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38. [Rhinosurgery in children: developmental and surgical aspects of the growing nose].

Author

Verwoerd CD and Verwoerd-Verhoef HL

Subjects
Adolescent, Animals, Child, Child, Preschool, Humans, Infant, Infant, Newborn, Maxillofacial Development physiology, Nasal Bone injuries, Nasal Bone physiopathology, Nasal Cartilages physiopathology, Nasal Cartilages surgery, Nasal Septum physiopathology, Nasal Septum surgery, Nose injuries, Nose physiopathology, Practice Guidelines as Topic, Rabbits, Risk Factors, Wound Healing physiology, Nose Deformities, Acquired physiopathology, Postoperative Complications physiopathology, Rhinoplasty adverse effects
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.

Published
2010
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