Septoplasty in children Cingi, Cemal; Muluk, Nuray Bayar; Ulusoy, Seckin ...
American journal of rhinology & allergy,
2016 Mar-Apr, 2016-03-00, 20160301, Volume:
30, Issue:
2
Journal Article
Peer reviewed
Physicians have long had concerns about the potential harmful effects of pediatric septoplasties on the nasoseptal growth process because septal cartilage is important for the growth and development ...of the face.
In this review article, pediatric septoplasty and its indications are discussed, together with a literature survey. In addition, overviews of development of the nasal skeleton from neonate to adult, nasal growth, and cartilaginous septum are presented. Important issues and comments on pediatric septoplasties are provided.
During septoplasty procedures, elevation of the mucoperichondrium unilaterally or bilaterally does not negatively affect growth of the face. Stabilization of the septum may be easier when mucosal elevation is performed unilaterally. The nasal floor mucosa should not be elevated so to avoid damage to the incisive nerves. Corrections and limited excisions may be done from the cartilaginous septum. Separation of the septal cartilage from the perpendicular plate, especially at the dorsal part, should not be performed because this area is important for the length and height of the nasal septum and nasal dorsum. Incisions or excisions should not be performed through the growing and supporting zones, especially at the sphenoethmoid dorsal zone.
If there are severe breathing problems related to the septal deviation, septoplasty should be performed. In the majority of cases, septal surgery may be conducted in 6-year-old children. However, if necessary, septal surgery may be performed in younger children and even at birth.
The first attempts to systematize septal distortions have been given by Cottle who defined four groups of septal deformities: subluxation, large spurs, caudal deflection and tension septum. ...Fortunately, the variations of the septal deformities show a certain order, thus enabling more precise classification. Mladina was the first to make user-friendly classification of septal deformities in six basic types. He also described the seventh type, named "Passali deformity", which presents individually, but is always a well-defined combination between some of the previous six types. Mladina types of septal deformities (SD) are divided in two main groups: so called "vertical" deformities (types 1, 2, 3 and 4), and "horizontal" ones (types 5 and 6). This classification was immediately well accepted by rhinologists worldwide and started to be cited from the very beginning. Since then it has been continuously cited increasingly more often, thus making Mladina classification a gold standard whenever clinical researches on nasal septum are concerned. More than forty clinical studies based on this classification have been performed to date. It is extremely important to make a strict distinction between the types of SD since all of them play some specific role in the nasal and general physiology in man.
We prospectively evaluated the efficacy of hyaluronic acid (HA) as an adjuvant treatment to hasten the improvement of nasal respiration and to minimize patients' discomfort in the postoperative ...radiofrequency volumetric tissue reduction (RFVTR) of inferior turbinates.
We enrolled 57 patients randomly assigned into two groups, HA (22 patients) and saline group (35 patients), which received isotonic saline nasal irrigation. We used the monopolar device somnoplasty for all patients. Visual analogic scale (VAS) and nasal endoscopy were used to assess the outcomes of the treatments during the 1st month of follow-up.
The mean VAS score of the HA group at the 1st week was significantly lower than the control group (3.36 ± 1.89 versus 6.95 ± 1.52; p < 0.05). The VAS score remained significantly lower in the HA group also at the 2nd week (3.43 ± 1.27 versus 5.75±1.39; p < 0.05), becoming similar to the control group at the 4th week (p = ns). Since the first visit the HA group also showed significantly lower crust score than the saline group (p < 0.05), and there was no crust found in either group at the last visit. The compliance to treatment was similar in both groups.
The results of this prospective study suggest a role of HA as a supportive treatment for faster improvement of nasal respiration, also minimizing patients' discomfort in postoperative nasal surgery, promoting nasal mucosa healing in postoperative RFVTR for inferior turbinate hypertrophy.
Staphylococcus aureus secretes numerous exotoxins which may exhibit superantigenic properties. Whereas the virulence of several of them is well documented, their exact biological effects are not ...fully understood. Exotoxins may influence the immune and inflammatory state of various organs, including the sinonasal mucosa: their possible involvement in chronic rhinosinusitis has been suggested and is one of the main trends in current research. The aim of this study was to investigate whether the presence of any of the 22 currently known staphylococcal exotoxin genes could be correlated with chronic rhinosinusitis.
We conducted a prospective, multi-centred European study, analysing 93 Staphylococcus aureus positive swabs taken from the middle meatus of patients suffering from chronic rhinosinusitis, with or without nasal polyposis, and controls. Strains were systematically tested for the presence of the 22 currently known exotoxin genes and genotyped according to their agr groups. No direct correlation was observed between chronic rhinosinusitis, with or without nasal polyposis, and either agr groups or the presence of the most studied exotoxins genes (egc, sea, seb, pvl, exfoliatins or tsst-1). However, genes for enterotoxins P and Q were frequently observed in nasal polyposis for the first time, but absent in the control group. The number of exotoxin genes detected was not statistically different among the 3 patient groups.
Unlike many previous studies have been suggesting, we did not find any evident correlation between staphylococcal exotoxin genes and the presence or severity of chronic rhinosinusitis with or without nasal polyposis.
BACKGROUND. Crista galli is an anatomical structure localized in the midline, that derives from the ethmoid bone, with a compact bone structure, sometimes pneumatized. The connection between the ...pneumatized crista galli and the adjacent paranasal structures is usually performed through an opening similar with a sinusal ostium.
MATERIAL AND METHODS. We performed a retrospective clinical study about the incidence of the pneumatization of crista galli in 196 patients with chronic sinusitis. We evaluated the degree of pneumatization and the drainage pathways of crista galli, trying to correlate the radiological findings with the symptomatology of the patients with crista galli “sinusitis”.
RESULTS. Pneumatization of crista galli was found in 30.1% of cases. From 59 patients with chronic rhinosinusitis and pneumatized crista galli, 66.4% had no opacification, 23.7% various degrees of opacification and 11.9% showed complete opacification. The presence of an opening of the pneumatized crista galli into surrounding air-cells was found in 16.98% of the patients. Headache was encountered in 76.2% of the patients with CRS and pneumatized crista galli sinusitis.
CONCLUSION. When analyzing a CT scan of a patient with CRS, we should also take into consideration the pneumatization of crista galli, which has a high variability. Most of the patients included in our study had also a certain degree of opacification of the pneumatized crista galli. Headache had a higher incidence in patients with crista galli inflammation than in CRS patients who showed no pneumatization or opacification of the crista galli (76.2% versus 60.5% in “simple” CRS patients).
Structured training in endonasal endoscopic sinus surgery (EESS) and skull base surgery is essential considering serious potential complications. We have developed a detailed concept on training ...these surgical skills on the lamb's head. This simple and extremely cheap model offers the possibility of training even more demanding and advanced procedures in human endonasal endoscopic surgery such as: frontal sinus surgery, orbital decompression, cerebrospinal fluid-leak repair followed also by the naso-septal flap, etc. Unfortunately, the sphenoid sinus surgery cannot be practiced since quadrupeds do not have this sinus. Still, despite this anatomical limitation, it seems that the lamb's head can be very useful even for the surgeons already practicing EESS, but in a limited edition because of a lack of the experience and dexterity. Only after gaining the essential surgical skills of this demanding field it makes sense to go for the expensive trainings on the human cadaveric model.
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