Nasal septum deformity in the newborn infant during labour

Evaluation of Olfactory Sensation, Acoustic Rhinometry, and Quality of Life of the Patients With Nasal Septal Deviation

OBJECTIVES

Nasal septum deviations are deformities that occur in the cartilage and bones of the septum. The aim of the present study is to evaluate the patients with septum deviation according to the acoustic rhinometry measurements in terms of changes in smell function and the effects on quality of life.

METHODS

Twenty patients with septum deviation between the ages18 to 75 years old and 20 subjects without septum deviation were included in the study. Control group consisted of the 20 subjects with no septal deviation. After ENT examinations, acoustic rhinometry measurements, the SF-36 quality of life scale, and the Brief Smell Identification Tests were applied to all patients. Type of septum deviation is classified according to Mladina classification by anterior rhinoscopy examination, nasal endoscopy, and paranasal computed tomography.

RESULTS

The study indicated that the most common deviation type was Mladina Type 3 (65%). Bilateral total smell score of the women in the septum straight group is significantly lower than the men in terms of total smell scores by gender (P < 0.05). The total smell score values in septum group were significantly lower than those of the control group (P < 0.05). According to the individual smell values, cinnamon, banana, and soap odors of the septum deviation group were seen to be significantly lower than the septum straight group (P < 0.05).

CONCLUSION

The results of the study indicated that olfactory dysfunction occurs in patients with septum deviation. Therefore, treatment of septum deviation is necessary for the improvement of nasal obstruction besides the treatment of the smell dysfunction.

Effects of septoplasty on olfactory function evaluated by the Brief Smell Identification Test: A study of 116 patients

We conducted a prospective study of 116 patients-61 men and 55 women, aged 17 to 64 years (mean: 26.4)-to investigate the effects of septoplasty on olfactory function in patients with septal deviation (SD). The Mladina classification system was used to define SD types, and olfactory function was assessed with the Brief Smell Identification test (BSIT). The BSIT, which includes 12 odorants, was administered preoperatively and at postoperative months 1 and 3. The most common SD types were types 2 (20.7% of patients) and 1 (19.0%), followed by types 3 and 5 (both 16.4%). At postoperative month 1, the mean BSIT score was significantly higher in men than in the women. For patients with types 1 and 2 SD, BSIT scores at 1 month were significantly lower than the scores preoperatively and 3 months postoperatively. For types 3 and 4, BSIT values were significantly higher at 3 months than preoperatively or at 1 month. For type 3 SD, the preoperative mean score was significantly lower than those for types 1, 4, 5, 6, and 7; for type 2 SD, the BSIT score was significantly lower than those of types 5 and 6 only. At 1 month, the scores for types 2 and 3 were significantly lower than those for types 4, 5, 6, and 7. At 3 months, the BSIT score for type 2 was significantly lower than those of types 1, 3, 4, 5, and 6; the type 3 SD score at 3 months was significantly higher than those for types 1, 2, 5, 6, and 7. We conclude that septoplasty surgery for patients with a type 3 SD may improve olfactory function. In contrast, we found that olfactory function in patients with a type 2 SD did not improve to a satisfactory degree, even when good nasal patency was achieved with a corrected septum and an enlarged intranasal volume. Our findings should be investigated further in future studies.

Impact of Hard Palate Angulation Caused by Septal Deviation on Maxillary Sinus Volume

Objective

To investigate the effect of hard palate angulation caused by septal deviation on the volume of the maxillary sinus.

Methods

Coronal computed tomographic (CT) scans of 1568 patients aged from 18 to 60 were examined. CT scans of 402 patients were included in the study. On these scans, the maxillary sinus volume, the angle of the nasal septal deviation, and the angulation of the hard palate were calculated using the ImageJ software. Each maxillary sinus volume was statistically compared with each other and with those in the control group. Correlations between palatal angulation and septal deviation were determined.

Results

Deviated nasal septum whether with or without deflection of the hard palate was noted to have caused changes in the volume of the maxillary sinus in both female and male patients. The volume of the maxillary sinus on the deviated side was less than that of the opposite side, and the differences between the volumes of both sinuses were statistically significant (p<0.05). No significant differences were noted when compared with the control group. A positive correlation was observed between the nasal septal deviation angle and the angulation of the hard palate.

Conclusion

Regardless of whether or not it affects the hard palate, nasal septal deviation reduces the volume of the maxillary sinus on the deviated side but does not affect the total volume of the maxillary sinuses. Significant differences between the volumes on the two sides can lead to facial asymmetry.

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

Background

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

Methods

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

Results

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

Conclusions

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

Nasal Septal Deformity in Relation to the Mode of Delivery

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Deformation of the nasal septum in children, adolescents, and adults in Western Pomerania province of Poland

OBJECTIVES

Nasal septum deformation (NSD) contributes to the occurrence of upper respiratory tract diseases in around 45-55% of Poland's population. The evaluation of frequency of occurrence and type of nasal septum deformation among randomly chosen representatives of the Szczecin and surrounding area population was the aim of this study.

METHODS

NSD was assessed in 235 patients (123 male, 112 female) aged 5-60. Mladina's classification system was used for the evaluation.

RESULTS

Deformations of nasal septum were found in 43% of the examined subjects. Type 3 of NSD dominated (12.4%), while types 2 and 1 were found in 10.3% and 4.2% of the subjects, respectively. 9.2% of the patients showed type 5 of deformation, while types 6, 4, and 7 were found in 1.3%, 3.2% and 2.7% of the patients, respectively.

CONCLUSIONS

Straight nasal septum was found in females more often than in males, mostly on the left side. Associations between NSD, on one side, and age, sex, and traumas, on the other were found. NSD influenced the quality of respiration and frequency of upper respiratory tract diseases in the examined subjects.

Management of naso-septal deformity in childhood: long-term results

OBJECTIVE

The classical teaching advocates a conservative approach for children presenting with various naso-septal deformities. It may not be appropriate especially when it causes nasal obstruction to the growing child. This study has two main purposes: to contribute in identifying the correct selection criteria for surgical management of pediatric patients and in selecting the most appropriate surgical technique.

MATERIAL AND METHOD

We reviewed a series of 46 cases of post-traumatic septal and naso-septal deformity not managed promptly or with recurrence of nasal deviation, following bones fracture correction alone. The mean follow-up was 10 years.

RESULTS

Patients with naso-septal deformity managed only by septoplasty had accentuation of nasal pyramid deformity; those treated by septorhinoplasty showed a good aesthetic and functional result after long-term follow-up.

CONCLUSION

Our series results demonstrated that the best results were obtained when we correct all evident alterations of nasal septum and pyramid at a single stage. Unsuccessful results seen in our first group suggest that immediate correction of septum alone with delayed management of nasal pyramid deformity leads to a poorer outcome.

The nasal septum deformities in children and adolescents from Warsaw, Poland

OBJECTIVE

The final shape of the nasal septum deformities is a result of irregular development of the nasomaxillary complex or of a nasal injury. Nasal septum deformities reveal in childhood. The aim of this study is to estimate the prevalence of the particular types of the septum deformities in children according to Mladina's classification, analysis of the correlation between types of deformities and age and sex and checking if nasal injury influences the occurrences of nasal septum deformities and determines the particular type of it.

METHODS

The nasal septum morphology was examined in 288 children aged 3-17. The investigation was performed in kindergartens and schools in Warsaw. The study population was divided into three groups. Anterior rhinoscopy without nasal vasocontrictive drugs was performed. A questionnaire was included. The nasal septum deformities were qualified according to Mladina's classification. Analysis of variance (ANOVA) and Wilcoxon's test were used to performed statistical significance.

RESULTS

Deviation of the nasal septum was diagnosed in nearly 34% of the sample population. The nasal septum deformities occurred in 29% of girls and in nearly 37% of boys. The prevalence of septum deformities in group 1 aged 3-7 years was 35.23%, in group 2 aged 8-13 years was 27.97% and in group 3 aged 14-17 years was 40.24%. We observed statistically significant correlation between age of patients and type of nasal septum deformities (F=3.65, p=0.000876). In children with nasal injures, 66.66% had nasal septum deformities while in group without injuries there was about 31.69%. We observed statistically significant correlation between type of nasal septum deformities and nasal injuries (Z=7.67, p<0.0000001).

CONCLUSIONS

The percentage of the nasal septum deformities change with age. Deviation of the nasal septum was more prevalent in boys. The risk of occurrence of the nasal septum deformities increases after nasal injury. Type 1 and type 5 according to Mladina's classification dominates in study population. Type 1 decreases with age, while type 5 increases with age.

Management of birth injuries

Birth injuries are a significant cause of neonatal morbidity and mortality. Although often associated with traumatic delivery, birth injuries often occur in normal spontaneous deliveries in the absence of any risk factors. This article discusses the diagnosis and management of the most common birth injuries that are encountered by health care providers who care for newborns.

Management of birth injuries

Birth injuries are a significant cause of neonatal morbidity and mortality. Although they are frequently associated with traumatic delivery, birth injuries often occur in normal spontaneous deliveries in the absence of any risk factors. This article discusses the diagnosis and management of the most common birth injuries encountered by health care providers caring for newborns.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Nasal septum deformities in children and adolescents: a cross sectional study of children from Zagreb, Croatia

OBJECTIVE

Numerous epidemiologic studies on the prevalence of nasal septum deformities in children have been performed over the last three decades. As these studies were performed in children of various age groups and used different classifications of septal deformities (without detailed morphologic systematization), it is no surprise that the results differ greatly from study to study. The purpose of the study was to evaluate clinical data on the total prevalence of nasal septum deformities and particular types of deformity in children and adolescents.

METHODS

The study population consisted of 1797 randomly selected subjects divided into pre-school (aged 2-6), primary school (aged 7-14), secondary school (aged 15-18) and university (aged 19-22) groups. The native state was determined by means of anterior rhinoscopy without previous application of vasoconstrictive drugs. The observed pathologic septal deformities were classified into seven types according to Mladina's classification. A straight septum was designated as S. The prevalence of septum deformities in the population was calculated with 95% probability. Differences with respect to sex and types of deformity were tested by chi(2)-test.

RESULTS

The prevalence of nasal septum deformities according to age groups was 28.0% in the 2-6 group, 21.1% in the 7-14 group, 40.6% in the 15--18 group and 41.8% in the 19-22 group. The distribution of the seven types of septal deformity was 51.1, 23.5, 5, 0.8, 10.0, 9.0 and 0.6%, respectively. The mean values (%) and 95% confidence intervals for the seven types of septal deformity were 14.7 (13.1-16.4%), 6.8 (5.6-7.9%), 1.4 (0.9-1.9%), 0.2 (0.0-0.4%), 2.9 (2.1-3.7%), 2.6 (1.9-3.4%) and 0.2 (0.0-0.4%), respectively. Total distribution in gender showed no difference (P = 0.102).

CONCLUSIONS

In the youngest age group (2-6 years), types 1 and 2 (deformities of anterior septal segments) were exclusively found, whereas types 5 and 6 were found in older age groups (become visible during and after the puberty). Types 1 and 2 are characteristic septal deformities for small children. Since, septal deformities can affect the growth and development of the maxilla and vice versa, the authors recommend examination of the nasal septum by an rhinologist who will be a part of a team performing the regular systematic health examination of children.

Neonatal septoplasty: case report and review of the literature

Treatment of nasal septal deformity in childhood has received growing acceptance in recent years. Traditionally, concern about the role of the septum in the overall growth of the midface has led otolaryngologists to take a very cautious approach to correction of septal deformities in children. However, a great deal of evidence now suggests that severe traumatic septal deviation can and should be corrected early in childhood to prevent future nasal and systemic complications. Closed manipulation of the septum in the first 1-2 days of an infant's life has been performed by many otolaryngologists with good results. The use of this technique, however, is usually limited to those subluxations of anterior cartilage which are diagnosed immediately or very shortly after birth. We present a case of severe traumatic nasal deformity presenting with obstructive asleep and awake apnea and cyanosis at the age of 8 days. The child underwent limited septoplasty using endoscopic techniques at age 14 days with resolution of both the apneic and cyanotic episodes immediately post-operatively. This unusual presentation and the literature surrounding infant nasal/septal surgery are discussed.