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A study of anthropometric measures before and after external septoplasty in children: a preliminary study
H El-Hakim1, W S Crysdale, M Abdollel
1Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada. helhakim@aol.com
Insights
Nasal septal surgery in children, involving cartilage removal and reinsertion, does not negatively impact facial development. This study challenges the notion that nasal surgery must always be avoided in pediatric patients.
Area of Science:
- Plastic Surgery
- Otolaryngology
- Pediatric Surgery
Background:
- Skeletal septal deformities in children can cause significant nasal obstruction and cosmetic issues.
- Previous beliefs suggested that any nasal surgery in children could adversely affect facial growth.
Purpose of the Study:
- To evaluate the long-term effects of nasal septal surgery on the developing midface and nasal dimensions in children.
- To test the hypothesis that surgical intervention does not hinder normal facial growth.
Main Methods:
- A paired study design was employed with 26 children undergoing nasal septal surgery.
- The intervention involved external approach surgery with excision, remodeling, and reinsertion of quadrilateral cartilage as a free graft.
- Anthropometric measurements of the nose and face were taken preoperatively and postoperatively, with data analyzed using statistical tests.
Main Results:
- Postoperative measurements showed no clinically significant adverse effects on nasal and midfacial dimensions.
- While minor statistically significant changes were noted in nasal dorsum length and tip protrusion, they were not considered detrimental to overall facial development.
- Relative to age-matched norms, the dimensions and proportionality of the nose and midface remained unchanged after surgery.
Conclusions:
- Nasal septal surgery, when performed with excision and reinsertion of remodeled cartilage, does not impede the normal development of the nose and midface.
- The findings suggest that the long-held belief of avoiding nasal surgery in children may be overly cautious and warrants re-evaluation.
Objective:
To test the hypothesis that surgery on the growing nasal septum does not adversely affect nasal and midfacial dimensions.
Design:
Paired study.
Setting:
Tertiary care center.
Participants:
Children treated consecutively during a 4-year period; all had significant nasal obstruction and cosmetic disfigurement secondary to skeletal septal deformities.
Intervention:
Nasal septal surgery (using an external approach), in which the quadrilateral cartilage was removed, remodeled, and reinserted as a free graft.
Outcome Measures:
Anthropometric linear measurements and indexes of the face and nose preoperatively and postoperatively; nasal dorsum length, nasal height, nasal dorsum index, nasal tip protrusion, columellar length, facial height, face width, upper face height, facial index, nose-upper face height index, and columellar length-nasal tip protrusion index. Continuous measurements were transformed into ordered categories with reference to normative data. Data were analyzed using Wilcoxon signed rank sum test (alpha level of.05) and by applying the Bonferroni adjustment for multiple testing.
Results:
Twenty-six children were studied (12 females and 14 males); age at surgery ranged from 4.5 to 15.5 years (mean age, 9.5 years); average age at postoperative measurement, 12.5 years; mean follow-up, 3.1 years. Only nasal dorsum length (P =.007) and nasal tip protrusion (P =.04) were decreased by a statistically significant level before the Bonferroni adjustment. The change was not considered clinically significant. Thus, relative to age-appropriate norms, the dimensions of the nose and midface and their proportionality did not change after surgery.
Conclusions:
Appropriate nasal septal surgery involving excision and subsequent reinsertion of a remodeled segment of the quadrilateral cartilage has no deleterious effects on development of the nose and midface. We question the absolute dogma that nasal surgery in children must always be avoided.
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