ORIGINAL RESEARCH
Septoplasty in Pediatric Population: A Five Years' Experience
Pediatrik Septoplasti: 5 Yıllık Tecrübemiz
Received Date : 06 Apr 2021
Accepted Date : 30 Jul 2021
Available Online : 13 Aug 2021
Yaşar Kemal DUYMAZa, Serap ŞAHİN ÖNDERa, Özgül GERGİN TİNAYb, Ahmet Adnan CIRIKa, Furkan BAYRAMa
aSağlık Bilimleri Üniversitesi, Ümraniye Eğitim ve Araştırma Hastanesi, Kulak Burun Boğaz Kliniği, İstanbul, TÜRKİYE
bMedipol Üniversitesi Hastanesi, Kulak Burun Boğaz Hastalıkları ABD, İstanbul, TÜRKİYE
Doi: 10.24179/kbbbbc.2021-83389 - Makale Dili: TR
KBB ve BBC Dergisi. 2021;29(4):249-53
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: Deviation of the nasal septum is a common
cause of nasal obstruction in pediatric population. Septal deviation is associated
with malocclusion, asymmetric facial enlargement, chronic
rhinosinusitis, sleep apnea. Resection from growing zones and wide resection
from cartilaginous septum should be avoided. In this study, we
aim to report our experience in surgical treatment of nasal septal deviation
in the pediatric population. Material and Methods: A retrospective
chart review of 93 pediatric patients underwent septoplasty at
Ümraniye Training and Research Hospital between 2015-2020 years
was carried out. Patients who had underwent aesthetic septorhinoplasty
surgery were excluded from this study. Patients’ demographic data, preoperative
indications, surgical technique, type of anesthesia, perioperative
and postoperative complications were recorded. Results:
Ninety-three patients were included in our study. Their mean age was
15.9±2.28 and 20 (21.5%) patients were females and 73 (78.5%) were
males. Indications for procedure were deviation of nasal septum (85
patients), nasal mass (7 patients) and septal abscess (1 patient). 51 patients
were operated under general anesthesia and 42 patients were operated
under local anesthesia with sedation. Postoperative complications
include deviation or residual crest (4 patients), synechiae (1
patient), hemorrhage (1 patient) and nasal vestibulitis (1 patient). Conclusion:
We conclude that pediatric septoplasty is a relatively safe procedure
when correction and limited resection from cartilaginous septum
and avoid resection from growing zones.
Keywords: Pediatric; nasal septum deviation; septoplasty
ÖZET
Amaç: Septum deviasyonu, pediatrik yaş grubunda nazal obstrüksiyonun
en önemli nedenleri arasında yer almaktadır. Pediatrik popülasyonda
septal deviasyon; maloklüzyon, asimetrik fasiyal büyüme,
kronik rinosinüzit, uyku apnesi gibi multisistemik bozukluklara neden
olmaktadır. Pediatrik septoplasti ameliyatında büyüme noktalarına müdahaleden
kaçınılması ve sınırlı kartilaj rezeksiyonu yapılması gerekmektedir.
Bu çalışmamızda, pediatrik septum deviasyonun temel
tedavisi olan septoplasti deneyimlerimizi ve sonuçlarımızı sunmayı
amaçladık. Gereç ve Yöntemler: Bu çalışma, Ümraniye Eğitim ve
Araştırma Hastanesinde 2015 ve 2020 yılları arasında septoplasti ameliyatı
yapılan pediatrik yaş grubundaki 93 hastanın dosyaları retrospektif
olarak incelenerek yapılmıştır. Estetik amaçlı septorinoplasti
ameliyatı olan hastalar bu çalışmaya dâhil edilmedi. Hastaların demografik
bilgileri, preoperatif endikasyonları, cerrahi tekniğin detayları,
anestezi şekli, peroperatif ve postoperatif komplikasyonlar kaydedildi.
Bulgular: Çalışmaya dâhil edilen 93 hastanın yaş ortalaması 15,9±2,28
yıl olup, 20’si (%21,5) kadın, 73’ü (%78,5) erkekti. Hastaların 85 tanesi
septal deviasyon endikasyonu ile 1 tanesi septal apse ve septal deviasyon
tanısıyla 7 tanesi ise nazal kitle ve septal deviasyon endikasyonu ile
ameliyat edildi. Hastaların 51 tanesi genel anestezi altında opere edilirken,
42 tanesi sedasyon altında lokal anestezi ile opere edildi. Ameliyat
sonrası takiplerde 4 hastada deviasyon veya rezidü kret
saptanırken, 1 hastada sineşi, 1 hastada kanama ve 1 hastada nazal vestibülit
saptandı. Sonuç: Çalışmamızda, pediatrik septoplastinin büyüme
noktalarına müdahaleden kaçınıldığında ve sınırlı kartilaj rezeksiyonu
yapıldığında güvenli bir cerrahi olduğu ortaya konmuştur.
Anahtar Kelimeler: Pediatrik; nazal septum deviasyonu; septoplasti
KAYNAKLAR
- Calvo-Henríquez C, Neves JC, Arancibia-Tagle D, Chiesa-Estomba C, Lechien JR, Mayo-Yá-ez M, et al. Does pediatric septoplasty compromise midfacial growth? A systematic review. Eur Arch Otorhinolaryngol. 2020;277(6):1565-74. [Crossref] [PubMed]
- Liu C, Legocki AT, Mader NS, Scott AR. Nasal fractures in children and adolescents: Mechanisms of injury and efficacy of closed reduction. Int J Pediatr Otorhinolaryngol. 2015; 79(12):2238-42. [Crossref] [PubMed]
- Subarić M, Mladina R. Nasal septum deformities in children and adolescents: a cross sectional study of children from Zagreb, Croatia. Int J Pediatr Otorhinolaryngol. 2002;63(1):41-8. [Crossref] [PubMed]
- Zimmermann CE, Troulis MJ, Kaban LB. Pediatric facial fractures: recent advances in prevention, diagnosis and management. Int J Oral Maxillofac Surg. 2006;35(1):2-13. [Crossref] [PubMed]
- Gray LP. The development and significance of septal and dental deformity from birth to eight years. Int J Pediatr Otorhinolaryngol. 1983; 6(3):265-77. [Crossref] [PubMed]
- Sparacino J, Hansell S. Physical attractiveness and academic performance: Beauty is not always talent. J Pers. 1979;47(3):449-69. [Crossref]
- Solow B, Siersbaek-Nielsen S, Greve E. Airway adequacy, head posture, and craniofacial morphology. Am J Orthod. 1984;86(3):214-23. [Crossref] [PubMed]
- Bláhová O. Late results of nasal septum injury in children. Int J Pediatr Otorhinolaryngol. 1985;10(2):137-41. [Crossref] [PubMed]
- Pentz S, Pirsig W, Lenders H. Long-term results of neonates with nasal deviation: a prospective study over 12 years. Int J Pediatr Otorhinolaryngol. 1994;28(2-3):183-91. [Crossref] [PubMed]
- Hafezi F, Naghibzadeh B, Nouhi A, Yavari P. Asymmetric facial growth and deviated nose: a new concept. Ann Plast Surg. 2010;64(1): 47-51. [Crossref] [PubMed]
- Vieira BB, Itikawa CE, de Almeida LA, Sander HS, Fernandes RM, Anselmo-Lima WT, et al. Cephalometric evaluation of facial pattern and hyoid bone position in children with obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol. 2011;75(3):383-6. [Crossref] [PubMed]
- Dicker GJ, Castelijns JA, Tuinzing DB, Stoelinga PJ. Do the changes in muscle mass, muscle direction, and rotations of the condyles that occur after sagittal split advancement osteotomies play a role in the aetiology of progressive condylar resorption? Int J Oral Maxillofac Surg. 2015;44(5):627-31. [Crossref] [PubMed]
- Lawrence R. Pediatric septoplasy: a review of the literature. Int J Pediatr Otorhinolaryngol. 2012;76(8):1078-81. [Crossref] [PubMed]
- Latham RA, Scott JH. A newly postulated factor in the early growth of the human middle face and the theory of multiple assurance. Arch Oral Biol. 1970;15(11):1097-100. [Crossref] [PubMed]
- Grymer LF, Pallisgaard C, Melsen B. The nasal septum in relation to the development of the nasomaxillary complex: a study in identical twins. Laryngoscope. 1991;101(8):863-8. [Crossref] [PubMed]
- D'Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N, Manzini M. Craniofacial growth in children with nasal septum deviation: a cephalometric comparative study. Int J Pediatr Otorhinolaryngol. 2010;74(10):1180-3. [Crossref] [PubMed]
- Justicz N, Choi S. When should pediatric septoplasty be performed for nasal airway obstruction? Laryngoscope. 2019;129(7):1489- 90. [Crossref] [PubMed]
- Cingi C, Muluk NB, Ulusoy S, Lopatin A, Şahin E, Passali D, et al. Septoplasty in children. Am J Rhinol Allergy. 2016;30(2):e42-7. [Crossref] [PubMed]
- Christophel JJ, Gross CW. Pediatric septoplasty. Otolaryngol Clin North Am. 2009;42(2): 287-94, ix. [Crossref] [PubMed]
- Vives I, Mateo D, Botana C, Agreda G, Salgado I. Septoplasties with local anesthetic and sedation in ambulatory surgery; clinical outcomes. Curr Opin Anaesthesiol. 2008;25(44): 19. [Crossref]
- Dogan R, Erbek S, Gonencer HH, Erbek HS, Isbilen C, Arslan G. Comparison of local anaesthesia with dexmedetomidine sedation and general anaesthesia during septoplasty. Eur J Anaesthesiol. 2010;27(11):960-4. [Crossref] [PubMed]
- Ketcham AS, Han JK. Complications and management of septoplasty. Otolaryngol Clin North Am. 2010;43(4):897-904. [Crossref] [PubMed]
- Rettinger G, Kirsche H. Complications in septoplasty. Facial Plast Surg. 2006;22(4):289-97. [Crossref] [PubMed]
- Tasca I, Compadretti GC. Nasal growth after pediatric septoplasty at long-term follow-up. Am J Rhinol Allergy. 2011;25(1):e7-12. [Crossref] [PubMed]
- Bae JS, Kim ES, Jang YJ. Treatment outcomes of pediatric rhinoplasty: the Asan Medical Center experience. Int J Pediatr Otorhi nolaryngol. 2013;77(10):1701-10. [Crossref] [PubMed]