paucity of evidence for the adverse effects of conservative management. This case highlights the therapeutic dilemma posed by such nasal injuries in the neonate and, to the best of the authors' knowledge, at the time of writing, represents the earliest reported case in the literature of nasal deformity in the neonate. The term nasal deformity is used to denote deformity of the nasal pyramid, soft tissue, and septum. Three main aspects of neonatal nasal deformity are addressed including, firstly, if nasal deformity at birth needs to be addressed, secondly, if left unaltered, what the long-term effects are and, finally, if intervention alters the normal course of midfacial development.