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A Study of Anthropometric Measures Before and After External Septoplasty in Children
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, noseupper face height index,
and columellar lengthnasal 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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