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Sinus and facial growth after pediatric endoscopic sinus surgery
E A Mair1, W E Bolger, E A Breisch
1Clinical Investigation Facility, Wilford Hall US Air Force Medical Center, San Antonio, Tex, USA.
Insights
Functional endoscopic sinus surgery (FESS) may impact facial growth in children. Piglet studies show reduced growth after FESS, suggesting further research is needed for pediatric patients.
Area of Science:
- Otolaryngology
- Pediatric surgery
- Craniofacial development
Background:
- Facial skeletal growth is a complex process influenced by various factors.
- Functional endoscopic sinus surgery (FESS) is a common procedure for pediatric sinonasal conditions.
- The potential impact of FESS on facial growth in children remains incompletely understood.
Purpose of the Study:
- To investigate the effects of functional endoscopic sinus surgery (FESS) on facial skeletal growth in pediatric patients.
- To evaluate the influence of FESS on sinus development in a preclinical animal model.
- To analyze the histologic characteristics of bone in pediatric FESS specimens.
Main Methods:
- A prospective randomized controlled animal study using piglets undergoing unilateral FESS.
- Computed tomography (CT) was used to compare facial and sinus development between surgical and nonsurgical sides in piglets.
- Retrospective histopathologic examination of paranasal sinus bone from pediatric FESS specimens.
Main Results:
- Piglets undergoing FESS exhibited significantly reduced facial growth on the surgical side, with maxillary sinus growth at 57% and ethmoid region growth at 65% compared to the nonsurgical side.
- Histologic analysis revealed that children younger than 9 years had immature (woven) bone, while those 9 years and older predominantly had mature (lamellar) bone.
- These findings suggest a potential link between FESS and impaired craniofacial development.
Conclusions:
- Even limited FESS in the anterior ethmoid region can adversely affect sinus and facial growth in developing animals.
- The study highlights the need for further investigation into potential facial and sinus growth disturbances following FESS in children.
- Understanding the age-related bone maturity is crucial when considering surgical interventions in pediatric patients.
Objective:
To determine the effect of functional endoscopic sinus surgery (FESS) on facial skeletal growth in children.
Design:
Prospective randomized controlled animal study; retrospective histopathologic study of pediatric FESS specimens.
Setting:
Academic tertiary referral medical center.
Participants:
Eight newly weaned piglets; uncinate and ethmoid bone of FESS specimens from 84 children.
Interventions:
The piglets underwent unilateral FESS. When they had developed to nearly adult size, computed tomography was used to compare facial and sinus development between the surgical and nonsurgical sides. The paranasal sinus contents from children were histologically examined to analyze bone types with respect to patient age.
Outcome Measures:
Sinus development and facial skeletal growth after FESS in piglets; histologic maturity of sinus bone in children.
Results:
Facial growth in piglets was significantly reduced on the side treated by FESS. When compared with the side that did not undergo the operation, growth reached only 57% in the maxillary sinus and 65% in the ethmoid region. Children younger than 9 years had woven (immature) bone; children 9 years and older had predominantly lamellar (mature) bone.
Conclusions:
This preliminary study shows that even limited surgery in the anterior ethmoid region can affect sinus and facial growth in the piglet. Review of corresponding human histologic specimens suggests that further investigation is warranted to rule out the possibility of facial and sinus growth disturbance after this surgery in children.