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A Preliminary Study

Hamdy El-Hakim, FRCSEd(Orl); William S. Crysdale, MD, FRCSC; Mohammed Abdollel, MSc; Leslie G. Farkas, MD, PhD, DSc, FRCSC

Arch Otolaryngol Head Neck Surg. 2001;127:1362-1366.

Objective  To test the hypothesis that surgery on the growing nasal septum does not adversely affect nasal and midfacial dimensions.

Design  Paired study.

Setting  Tertiary care center.

Participants  Children treated consecutively during a 4-year period; all had significant nasal obstruction and cosmetic disfigurement secondary to skeletal septal deformities.

Intervention  Nasal septal surgery (using an external approach), in which the quadrilateral cartilage was removed, remodeled, and reinserted as a free graft.

Outcome Measures  Anthropometric linear measurements and indexes of the face and nose preoperatively and postoperatively; nasal dorsum length, nasal height, nasal dorsum index, nasal tip protrusion, columellar length, facial height, face width, upper face height, facial index, nose–upper face height index, and columellar length–nasal tip protrusion index. Continuous measurements were transformed into ordered categories with reference to normative data. Data were analyzed using Wilcoxon signed rank sum test ( level of .05) and by applying the Bonferroni adjustment for multiple testing.

Results  Twenty-six children were studied (12 females and 14 males); age at surgery ranged from 4.5 to 15.5 years (mean age, 9.5 years); average age at postoperative measurement, 12.5 years; mean follow-up, 3.1 years. Only nasal dorsum length (P = .007) and nasal tip protrusion (P = .04) were decreased by a statistically significant level before the Bonferroni adjustment. The change was not considered clinically significant. Thus, relative to age-appropriate norms, the dimensions of the nose and midface and their proportionality did not change after surgery.

Conclusions  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. We question the absolute dogma that nasal surgery in children must always be avoided.

From the Departments of Otolaryngology (Drs El-Hakim and Crysdale) and Epidemiology (Mr Abdollel) and the Craniofacial Measurement Laboratory, Department of Plastic and Reconstructive Surgery (Dr Farkas), The Hospital for Sick Children, Toronto, Ontario. Dr El-Hakim is now with the Otolaryngology Department, Aberdeen Royal Infirmary, Foresterhill, Scotland.

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