Aetiology and detection of congenital nasal deformities

A modified reconstructive technique for paediatric congenital alar rim deformity

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.

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.

Supernumerary Nostril: Two Years Follow-Up

Supernumerary nostril is a very rare congenital anomaly of the nose. Since the first patient reported by Lindsay in 1906, few number of patients were reported in the literature. Various types had been described with different surgical modalities for correction. It can be isolated or associated with other malformations such as facial cleft, esophageal atresia, and imperforate anus. Most of the patients are unilateral, but it may be bilateral. It may have a communication with a normal nasal cavity or not.In this study, the authors present a case of a 1-year-old male with a positive perinatal history of teratogen exposure had isolated supernumerary left nostril with communication to the nasal cavity.The authors will discuss different theories related to supernumerary nostril development, differences between published reports, the proposed surgical techniques, and the outcome of their treatment approach.

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.

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.

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.

Congenital nasal anomalies: a classification scheme

The purpose of this work was to develop a simple yet comprehensive classification scheme dedicated to congenital nasal anomalies. To date, no such classification system has been proposed and widely used. A 22-year retrospective review was performed. Two hundred sixty-one patients with congenital nasal anomalies were identified. From this extensive database, a systematic morphogenic classification system was devised. Congenital nasal deformities were classified into four categories. Type I, hypoplasia and atrophy, represents paucity, atrophy, or underdevelopments of skin, subcutaneous tissue, muscle, cartilage, and/or bone. Type II, hyperplasia and duplications, representing anomalies of excess tissue, ranging from duplications of parts to complete multiples, are categorized here. In the type III category, clefts, the comprehensive and widely utilized Tessier classification of craniofacial clefts is applied. Type IV deformities consist of neoplasms and vascular anomalies. Both benign and malignant neoplasms are found in this category.

Nasal septum deformity in the newborn infant during labour

The incidence of nasal septum dislocation (NSD) was studied in 447 newborns and was found to be 17%. The aim of this study was to establish its aetiology as well as to find ways of prevention and early diagnosis of this obstetrical injury. The following conclusions were drawn: (a) The high frequency of NSD is due to the inadequate support technique (Playfair manoeuvre) currently in use. This is true even when birth weight is normal or less than normal. (b) The severity of injury is lessened by the degree of experience of the obstetrician. This is why NSD is characterised as an obstetrical injury. (c) NSD to the right is more frequent in the front left position of occipital presentation. (d) NSD is more frequent in the anterior part of the nose because the injury is sustained by the anterior part of the septum. (e) The frequency of NSD was not higher in classical forceps delivery, in caesarean section, and in spontaneous delivery. (f) No statistically significant correlation was found between the duration of expulsion and nasal septum dislocation (chi 2 = 4.43, p greater than 0.1). Due to present conditions, a general rhinological examination of all neonates is necessary. The use of Metzenbaum's sign (asymmetry of nostrils) and Jeppesen and Windfeld's test (pressure on the tip of the nose), along with rhinoscopy are recommended. Early diagnosis and treatment of NSD is of great importance, since all complications arising from this obstetrical injury can be prevented and normal function of the nose restored.

Immediate correction of congenital nasal deformities; follow-up of 8 years

A total of 4724 newborns was screened for congenital nasal deformities. Altogether 91 (1.9%) pathological, screening-positive cases were found. Because of refusal to participate, 3 pathological cases were lost leaving 88 cases. The first 55 screening positive newborns were left without treatment while an attempt was made by an otolaryngologist to correct the remaining 33 cases within a week from delivery. Eighty-two newborns of those who passed the screening tests were analyzed as a control group. In 1987, at the age of 8 years the case and control children were interviewed by mailed questionnaire and invited to be re-examined by an ENT-surgeon. Forty-seven of the not corrected, 21 of the corrected cases and 61 controls came to the re-examination. The luxated septal cauda tended to be straight both spontaneously as well as after active treatment. The few mid-septal pathologies (vomerine junction) in the corrected group were resistant to the treatment attempted. The mid-septal deformities found in the follow-up were connected with frequent antibiotic prescriptions but not respiratory infections. No increase in frequency of otitis media or sinusitis was noticed. The immediate treatment of nasal deformities did not significantly affect the clinical status of the nose at the follow-up. Thus the benefit of immediate treatment on nasal deformities in newborns and screening to find them remains questionable.

Septal deviation in newborn infants

Authors report an experiment performed in a randomized group of newborns to evaluate the frequency of post-partum septal deviations. A number of 423 subjects out of 1142 have been examined in a 17-month period. Newborns have been examined with an otoscope and two different kinds of nasal lesions have been considered: (1) pyramid deformation with septum dislocation and columella deviation; (2) deviation and subluxation of the septum. A number of 315 newborns were naturally delivered and 108 by cesarean section. In the former group, 10 pyramid deformations and 12 septal deviations have been found; in the latter, only septal deviations have been revealed (5 infants). Pyramid deformations may be related to delivery(labor)trauma while for septal deviations a developmental defect may be postulated.

Late results of nasal septum injury in children

In the period 1973-1982 241 children with nasal injuries were treated in ORL Clinics in Prague-Motol. The pathological septal findings were confirmed at the time by rhinoscopy in 98 cases (40%). In these cases, deviation, subluxation, or fracture were found 73 times, subperichondrial abscess 12 times, and hematoma 13 times. At the time of control examination 2-10 years after the injury, the unfavourable effects of the injury on the septum or the nasal passage were confirmed. Deviation of the septum was found in 55% of children; bad or insufficient rhinomanometric values in 62%. The septal deviation was associated with snoring in 52%, with colds in 56%, and in 37% with bronchitis and sinusitis. It was found necessary to carry out surgical correction of the nasal septum in several children of the 10-12 year age group; rhinotomy was not deemed necessary in any case.

Septal manipulation in the neonate: method and results

The septal configuration at birth may be straight (type A) which occurs in 42% cases, bent to one side (type B), or deformed to both sides (type C). There is a close correlation of these types, immediately with nasal obstruction and feeding problems and later with the development of dental abnormalities and respiratory infections of the throat and ear. These symptoms occur most in type B cases and least in type A cases. A total of 284 babies was assessed at birth and then when aged about 5 years. A total of 105 babies, who had minimal trouble and were used as controls and not manipulated, were compared with 179 who had troublesome symptoms and were manipulated. Manipulation greatly reduced the incidence of these problems at a statistically significant level. The physiological reason why type B causes more ear disease than types A or C is described. This involves the normally occurring Bernouilli's phenomenon in the nose. The external nasal deformity which causes minimal physiological changes, and occurs in 4% of births, can be successfully straightened by manipulation.