Pediatric septoplasty

1. Pediatric septoplasty Babak Saedi Associate Professor of Tehran University of Medical sciences www:dr.babaksaedi.com

3. www:dr.babaksaedi.com Chronic Mouth Breathing

6. Limitation of articles www:dr.babaksaedi.com

7. HISTORICAL OVERVIEW: ANIMAL STUDIES • Preserving septal mucoperichondrial flaps in young pups did not result in any perceptible growth whether cartilaginous septum was removed or autotransplanted. Interestingly,inseptums from which cartilage was removed, there was evidence of cartilage regrowth at 10 months

8. HISTORICAL OVERVIEW: HUMAN STUDIES • El-Hakim and colleagues followed the anthropometric measurements of children who underwent septoplasty via an external approach with autotransplantation of the quadrilateral cartilage and compared their craniofacial development to that of age-matched control subjects. • There were no deleterious effects on the development of the nose or midface

9. Other literates • The more recent literature mentioned above shows that septoplasty can be performed safely in a selected population using mucoperichondrium- and cartilage-preserving techniques

10. Septoplasty indication • Absolute indications for performing a septoplasty in a pediatric patient include septal abscess, septal hematoma, severe deformity secondary to acute nasal fracture, dermoid cyst, and cleft lip nose

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13. Septal dislocation in neonate • it is accepted that closed reduction is not efficacious in providing long-term relief of adult septal deviation, it can provide lasting results for the pediatric patient when correctly performed.

14. Septal dislocation in neonate • There is no need for splints or nasal packing. If the procedure is unsuccessful, proceed to a surgical septoplasty

15. Imaginary Line • Crysdale's group proposed two approaches. • When the deviation is located caudally and posterior to an imaginary line from the anterior nasal spine to the anterior aspect of the nasal bones, a hemitransfixion incision and limited excision of cartilage, maxillary crest, and vomer is indicated. • If the deviation is anterior to this line, they suggested an open approach removing the whole quadrilateral cartilage and replacing it using its posterior edge, creating a “new” septal midline

16. Open Techniques • Cartilage weakening without resection • Cartilage resection • it is important to consider reimplantation of • the cartilage after appropriate manipulations have been performed to straighten the • cartilage or trim excess length that causes bow in

17. Nasal growth after pediatric septoplasty at long-term follow-up • Pediatric septoplasty may be indicated in selected cases of obstructing nasal septum deformities. The operation, performed via endonasal approach, does not interfere with the normal growing nasal process • American Journal of Rhinology & Allergy

18. continuing article • the obstructive deviation of anterior nasal septum involving the valvular area required total removal of the quadrangular cartilage, • remodeling it outside the body and replacing it.

19. Open rhinoplasty in children. Absolute indications for open rhinoplasty in children include dermoid cyst, cleft lip nose, and septal abscess. Relative indications include septal deviations causing severe nasal airway obstruction and or progressive distortion of the nose Facial Plast Surg. 2007 Nov;23(4):259-66.

20. A Study of Anthropometric Measures Beforeand After External Septoplasty in Children • Appropriate nasal septal surgery involving excision and subsequent reinsertion of a remodeled segment of the quadrilateral cartilage has no deleterious effects on development of the nose and midface Arch Otolaryngol Head Neck Surg. 2001;127:1362-1366