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Septum surgery in children; indications, surgical technique and long-term results
Insights
Septum surgery in children is recommended for breathing problems at rest, but exercise-induced difficulties require considering age and other factors. Untreated deformities without symptoms are left alone, though surgery can prevent growth issues.
Area of Science:
- Pediatric Otolaryngology
- Rhinology
Background:
- Septal deformities in children can impact respiration and nasal development.
- Surgical intervention decisions for pediatric septal deviations require careful consideration of various factors.
Observation:
- Over 150 pediatric patients underwent septum surgery between 1963 and 1978, with many available for follow-up.
- Indications for surgery ranged from breathing problems at rest to acute conditions like septal hematomas.
- Long-term follow-up of a patient operated on at age 4 revealed normal nasal development until puberty, followed by a growth disturbance.
Findings:
- Conservative septum surgery is indicated for resting breathing problems, irrespective of age.
- Decision-making for exercise-induced breathing difficulty involves age, external nasal deformity, and psychological factors.
- Septal deformities without functional complaints are managed conservatively, while acute conditions necessitate surgery.
- Preventing growth deformities can be a factor in surgical decision-making.
Implications:
- Establishes criteria for pediatric septum surgery based on functional and developmental considerations.
- Highlights the potential for growth disturbances post-puberty even after successful early childhood surgery.
- Informs surgical decision-making for pediatric nasal septum deviations to optimize functional outcomes and minimize growth impact.
Abstract:
This paper summarizes the author's experience with septum surgery in children from 1963 to 1978. Some 150 children have been operated upon and many of them could be followed up. A septal deformation with breathing problems at rest is an indication for conservative surgery regardless of the patient's age. If there is only breathing difficulty during exercise, other factors (age, external deformity, psyche) play a role in making the decision. Septal deformities without functional complaints are left untouched. The prevention of a growth deformity can be a concomitant factor in deciding whether to operate. Fresh fractures, septal haematoma's and abscesses are undisputable indications for surgery. The surgical technique as used in the two most frequent types of deformation is described. A boy operated upon at the age of 4 was followed-up over a period of 15 years. His nose developed normally until puberty. Then some growth disturbance became apparent.