1
|
Howard T, Williams I, Navaratnam A, Haloob N, Stoenchev K, Saleh H. "Should Pediatric Septal Surgery and Septorhinoplasty Be Performed for Nasal Obstruction?"-A Systematic Review of the Literature. Facial Plast Surg 2024; 40:378-393. [PMID: 38035612 DOI: 10.1055/a-2219-9266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Theodore Howard
- Department of Rhinology and Otolaryngology, Charing Cross Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Isabelle Williams
- Department of Rhinology and Otolaryngology, Charing Cross Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Annakan Navaratnam
- Department of Rhinology and Otolaryngology, Charing Cross Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Nora Haloob
- Department of Rhinology and Otolaryngology, Charing Cross Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Kostadin Stoenchev
- Department of Allergy and Clinical Immunology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Hesham Saleh
- Department of Rhinology and Otolaryngology, Charing Cross Hospital, Imperial College NHS Trust, London, United Kingdom
| |
Collapse
|
2
|
Baldwin MC, Zarudnaya D, Liu ZJ, Herring SW. The nasal septum and midfacial growth. Anat Rec (Hoboken) 2023. [PMID: 36965023 DOI: 10.1002/ar.25214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/22/2023] [Accepted: 03/09/2023] [Indexed: 03/27/2023]
Abstract
The nasal septum is the only element of the chondrocranium which never completely ossifies. The persistence of this nonarticular cartilage has given rise to a variety of theories concerning cranial mechanics and growth of the midface. Previously, using pigs, we demonstrated that the septum is not a strut supporting the snout and that septal growth seems capable of stretching the overlying nasofrontal suture, a major contributor to snout elongation. Here we investigate whether abnormalities of the septum are implicated in cases of midfacial hypoplasia, in which growth of the midface is inadequate. Mild midfacial hypoplasia is common in domestic pig breeds and often severe in the Yucatan minipig, a popular laboratory breed. Normal-snouted and midfacial hypoplastic heads of standard (farm mixed breed) and minipigs ranging in age from perinatal to 12 months were dissected, imaged by CT, and/or prepared for histology. Even at birth, Yucatan minipigs with midfacial hypoplasia exhibited greater caudal ossification than normal; the ventral cartilaginous sphenoidal "tail" was diminished or missing. In addition, cells that morphologically appeared to have divided recently were less numerous than in newborn standard pigs. Juvenile Yucatan minipigs lacked caudal cartilaginous growth zones almost completely. In standard newborns, the ventral caudal septum was more replicative than the dorsal, but this trend was not seen in Yucatan newborns. In conclusion, accelerated maturation of the caudal septum was associated with midfacial hypoplasia, a further indication that the septum, particularly its ventral portion, is important for midfacial elongation.
Collapse
Affiliation(s)
- Michael C Baldwin
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, Washington, 98195, USA
| | - Diana Zarudnaya
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, Washington, 98195, USA
| | - Zi-Jun Liu
- Department of Orthodontics, University of Washington, Box 357446, Seattle, Washington, 98195, USA
| | - Susan W Herring
- Department of Orthodontics, University of Washington, Box 357446, Seattle, Washington, 98195, USA
| |
Collapse
|
3
|
Smith TD, Ruf I, DeLeon VB. Ontogenetic transformation of the cartilaginous nasal capsule in mammals, a review with new observations on bats. Anat Rec (Hoboken) 2023. [PMID: 36647334 DOI: 10.1002/ar.25152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023]
Abstract
The nasal capsule, as the most rostral part of the chondrocranium, is a critical point of connection with the facial skeleton. Its fate may influence facial form, and the varied fates of cartilage may be a vehicle contributing to morphological diversity. Here, we review ontogenetic changes in the cartilaginous nasal capsule of mammals, and make new observations on perinatal specimens of two chiropteran species of different suborders. Our observations reveal some commonalities between Rousettus leschenaultii and Desmodus rotundus, such as perinatal ossification of the first ethmoturbinal. However, in Rousettus, ossification of turbinals is demonstrated as either perichondrial or endochondral. In Desmodus, perichondrial and endochondral ossification of the posterior nasal cupula is observed at birth, a part of the nasal capsule previously shown to persist as cartilage into infancy in Rousettus. Combined with prior findings on cranial cartilages we identify several diverse transformational mechanisms by which cartilage as a tissue type may contribute to morphological diversity of the cranium. First, cartilage differentiates in an iterative fashion to increase nasal complexity, but still retains the capacity for later elaboration via de novo bone emanating outward before or after cartilage ossifies. Second, cartilage acts as a driver of growth at growth centers, or via interstitial growth (e.g., septal cartilage). Finally, cartilage as a tissue may influence the timing of ossification and union of the facial and basicranial skeleton. In particular, cartilage at certain points of ontogeny may "model" via selective resorption, showing some similarity to bone.
Collapse
Affiliation(s)
- Timothy D Smith
- School of Physical Therapy, Slippery Rock University, Slippery Rock, Pennsylvania, USA
| | - Irina Ruf
- Senckenberg Forschungsinstitut und Naturmuseum Frankfurt, Frankfurt am Main, Germany
- Institut für Geowissenschaften, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Valerie B DeLeon
- Department of Anthropology, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
4
|
Calvo-Henríquez C, Neves JC, Arancibia-Tagle D, Chiesa-Estomba C, Lechien JR, Mayo-Yáñez M, Martinez-Capoccioni G, Martin-Martin C. Does pediatric septoplasty compromise midfacial growth? A systematic review. Eur Arch Otorhinolaryngol 2020; 277:1565-1574. [PMID: 32200434 DOI: 10.1007/s00405-020-05919-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/10/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Septal deviation is an important cause of impaired nasal breathing among pediatric patients. A widespread solution to septal deviation is septoplasty. However, there are certain controversies surrounding the effect of this technique on pediatric patients and its influence on the growth centers of the nose. The objective of this review is to study if there is a strong and valid evidence in the literature that supports a detrimental effect of pediatric septo- and rhinoseptoplasty in facial growth DATA SOURCES: Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database. REVIEW METHODS The outcome assessed was the midfacial growth after pediatric septoplasty. RESULTS Eight publications met the inclusion criteria. None found major disturbances in facial growth. Only minor nasal anomalies were reported by 4 authors. CONCLUSION Septoplasty in pediatric patients does not seem to affect midfacial growth according to available evidence. However, due to their design, the degree of recommendation of these studies was not superior to level C.
Collapse
Affiliation(s)
- Christian Calvo-Henríquez
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.
- Service of Otolaryngology, Travesía de Choupana, Hospital Complex of Santiago de Compostela, s/n. 15706, Santiago de Compostela, Spain.
| | - J Carlos Neves
- Department of Facial Plastic Surgery - My Face Clinics and Academy, Lisbon, Portugal
| | - Diego Arancibia-Tagle
- Department of Facial Plastic Surgery - My Face Clinics and Academy, Lisbon, Portugal
| | - Carlos Chiesa-Estomba
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Service of Otolaryngology, Donostia University Hospital, San Sebastian, Spain
| | - Jerome R Lechien
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Foch Hospital, University of Paris Saclay, Paris, France
| | - Miguel Mayo-Yáñez
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Service of Otolaryngology, Hospital Complex of La Coruña, La Coruña, Spain
| | - Gabriel Martinez-Capoccioni
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Service of Otolaryngology, Travesía de Choupana, Hospital Complex of Santiago de Compostela, s/n. 15706, Santiago de Compostela, Spain
| | - Carlos Martin-Martin
- Service of Otolaryngology, Travesía de Choupana, Hospital Complex of Santiago de Compostela, s/n. 15706, Santiago de Compostela, Spain
| |
Collapse
|
5
|
Saniasiaya J, Abdullah B. Quality of life in children following nasal septal surgery: A review of its outcome. Pediatr Investig 2019; 3:180-184. [PMID: 32851314 PMCID: PMC7331304 DOI: 10.1002/ped4.12145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/20/2019] [Indexed: 12/03/2022] Open
Abstract
Nasal septal surgery among children remains controversial because of its adverse effect on craniofacial development. Recent studies, however, have demonstrated that early nasal septal correction prevents the midfacial and nasal growth deformity that is the inevitable consequence of nasal septal abnormality. Nasal septal surgery in children has been reported to lead to significant improvement in quality of life. We reviewed the existing literature to evaluate the outcomes of pediatric nasal septal surgery.
Collapse
Affiliation(s)
- Jeyasakthy Saniasiaya
- Department of OtorhinolaryngologyHospital Tuanku Ja'afarSerembanNegeri SembilanMalaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology‐Head and Neck SurgerySchool of Medical SciencesUniversiti Sains MalaysiaKubang KerianKelantanMalaysia
| |
Collapse
|
6
|
Abstract
Background After septoplasty, the rhinologic surgeon often encounters an unexpected deviation of the septum toward the side contralateral to the initial deflection, a phenomenon which we would call an overcorrection. Methods To investigate the incidence of overcorrected septum, we assessed the incidence of overcorrection in different age groups by reviewing medical records. Results Of 1124 patients, 22 (2.0%) showed occurrence of overcorrection after septoplasty. The incidence of overcorrection was 7.3% (16/218) in subjects aged 10 to 19, 1.7% (5/294) in their twenties, 0.4% (1/250) in their thirties, and 0% in the older ages. Conclusion The results of this study indicate that the risk of overcorrection following septoplasty is particularly higher in the younger patient group.
Collapse
Affiliation(s)
- Bong-Jae Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoo-Sam Chung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Ju Jang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
7
|
Fearon JA. Discussion: Primary Septal Cartilage Graft for the Unilateral Cleft Rhinoplasty. Plast Reconstr Surg 2017; 139:1187-8. [PMID: 28445370 DOI: 10.1097/PRS.0000000000003298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Brihaye P, Delpierre I, De Villé A, Johansson AB, Biarent D, Mansbach AL. Comprehensive management of congenital choanal atresia. Int J Pediatr Otorhinolaryngol 2017; 98:9-18. [PMID: 28583512 DOI: 10.1016/j.ijporl.2017.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To present results of a one-stage minimally invasive surgical procedure for congenital choanal atresia (CCA). Seven outcome measures were applied. MATERIALS AND METHODS Retrospective study conducted between 1999 and 2015. The same endonasal endoscopic approach with multiflaps and no stenting was used on 36 children. The flaps were attached with fibrine glue. There were 50% unilateral and 50% bilateral cases, 70% primary and 30% secondary surgery. The mean age at primary surgery for bilateral atresia was 10 days and for unilateral atresia 4 years. Associated loco-regional disorders were: hypoplasia of the inferior turbinate, rhinopharyngeal stenosis and rhinopharyngeal web. RESULTS The average follow-up time was 6 years, ranging from 1 to 14 years. There was a functionally patent choanae in 94% of children, and 6% showed severe restenosis with a diameter less than 4 mm, which needed one revision surgery each. Charge patients were not associated with worse outcome. There was no external nasal valve stenosis and no permanent Eustachian tube dysfunction. Synechiae occurred in 3 patients with hyperplastic inferior turbinate. No patients showed any disharmonious nasal growth. In neonates with isolated bilateral CCA, breast-suction could be started within 1 day (range 1-2 days), and pain-killers were needed on average for 1.5 days (range 1-4 days). The hospital stay for unilateral isolated CCA was on average 1.5 days (range 1-2 days) and for bilateral isolated CCA, 8 days (range 3-20 days). Postoperative procedures under a short general anesthesia were necessary in 12 cases, 10 of them were infants under 6 months of age. CONCLUSION Surgery could be performed safely in the newborn in the early stage of life, even for unilateral atresia. Tendency for restenosis can be minimized by: 1. the construction of an as large as possible uni-neochoanae by removing the posterior part of the vomer and by drilling away the medial pterygoid; 2. in case of rhinopharyngeal stenosis, part of the endochondral clivus bone should be resected; 3. all raw surfaces should be covered by multiple mucosal flaps secured with fibrin glue; 4. no stenting; 5. appropriate postoperative care.
Collapse
Affiliation(s)
- Pierre Brihaye
- University Children's Hospital Reine Fabiola, Department of ENT, Brussels, Belgium.
| | - Isabelle Delpierre
- University Children's Hospital Reine Fabiola, Department of Neuroradiology, Brussels, Belgium
| | - Andrée De Villé
- University Children's Hospital Reine Fabiola, Department of Anesthesiology, Brussels, Belgium
| | - Anne-Britt Johansson
- University Children's Hospital Reine Fabiola, Department of Neonatal Intensive Care, Brussels, Belgium
| | - Dominique Biarent
- University Children's Hospital Reine Fabiola, Department of Pediatric Intensive Care, Brussels, Belgium
| | - Anne-Laure Mansbach
- University Children's Hospital Reine Fabiola, Department of ENT, Brussels, Belgium
| |
Collapse
|
9
|
Abstract
Pediatric septorhinoplasty has been an area of controversy because early surgical intervention can prevent normal growth. There are certain conditions where early correction of the nose is indicated, such as in cleft lip nasal deformities, severe traumatic deformities, and congenital nasal lesions. Animal and clinical studies have been helpful in elucidating certain areas of the nose that are potential growth zones that should be left undisturbed when performing nasal surgeries on pediatric patients. We discuss the timing, indications, and surgical technique in pediatric septorhinoplasty.
Collapse
Affiliation(s)
- Aditi Bhuskute
- Department of Otolaryngology, University of California, Davis, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Mika Sumiyoshi
- Department of Otolaryngology, University of California, Davis, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Craig Senders
- Department of Otolaryngology, University of California, Davis, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA.
| |
Collapse
|
10
|
Abstract
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.
Collapse
Affiliation(s)
- Matthew D Johnson
- Facial Plastic & Reconstructive Surgery, Division of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, 747 N Rutledge Street, 5th floor, PO box 19649, Springfield, IL 62794-9649, USA.
| |
Collapse
|
11
|
Abstract
BACKGROUND Choanal atresia is the most common inborn nasal anomaly, and its definitive treatment is surgical to achieve proper bilateral nasal patency. Four main surgical approaches were used for repair: transantral, transpalatal, transseptal, and transnasal. The transnasal endoscopic approach is the most widely accepted nowadays. In this study, we aimed to evaluate the long-term results of a transnasal endoscopic repair of congenital choanal atresia started with resection of the posterior portion of the vomer and was completed without the use of stents in a large series of patients. METHODS Twenty-five patients (age range, 3-15 days) with bilateral congenital choanal atresia had surgery by using stentless endoscopic transnasal repair by starting with resection of the vomer bone. Postoperative control included office fiberoptic nasal endoscopy. RESULTS During the follow-up period of 15-66 months (mean [standard deviation], 35.76 ± 16.8 months), 18 patients (72%) had a wide choana with adequate nasal breathing; Six patients (24%) had narrowing of the choana (<50%), still with adequate and satisfactory airway without feeding difficulties, and one patient (4%) developed restenosis (>50%) after 7 months, which necessitated repeated surgery. One patient (the fourth case) developed a palatal defect, which healed conservatively. No other complications were detected. CONCLUSION The described technique proved to be effective and easier, with good long-term satisfactory results in a large series of patients. This technique allows early use of both nasal passages for simultaneous endoscope and instrument insertion to excise both atretic plates without the use of stents or flaps.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | |
Collapse
|
12
|
Gupta A, Svider PF, Rayess H, Sheyn A, Folbe AJ, Eloy JA, Zuliani G, Carron MA. Pediatric rhinoplasty: A discussion of perioperative considerations and systematic review. Int J Pediatr Otorhinolaryngol 2017; 92:11-16. [PMID: 28012510 DOI: 10.1016/j.ijporl.2016.10.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Pediatric rhinoplasty has traditionally raised numerous concerns, including its impact on growth as well as the psychological sequelae of undergoing a potentially appearance-altering procedure. Our objective was to critically evaluate available individual patient data relevant to pediatric rhinoplasty, and further discuss perioperative considerations. METHODS A systematic review was conducted using PubMed/MEDLINE databases. Data extracted and analyzed from included studies included patient demographics, surgical indications, operative approaches, outcomes, complications, revision rates, and other clinical considerations. RESULTS Seven studies encompassing 253 patients were included, with age ranging from 7 months to 19 years. Two-thirds of patients were male. 41.7% reported antecedent trauma, and common overall surgical indications included "functional aesthetic" (24.5%) followed by cleft lip nasal deformity (15.8%). The majority (79.1%) underwent open approaches, and 71.1% of patients underwent concomitant septal intervention. The most frequently used grafting materials were septal cartilage (52.8%) and conchal cartilage (16.5%). Surgical outcomes were heterogeneous among these studies. Complication rates were only specified in 5 of the 7 studies and totaled 57 patients (39.6%). Aesthetic dissatisfaction (11.8%) and postoperative nasal obstruction (5.6%) were the most commonly reported complications. Revisions were performed in 13.5%. CONCLUSION Rhinoplasty is safe in the pediatric population, although revisions rates appear greater than those reported in adults. This study of 253 represents the largest pooled sample size to date; nonetheless, non-standardized outcome measures, minimal long-term followup data, and lack of discussion regarding psychological sequelae all contribute to the need for further high-quality studies evaluating this topic.
Collapse
Affiliation(s)
- Amar Gupta
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Peter F Svider
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Hani Rayess
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Anthony Sheyn
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA; Division of Pediatric Otolaryngology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adam J Folbe
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, NJ, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Giancarlo Zuliani
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael A Carron
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
13
|
Foster A, Holton N. Variation in the Developmental and Morphological Interaction Between the Nasal Septum and Facial Skeleton. Anat Rec (Hoboken) 2016; 299:730-40. [PMID: 26940849 DOI: 10.1002/ar.23340] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/30/2015] [Accepted: 02/04/2016] [Indexed: 11/11/2022]
Abstract
While the nasal septum exerts a morphogenetic influence on the facial skeleton, there is evidence that this relationship is highly variable. To better appreciate the precise role of the septum, it is important understand the variable interaction between the septum and surrounding skeleton during ontogeny. Here we analyzed nasal septal and facial skeletal postnatal phenotypic variation using cross-sectional samples of C3H/HeJ and C57BL/6J mice. Initial observations indicated between-strain variation in the magnitude of septal deviation, suggesting differences in septal and facial skeletal interaction. We examined whether variation in septal deviation is due to ontogenetic differences in septal size, or whether variation in facial skeletal growth imposes spatial constraints on the septum. Using microCT we quantified septal size and deviation, and collected coordinate landmark data, which we analyzed using geometric morphometrics. C3H/HeJ mice were significantly more deviated than C57BL/6J during development. We found no differences in septal size between the two strains. However, while both strains exhibited an ontogenetic increase in snout length, C3H/HeJ mice exhibited a non-allometric reduction in nasal bone length. This appears to be influenced by between-strain variation in the spatial relationship between the nasal septum and nasofrontal suture. Unlike C57BL/6J mice, the C3H/HeJ nasal septum is positioned anterior to the nasofrontal suture potentially limiting an early direct influence of septal growth (e.g., through interstitial expansion) on sutural growth. Ultimately, our results underscore that while the septum is a key facial growth center, its precise influence on facial growth varies even in narrow morphological and taxonomic ranges. Anat Rec, 299:730-740, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Austin Foster
- Department of Orthodontics, The University of Iowa, Iowa City, Iowa
| | - Nathan Holton
- Department of Orthodontics, The University of Iowa, Iowa City, Iowa.,Department of Anthropology, The University of Iowa, Iowa City, Iowa
| |
Collapse
|
14
|
Hartman C, Holton N, Miller S, Yokley T, Marshall S, Srinivasan S, Southard T. Nasal Septal Deviation and Facial Skeletal Asymmetries. Anat Rec (Hoboken) 2016; 299:295-306. [DOI: 10.1002/ar.23303] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/12/2015] [Accepted: 11/02/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Christopher Hartman
- The University of Iowa - Orthodontics; S219 Dental Science Building Iowa City Iowa
| | - Nathan Holton
- The University of Iowa - Orthodontics; S219 Dental Science Building Iowa City Iowa
- The University of Iowa - Anthropology; 114 Macbride Hall Iowa City Iowa
| | - Steven Miller
- The University of Iowa - Dows Institute for Dental Research; N444B Dental Science Building Iowa City
| | - Todd Yokley
- Metropolitan State University of Denver - Sociology and Anthropology; Campus Box 28, P.O. Box 173362 Denver Colorado
| | - Steven Marshall
- The University of Iowa - Orthodontics; S219 Dental Science Building Iowa City Iowa
| | - Sreedevi Srinivasan
- The University of Iowa - Orthodontics; S219 Dental Science Building Iowa City Iowa
| | - Thomas Southard
- The University of Iowa - Orthodontics; S219 Dental Science Building Iowa City Iowa
| |
Collapse
|
15
|
Abstract
In the appropriately selected patient, septorhinoplasty can benefit a pediatric patient presenting with significant nasal trauma, abscess, or mass that will likely result in a progressive deformity in the growing nose or with negative functional or psychosocial effect. Clinical and experimental observations support a conservative approach to cartilage scoring and resection in pediatric patients in which septorhinoplasty is deemed necessary.
Collapse
Affiliation(s)
- Jamie L Funamura
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, University of California Davis Health System, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Jonathan M Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, University of California Davis Health System, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA.
| |
Collapse
|
16
|
Ali Abde Elfatah MK, El-anwar MW, Quriba AS. Early functional outcome of two surgical protocols used in the repair of complete unilateral cleft lip palate: a comparative study. Annals of Pediatric Surgery 2014; 10:99-106. [DOI: 10.1097/01.xps.0000452062.30697.91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
17
|
Martins MBB, Lima RGD, Lima FVFD, Barreto VMP, Santos ACG, Júnior RCS. Demystifying septoplasty in children. Int Arch Otorhinolaryngol 2014; 18:54-6. [PMID: 25992064 PMCID: PMC4296948 DOI: 10.1055/s-0033-1358576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 08/11/2013] [Indexed: 12/05/2022] Open
Abstract
Introduction Septum deviation in children may alter the early physiologic process of breathing, causing obligatory oral breathing and consequently changing craniofacial development and even intellect. Because of these consequences, septoplasty should be performed as early as possible. Materials and Methods The retrospective study reviewed the results of septoplasty in 40 children under 12 years old who had follow-up after surgery for a maximum period of 7 years. The research was submitted to the ethics committee and approved with protocol number 10331912.0.0000.0058. Results Forty patients underwent septoplasty, 39 (97.5%) had cauterization of inferior turbinate and associated procedure, 20 (50%) had adenotonsillectomy, and 17 (42.5%) had adenoidectomy. Conclusion Nasal septum deviation should be corrected early to provide the harmonious growth of the face and to enable normal development of the child, without the occurrence of nasal deformity.
Collapse
Affiliation(s)
- Mariane Barreto Brandão Martins
- Department of Otorhinolaryngology, University Hospital, Faculty of medicine, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
| | - Rosa Grazielle de Lima
- Department of Otorhinolaryngology, University Hospital, Faculty of medicine, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
| | - Francis Vinícius Fontes de Lima
- Department of Otorhinolaryngology, University Hospital, Faculty of medicine, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
| | | | | | - Ronaldo Carvalho Santos Júnior
- Department of Otolaryngology, Universidade de São Paulo, São Paulo, SP, Brazil; University Hospital of Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
| |
Collapse
|
18
|
Costa DB, Anselmo-Lima WT, Tamashiro E, Enoki C, Valera FCP. The impact of Metzembaum septoplasty on nasal and facial growth in children. Braz J Otorhinolaryngol 2013; 79:454-9. [PMID: 23929145 PMCID: PMC9442431 DOI: 10.5935/1808-8694.20130081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/27/2013] [Indexed: 11/20/2022] Open
Abstract
Several studies have investigated the effects of septoplasty on facial growth in children, with conflicting results. However, just handful of those employed objective measures or evaluated patients after facial growth completion. Objective This study assesses the effects of the Metzenbaum septoplasty, which preserves the perichondrium and growth-related areas on nasal and facial growth in children. Method We included those children submitted to surgery before the age of 14 and who had 16 years or years of follow up. Sixteen patients were selected. We evaluated the following parameters: clinical satisfaction (nasal patency and aesthetics), anthropometric measurements and cephalometry. Scientific design: cross-sectional historical cohort. Results The mean age at surgery was 13 years, children were assessed on average 4.3 years after surgery. Only one patient had anthropometric and cephalometric values below normal, but no aesthetics or patency complaints. Four other patients complained about their nasal aesthetics and three had patency complaints. Conclusion The Metzenbaum septoplasty appears to be a safe technique to correct caudal septum deviations. This technique had no significant impact on facial growth of the patients assessed.
Collapse
Affiliation(s)
- Denise Barreiro Costa
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes no. 3900, Ribeirão Preto - SP, Brazil
| | | | | | | | | |
Collapse
|
19
|
Abstract
OBJECTIVES Controversy has surrounded the procedure of pediatric septoplasty since the 1950s due to concerns over an adverse effect on nasal and facial growth. However, more recent evidence has demonstrated that septoplasty can be safely performed without affecting nasal and facial development in the appropriately selected pediatric patient. The purpose of this article is to establish the impact of pediatric septoplasty on nasal and facial growth and review the clinical indications and evidence for timing of surgery according to the most recent literature. METHODS A structured review of the PubMed, Ovid Medline and Cochrane Collaboration databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews) was undertaken, using the terms: pediatric, childhood, septoplasty, nasal septum, indications, nasal growth and facial growth. RESULTS Three long term follow up studies using anthropometric measurements were identified which concluded that pediatric septoplasty does not interfere with normal nasal or facial development. A further similar study concluded that external septoplasty does not affect most aspects of nasal and facial growth, but may negatively influence growth of the nasal dorsum. Furthermore, one study demonstrated that a group of children with symptomatic uncorrected deviated nasal septum had a statistically significant increased occurrence of facial and dental anomalies compared with age and sex matched controls, therefore supporting a role for septoplasty. CONCLUSIONS Evidence exists to support that pediatric septoplasty can be performed without affecting most aspects of nasal and facial growth. Furthermore, not performing or delaying septoplasty when indicated may adversely affect nasal and facial growth with compounding adverse effects in terms of deformity and 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.
Collapse
|
20
|
Abstract
As a component of the chondrocranium, the nasal septum influences the anteroposterior dimensions of the facial skeleton. The role of the septum as a facial growth center, however, has been studied primarily in long-snouted mammals, and its precise influence on human facial growth is not as well understood. Whereas the nasal septum may be important in the anterior growth of the human facial skeleton early in ontogeny, the high incidence of nasal septal deviation in humans suggests the septum's influence on human facial length is limited to the early phases of facial growth. Nevertheless, the nasal septum follows a growth trajectory similar to the facial skeleton and, as such, its prolonged period of growth may influence other aspects of facial development. Using computed tomography scans of living human subjects (n = 70), the goal of the present study is to assess the morphological relationship between the nasal septum and facial skeleton in European- and African-derived populations, which have been shown to exhibit early developmental differences in the nasal septal-premaxillary complex. First we assessed whether there is population variation in the size of the nasal septum in European- and African-derived samples. This included an evaluation of septal deviation and the spatial constraints that influence variation in this condition. Next, we assessed the relationship between nasal septal size and craniofacial shape using multivariate regression techniques. Our results indicate that there is significant population variation in septal size and magnitude of septal deviation, both of which are greater in the European-derived sample. While septal deviation suggests a disjunction between the nasal septum and other components of the facial skeleton, we nevertheless found a significant relationship between the size of the nasal septum and craniofacial shape, which appears to largely be a response to the need to accommodate variation in nasal septal size.
Collapse
Affiliation(s)
- Nathan E Holton
- Department of Orthodontics, University of Iowa, Iowa City, IA, USA.
| | | | | |
Collapse
|
21
|
El-Ahl MAS, El-Anwar MW. Stentless endoscopic transnasal repair of bilateral choanal atresia starting with resection of vomer. Int J Pediatr Otorhinolaryngol 2012; 76:1002-6. [PMID: 22542285 DOI: 10.1016/j.ijporl.2012.03.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/18/2012] [Accepted: 03/20/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the results of a transnasal endoscopic repair of congenital choanal atresia beginning by resection of the posterior portion of the vomer and ending by no stent. METHODS Seven patients with bilateral congenital choanal atresia aged ranging from 3 to 15 days were operated upon between June 2009 and September 2011. This transnasal endoscopic approach allowed resection of the posterior portion of the vomer first then the atretic plates and part of the medial pterygoid plate if needed leaving no stent. Postoperative control included office fiberoptic nasal endoscopy. RESULTS Adequate functional nasal breathing was maintained in all patients during follow up of 11 to 23 months. Apart from one case that complicated by palatal defect, no any other complications were detected. CONCLUSION The described technique was proved to be very effective, allowing fast recovery, and one step surgery with early discharge from hospital using neither stents nor nasal packing. Good patency with no reduction in functional quality was also observed.
Collapse
|
22
|
Verwoerd CDA, Verwoerd-Verhoef HL. Rhinosurgery in children: developmental and surgical aspects of the growing nose. GMS Curr Top Otorhinolaryngol Head Neck Surg 2011; 9:Doc05. [PMID: 22073109 PMCID: PMC3199823 DOI: 10.3205/cto000069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The anatomy of the nasal skeleton in newborns and adults are not alike. The complete cartilaginous framework of the neonatal nose becomes partly and gradually ossified during the years of growth and is more vulnerable to trauma in that period. Injury in early youth may have large consequences for development and may result in a nasal deformity which will increase during growth and reach its peak during and after the adolescent growth spurt. To understand more of the underlying problems of nasal malformations and their surgical treatment (septorhinoplasty) these items became the focus of multiple animal studies in the last 40 years. The effects of surgery on the nasal septum varied considerably, seemingly depending on which experimental animal was used. In review, however, the very different techniques of the experimental surgery might be even more influential in this respect. Study of one of the larger series of experiments in young rabbits comprised skeletal measurements with statistical analysis, and microscopic observations of the tissues. The behaviour of hyaline cartilage of the human nose appeared to be comparable to that of other mammals. Cartilage, although resilient, can be easily fractured whereas its tendency to integrated healing is very low, even when the perichondrium has been saved. Also surgical procedures - like in septoplasty - may result in growth disturbances of the nasal skeleton like recurrent deviations or duplicature. Loss of cartilage, as might occur after a septum abscess, is never completely restored despite some cartilage regeneration. In this article experimental studies are reviewed and compared.Still there remains a lack of consensus in the literature concerning the developmental effects of rhinosurgry in children.Based on their observations in animals and a few clinical studies, mostly with small numbers of patients but with a long follow-up, the authors have compiled a list of guidelines to be considered before starting to perform surgery on the growing midface in children.
Collapse
Affiliation(s)
- Carel D A Verwoerd
- Department of Otorhinolaryngology, ErasmusMC, Erasmus University, Rotterdam, The Netherlands
| | | |
Collapse
|
23
|
Holton NE, Franciscus RG, Marshall SD, Southard TE, Nieves MA. Nasal septal and premaxillary developmental integration: implications for facial reduction in Homo. Anat Rec (Hoboken) 2010; 294:68-78. [PMID: 21157917 DOI: 10.1002/ar.21288] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 09/02/2010] [Accepted: 09/02/2010] [Indexed: 11/06/2022]
Abstract
The influence of the chondrocranium in craniofacial development and its role in the reduction of facial size and projection in the genus Homo is incompletely understood. As one component of the chondrocranium, the nasal septum has been argued to play a significant role in human midfacial growth, particularly with respect to its interaction with the premaxilla during prenatal and early postnatal development. Thus, understanding the precise role of nasal septal growth on the facial skeleton is potentially informative with respect to the evolutionary change in craniofacial form. In this study, we assessed the integrative effects of the nasal septum and premaxilla by experimentally reducing facial length in Sus scrofa via circummaxillary suture fixation. Following from the nasal septal-traction model, we tested the following hypotheses: (1) facial growth restriction produces no change in nasal septum length; and (2) restriction of facial length produces compensatory premaxillary growth due to continued nasal septal growth. With respect to hypothesis 1, we found no significant differences in septum length (using the vomer as a proxy) in our experimental (n = 10), control (n = 9) and surgical sham (n = 9) trial groups. With respect to hypothesis 2, the experimental group exhibited a significant increase in premaxilla length. Our hypotheses were further supported by multivariate geometric morphometric analysis and support an integrative relationship between the nasal septum and premaxilla. Thus, continued assessment of the growth and integration of the nasal septum and premaxilla is potentially informative regarding the complex developmental mechanisms that underlie facial reduction in genus Homo evolution.
Collapse
Affiliation(s)
- Nathan E Holton
- Department of Orthodontics, University of Iowa, Iowa City, Iowa 52242, USA.
| | | | | | | | | |
Collapse
|
24
|
Abstract
Endochondral ossification at the caudal junctions of the cartilaginous nasal septum, in combination with interstitial expansion of the septum, is thought to displace the facial skeleton away from the neurocranium. However, the rate of endochondral ossification has not been measured or related to rates of septal enlargement. This study examined endochondral ossification at these junctions in mice from postnatal days 0-15, in the context of known cranial growth sites, the synchondroses. BrdU labeling was used to compare cell division at the septoethmoidal and septopresphenoidal junctions with cell division at the synchondroses, and double-fluorochrome labeling was used to measure mineralization rate. The results showed that the septoethmoidal and septopresphenoidal junctions develop the characteristic morphology of growth plates postnatally, and that the pattern of cell division is similar to that of synchondroses. Mineralization at these junctions occurred at rates that were not statistically different from those of the synchondroses. However, the cartilaginous septum increased in length much more rapidly than could be explained by caudal growth, implying that interstitial expansion is the more important contributor to septal growth.
Collapse
|