nasal septum deformity in
children
Dr. Sayed Mostafa Hashemi
Figure 1: (a) Facial profile
of a child (1.5 years of
age) and (b) his father (37
years).
Proportional differences in
facial and brain skull of the
father and son.
The infant face shows
smaller vertical
dimensions, less frontal
projection of the nose and
a largernasolabial angle.
Evidence for timing of pediatric
septoplasty
 Be´ jar et al. concluded from their study in the 1990s that they would
encourage children with mild nasal obstruction to wait for surgery until after
the nasal growth process is complete [16].
 They considered this to be age 16 years for boys and age 14 years for girls.
Consequences of conservative
management
 A recent study by D’Ascanio et al. performed a cephalometric study to
compare 98 children (mean age 8.8 years, age range 7–12 years)
 children (due to nasal septum deviations) demonstrate facial and dental
anomalies in comparison to nose-breathing controls [4].
 most septal deformities are bound to worsen after the growth of the nose
and thus can cause or increase sinusitis and infections of the upper airways
and middle ear and obstructive sleep apnea.
Figure 8: (a) 5-year-old girl with
minimal deviation of the nose due to
nasal trauma 1 year previously; (b)
progressive deformity at the age of 8
years and (c) 15 years.
Growth of the nasal septum
 Growth of the nasal septum occurs in two phases, with the cartilaginous septum reaching
adult size by the time the child is 2 years old, and further enlargement due to growth of
the bony septum.16
Figure 3: Radiographs of three anatomic specimens: 10 (a), 17
(b) and 30 (c) years of age. (A) septum cartilage
prevalence of nasal septum deformity in
children
The overall prevalence of nasal septum
deformity in children ranges from 0.93 to 55%
and varies according to age and different types
of nasal septum deformity classifications.1
Etiology
 The increase in age is associated with an increased rate of nasal septum
deformities, probably because of the greater likelihood of suffering
traumatic events.2
 passing through the birth canal can produce a traumatic event to the
nasal septum. In fact, Kawalski and Spiewak found a 22.2% rate of septum
deformity in children born by spontaneous birth, whereas this rate was
reduced to only 3.9% in children born by caesarean birth.
 For this reason, the importance of an early diagnosis of septum deformity in
newborns has been underlined to enable immediate treatment and avoid
possible worsening of respiratory function in adult age.4
Appropriate surgery base on animal study
 in vitro studies appreciated the importance of the muco
perichondrium on the survival of underlying septal cartilage
and its contribution to skeletal growth
 Bernstein showed that submucous resection of cartilage with preservation of a muco
perichondrial flap in young pups did not result in any growth disturbances.
 Functional septoplasty with mucoperichondrium preservation
in ferrets also showed no differences in facial growth on
cephalometric analysis
Clinical studies of pediatric septoplasty
 Results from animal studies provided clinicians with the confidence to
perform septal surgery in children
 An appreciation for preservation of the mucoperichondrium appeared to
be paramount for all surgeons performing this type of surgery.
 no wide cartilaginous resections must be made, the areas of contact
between the septum, the vomer, and the perpendicular lamina of the
ethmoid must be reconstituted, and finally, the remodeled cartilage must
be repositioned.
warning
 Avoid incisions through the growing and supporting zones, in particular of
the (spheno)ethmoido-dorsal zone.
 Posterior chondrotomy or separation of the septum cartilage from the
perpendicular plate (in particular the dorsal part) should be avoided as this
area is of paramount importance for support and further growth (length
and height) of the nasal septum and nasal dorsum;
Effects of different technique on anthropometry
 After separating the patients into two groups,
 those treated by removing and repositioning of the quadrangular cartilage
(external approach/extracorporeal septoplasty)
 those treated by minimal septal resections (conservative endonasal approach),
 it was noted that in both sexes the nasolabial angle of patients undergoing
the extracorporeal septoplasty was significantly lower than that of patients
undergoing conservative septoplasty
 therefore concluded that septoplasty performed by the endonasal
approach does not interfere with the normal nasal growing process
Absolute and relative indications for
pediatric septoplasty [3].
advocating the timing of septal
 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.
 However, before considering pediatric nasal septal surgery, a thorough
clinical examination must be performed to ensure the correct diagnosis has
been made
septal deviations at birth
 A long term follow up study by Sooknundun et al. supported closed
reduction of nasal septal deviations at birth [23]. Results of this study
revealed no untoward effects such as nasofacial disproportion or
retardation of facial growth.
 The authors reported that uncorrected septal deviation is accompanied
by statistically valid symptoms such as upper respiratory tract infections, ear
pain and discharge and that surgical correction of septal deviations at
birth can prevent the need for septoplasty surgery at a later date in
addition to preventing a number of airway related conditions
4. Conclusion
 Numerous long term follow up studies have provided evidence that
pediatric septoplasty can be performed without affecting nasal and facial
growth.
 Studies have also shown that conservative management of deviations of
the nasal septum can lead to facial 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.
