PDF herunterladen
Facial Plast Surg 2007; 23(4): 219-230
DOI: 10.1055/s-2007-995814
© Thieme Medical Publishers

Rhinosurgery in Children: Basic Concepts

Carel D.A Verwoerd1 , Henriette L. Verwoerd-Verhoef1
  • 1Department of Otorhinolaryngology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
18. Dezember 2007 (online)

Auch verfügbar auf
    Lizenzen und Reprints

ABSTRACT

In newborns, the main supporting structure of the nose is the dorsoseptal cartilage, a T-bar-formed complex of septum and upper lateral cartilages, which is essentially an external extension of the cartilage of the anterior cranial base. Later the anatomic situation gradually changes-a potential pitfall for surgeons and radiologists. The vulnerability of various processes underlying postnatal development of the facial skeleton is discussed. The cartilaginous septum is the dominant growth center. Loss of septal cartilage at different ages leads to different facial syndromes involving nose, maxilla, and orbita. The septal cartilage in children demonstrates thinner fracture-prone areas next to thicker growth zones. Septum fractures have a preference for the thinner regions, corresponding with the most frequent septum deviations observed in growing children. The essential problem in pediatric rhinosurgery is not the age-specific anatomy but the poor wound-healing capacity: fractured or transected septum cartilage will not heal, and disconnected ends tend to overlap, resulting in increasing or recurrent deviations. Based on clinical and experimental evidence, indications and “safe” and “unsafe” techniques of rhinosurgery are presented for children of various age groups.

KEYWORDS

Nasal injury - nasal growth - facial growth - pediatric rhinosurgery

REFERENCES

  • 1 Farrior R T, Connolly M E. Septorhinoplasty in children.  Otolaryngol Clin North Am. 1970;  3 345-364
    PubMedSuche in Google Scholar
  • 2 Gross Ch W, Boyle T R. Nasal surgery for congenital and acquired disease. In: Smith JD, Bumsted R Pediatric Facial Plastic Surgery and Reconstructive Surgery. New York; Raven Press 1993: 31-41
    Suche in Google Scholar
  • 3 Stucker Jr F J, Bryarly R C, Shockley W W. Management of nasal trauma in children.  Arch Otolaryngol. 1984;  110 190-192
    CrossrefPubMedSuche in Google Scholar
  • 4 Tardy M E, Broadway D. Septorhinoplasty in the preadolescent. In: Healy G Common problems in Pediatric Otolaryngology. Chicago; Yearbook Medical Public 1990
    Suche in Google Scholar
  • 5 Pirsig W. Open questions in nasal surgery in children.  Rhinology. 1986;  24 37-40
    PubMedSuche in Google Scholar
  • 6 El-Hakim H, Crysdale W S, Abdollei M, Farkas L G. A study of anthropometric measures before and after external septoplasty: a preliminary study in children.  Arch Otolaryngol Head Neck Surg. 2001;  127 1362-1366
    PubMedSuche in Google Scholar
  • 7 Potsic W P, Cotton R T, Handler S D. Nasal deformity. In: Surgical Pediatric Otolaryngology. New York; Thieme Medical Publishers 1997: 168-180
    Suche in Google Scholar
  • 8 Stool S, Marasovich W A. Postnatal craniofacial growth and development. In: Bluestone CD, Stool SE Pediatric Otolaryngology. Philadelphia; WB Saunders 1990: 17-31
    Suche in Google Scholar
  • 9 Loosen van J, Verwoerd-Verhoef H L, Verwoerd C DA. The nasal septal cartilage in the newborn.  Rhinology. 1988;  26 161-165
    PubMedSuche in Google Scholar
  • 10 Poublon R ML, Verwoerd C DA, Verwoerd-Verhoef H L. Anatomy of the upper lateral cartilages in the human newborn.  Rhinology. 1990;  28 41-46
    PubMedSuche in Google Scholar
  • 11 Graber T M. Postnatal development of cranial, facial and oral structures: the dynamics of facial growth. In: Orthodontics: Principles and Practice. Philadelphia; WB Saunders 1966: 69-78
    Suche in Google Scholar
  • 12 Schultz-Coulon H J, Eckermaier L. Zum postnatalen Wachstum der Nasenscheide-wand.  Acta Otolaryngol. 1976;  82 131-142
    CrossrefPubMedSuche in Google Scholar
  • 13 Verwoerd C D, van Loosen J, Schütte H E, Verwoerd-Verhoef H L, van Velzen D. Surgical aspects of the anatomy of the vomer in children and adults.  Rhinology. 1989;  9 87-96
    PubMedSuche in Google Scholar
  • 14 van Loosen J, van Velzen D, Verwoerd-Verhoef H L, Verwoerd C DA. Growth characteristics of the human nasal septum.  Rhinology. 1996;  34 78-82
    PubMedSuche in Google Scholar
  • 15 Takahashi R. The evolution of the nasal septum and the formation of septal deformity.  Rhinology. 1988;  6 1-23
    PubMedSuche in Google Scholar
  • 16 Meeuwis J, Verwoerd-Verhoef H L, Verwoerd C DA. Normal and abnormal nasal growth after partial submucous resection of the cartilaginous septum.  Acta Otolaryngol. 1993;  113 379-382
    CrossrefPubMedSuche in Google Scholar
  • 17 Verwoerd C DA, Mladina R, Nolst Trenité G J, Pigott R W. The nose in children with unilateral cleft lip and palate.  Int J Pediatr Otorhinolaryngol. 1995;  32S 45-52
    PubMedSuche in Google Scholar
  • 18 Verwoerd-Verhoef H L, Verwoerd C DA. Nasal malformations. In: Cauwenberge P van, Wang DY, Ingels K, Bachert C The Nose. The Hague, The Netherlands; Kugler 1998: 335-342
    Suche in Google Scholar
  • 19 Verwoerd C DA, Urbanus N AM, Verwoerd-Verhoef H L. Growth mechanisms in skulls with facial clefts.  Acta Otolaryngol. 1979;  87 335-339
    CrossrefPubMedSuche in Google Scholar
  • 20 Pirsig W. Morphological aspects of the injured septum in children.  Rhinology. 1979;  17 65-76
    PubMedSuche in Google Scholar
  • 21 Pirsig W. The influence of trauma on the growing nose. In: Mladina R, Passali D Pediatric Rhinology. Siena; Tipografia Sense 2000: 145-159
    Suche in Google Scholar
  • 22 Gibson T, Davis W B. The distortion of autogenous cartilage grafts: its cause and prevention.  Br J Plast Surg. 1958;  10 257-274
    PubMedSuche in Google Scholar
  • 23 Fry H. Nasal skeletal trauma and the interlocked stresses of the nasal septal cartilage.  Br J Plast Surg. 1967;  20 146-158
    CrossrefPubMedSuche in Google Scholar
  • 24 Verwoerd C DA, Verwoerd-Verhoef H L, Meeuwis C A. Stress and wound healing of the cartilaginous nasal septum.  Acta Otolaryngol. 1989;  107 441-445
    CrossrefPubMedSuche in Google Scholar
  • 25 Verwoerd-Verhoef H L, ten Koppel P GJ, van Osch G JVM, Meeuwis C A, Verwoerd C DA. Wound healing of cartilage structures in the head and neck region.  Int J Pediatr Otorhinolaryngol. 1998;  43 241-251
    CrossrefPubMedSuche in Google Scholar
  • 26 Duynstee M LG, Verwoerd-Verhoef H L, Verwoerd C DA, van Osch G JVM. The dual role of perichondrium in cartilage wound healing.  Plast Reconstr Surg. 2002;  110 1073-1079
    CrossrefPubMedSuche in Google Scholar
  • 27 van Velzen D, van Loosen J, Verwoerd C DA, Verwoerd-Verhoef H L. Persistent pattern of variations in thickness of the nasal septum: implications for stress and trauma as illustrated by a complex fracture in a 4-year-old boy.  ORL-J Otorhinolaryngol Relat Spec. 1997;  51 46-70
    PubMedSuche in Google Scholar
  • 28 Subaric M, Mladina R. Nasal septum deformities in children and adolescents: a cross sectional study of children from Zagreb, Croatia.  J Pediatr Otorhinolaryngol. 2002;  63 41-48
    PubMedSuche in Google Scholar
  • 29 Verwoerd C DA, Verwoerd-Verhoef H L. Rhinosurgery in children: surgical and developmental aspects. In: Nolst Trenité GJ Rhinoplasty, 3rd ed. The Hague, The Netherlands; Kugler 2005: 201-208
    Suche in Google Scholar
  • 30 Verwoerd C DA, Verwoerd-Verhoef H L. Anatomy and development of the nasal septum in relation to septal surgery in children. In: Sih T, Clement PAR Pediatric Nasal and Sinus Disorders. Boca Raton, FL; Taylor & Francis Group 2005: 127-145
    Suche in Google Scholar
  • 31 ten Koppel P G, van der Veen J M, Hein D et al. Controlling incision-induced distortion of nasal septal cartilage: a model to predict the effect of scoring of rabbit septa.  Plast Reconstr Surg. 2003;  111 1948-1957
    CrossrefPubMedSuche in Google Scholar
  • 32 Nolst Trenité G J, Verwoerd C DA, Verwoerd-Verhoef H L. Reimplantation of autologous septal cartilage in the growing nasal septum, II.  Rhinology. 1988;  26 25-32
    PubMedSuche in Google Scholar
  • 33 Nolst Trenité G J, Verwoerd C DA, Verwoerd-Verhoef H L. Reimplantation of autologous septal cartilage in the growing nasal septum, II.  Rhinology. 1988;  26 25-32
    PubMedSuche in Google Scholar
  • 34 Verwoerd C D, Meeuwis C A, van der Heul R O. Wound healing of the nasal septal perichondrium in young rabbits.  ORL J Otorhinolaryngol Relat Spec. 1990;  52 180-186
    CrossrefPubMedSuche in Google Scholar
  • 35 Verwoerd-Verhoef H L, Meeuwis C A, van der Heul R O, Verwoerd C D. Histologic evaluation of crushed cartilage grafts in the growing nasal septum of young rabbits.  ORL J Otorhinolaryngol Relat Spec. 1991;  53 305-309
    PubMedSuche in Google Scholar
  • 36 Pirsig W, Bean J K, Lenders C DA, Verwoerd C D, Verwoerd-Verhoef H L. Cartilage transformation in a composite graft of demineralized bovine bone matrix and ear perichondrium used in a child for the reconstruction of the nasal septum.  Int J Pediatr Otorhinolaryngol. 1995;  32 171-181
    CrossrefPubMedSuche in Google Scholar
  • 37 ten Koppel P GJ, van Osch G JVM, Verwoerd C D, Verwoerd-Verhoef H L. Efficacy of perichondrium and a trabecular demineralized bone matrix for generating cartilage.  Plast Reconstr Surg. 1998;  102 2012-2020
    PubMedSuche in Google Scholar
  • 38 Verwoerd-Verhoef H L, Bean J K, van Osch G JVM, ten Koppel P GJ, Meeuwis J A, Verwoerd C DA. Induction in vivo of cartilage grafts for craniofacial reconstruction.  Am J Rhinol. 1998;  12 27-31
    CrossrefPubMedSuche in Google Scholar
  • 39 Bos P K, van Osch G JVM, Frenz D A, Verhaar J AN, Verwoerd-Verhoef H L. Growth factor expression in cartilage wound healing: temporal and spatial immunolocalisation in a rabbit auricular cartilage wound model.  Osteoarthritis Cartilage. 2001;  9 382-389
    CrossrefPubMedSuche in Google Scholar

Carel D.A Verwoerd

Kroeskarper 36, 2661 KL Bergschenhoek

The Netherlands