Rhinochirurgie bei Kindern: Entwicklungsphysiologische und chirurgische Aspekte der wachsenden Nase

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 the early youth may have large consequences for development of 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 treatment (septoplasty) 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, it appeared that the very different techniques of 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 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 deviation or nasal spine. Loss of cartilage, as might occur after a septum abscess, is never completely restored despite some cartilage regeneration. In this article the many experimental studies are reviewed and compared. Still there remains a lack of real 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.

Demystifying Septoplasty in Children

“…Thus, the studies found in the literature, 1 2 3 4 5 6 7 8 9 10 whether anthropometric or clinical trials, corroborated our findings that septoplasty in children allows appropriate craniofacial growth and development, prevents abnormalities in somatic and psychic component of the patient, as well as demystifies the concept that septoplasty should only be performed after the age of 17 to 18 years old.…”

“… 2 Dispenza et al 3 stated that more important than the age of indication for the procedure is the degree of nasal obstruction, placing it as an absolute indication, because nasal obstruction during infancy disrupts the normal development of the angle of the skull base and consequently the maxillofacial growth and may cause malocclusion and jaw protrusion with bone deformities, confirmed even with anthropometric measurements. Others 4 5 6 7 also claimed that delay defect correction can bring negative effect on organ systems that play a role in somatic and psychic development of the child including voice changes and sleep disturbances, but speculated that in some situations monitoring should be done for real indication for surgical treatment. A study performed with 44 patients aged between 8 and 12 years old who underwent septal surgery (reconstructive rhinoplasty) showed efficacy in relation to nasal obstruction and demonstrated that surgery when performed conservatively does not harm the facial growth or promote nasal deformities.…”

Epidemiology of violence in pediatric and adolescent nasal fracture compared with adult nasal fracture: An 8-year study

“…The sphenodorsal zone, which extends from the sphenoid to the nasal dorsum, is believed to be responsible for the growth of the length and height of the nasal dorsum. Conversely, the sphenospinal zone, which extends from the sphenoid to the anterior nasal spine, appears to control the outgrowth of the maxilla [17]. Septal injury may cause permanent facial deformity by disrupting the growth of the center of the face [18].…”

Justification for Rhinoseptoplasty in Children – Our 10 Years Overview

“…Patient (child) and parents should be informed of the potential benefits of the surgery, and of continuing a follow-up of the facial growth till after the adolescent growth spurt [ 15 , 16 ] ( Fig. 2 ).…”