Corrective nasal surgery in the younger patient

摘要

IMPORTANCE To describe clinical parameters for the management of the pediatric patient with nasal anatomical deformity or functional impairment. OBJECTIVES To review the authors' experience with corrective nasal surgery in pediatric patients and make recommendations regarding indications for surgery and surgical techniques. DESIGN, SETTING, AND PARTICIPANTS A retrospective medical chart reviewwas performed for all male patients younger than 16 years and female patients younger than 14 years seen by the senior author (F.G.F.) at a tertiary referral center between August 1996 and August 2012. The database was searched for patients who underwent septoplasty or corrective nasal surgery by the senior author. EXPOSURES Patients included in the study underwent either septoplasty or corrective nasal surgery by the senior author. MAIN OUTCOMES AND MEASURES Age, indication for surgery, surgery performed, and last follow-up appointment was recorded for each patient. In addition, any complications or need for revision surgical or adjunct procedures were noted. RESULTS Demographics and outcomes for 54 pediatric patients were included in the study. The most common indications for surgery were posttraumatic deformities (n = 36) and severe airway obstruction (n = 48). Fifteen patients with severe nasal airway obstruction did not have a documented history of trauma. The mean follow-up period was 646 days (approximately 21 months), with a range of 8 to 4062 days. Five patients underwent a staged procedure, and no patients underwent a revision procedure for unsatisfactory results. CONCLUSIONS AND RELEVANCE Children with nasal obstruction and deformity can safely undergo nasal corrective surgery prior to adolescence. Special considerations include preserving normal structures and the judicious use of grafts. The recommended approaches to managing the pediatric septoplasty and nasal surgery patient are described herein through a series of representative cases.