Why Should Operation of Septoplasty Not Be Performed in Children?

Why should operation of septoplasty not be performed in children? - Septoplasty operation risks in children - Septum deviation treatment in children - Pediatric septoplasty

The nasal septum is a wall that divides the nasal cavity in the middle. The front part of the septum consists of a sturdy but bendable cartilage and the back part is made of bone. Ideally, the septum should be in the midline and the right and left nasal cavities should be equidistant. In 80% of people, the septum is not exactly midline. The septum is located in a position that deviates much from the midline and is called the septum deviation. 

One of the growth points is located in the anterior part of the nasal septum. There is a risk of injury to these growth points during the deviation surgery in children, where the skull and bone structure grow. Some doctors advocate that these operations can be done in children when limited cartilage resection is done; the general view is that these surgeries should not be done in the first 18 years of life, which continues to grow. 

What are the causes of nasal septum deviation?

Trauma during childbirth, a blow to the nose in early childhood, and most importantly, hereditary features that pass through parents cause nasal septum curvatures. Septum deviation is an extremely common condition in our country for hereditary reasons. The formation mechanisms of septal deviation are various. Rarely, some babies are born with septal deviation due to the curve development of the septum in the womb. Sometimes the septum bends as the baby passes through the birth canal. Bumps, falls, sports injuries, traffic accidents in childhood and adulthood can also cause septum deviation. Septum deviations may also occur as a result of the bone and cartilage parts of the septum developing at different speeds during the age of growth.

What are the complaints of patients with septal deviation?

As a result of impaired respiratory function of the nose, serious problems arise in the development of the nasal cavity, sinuses and, accordingly, the face and jaw. Facial development ends with asymmetry due to aeration disorder of the sinuses. Mouth breathing leads to disruption of the structure of the lower-upper jaw and teeth. In addition, septum deviation; sleep problems, obstructive sleep apnea, upper respiratory tract resistance syndrome, snoring, night bed urination, restlessness-irritability, decreased school success, and physical growth-development retardation. When mouth breathing is used instead of nose, the heating, humidification and cleaning functions of the air with nose functions are disabled. The inhaled air goes directly into the lungs. Deviation negatively affects the sense of smell and therefore taste. Fatigue and excessive sleep occur during the day due to snoring. Bad breath, dry mouth, dental diseases also adversely affect the patient's life.

How is septal deviation treated?

The treatment of the septum deviation is surgery and this operation is called septoplasty. Septoplasty surgery is usually done under general anesthesia. In surgery, the septum is brought to its midline position, which should be made through the nostrils and with incisions that are not visible from the outside after surgery. During the operation, excessive oblique parts of the septum are completely removed, and the parts that can be corrected are reshaped and placed in their place again. The surgery usually takes 20-45 minutes. Septoplasty surgeries can be performed together with nasal aesthetics (rhinoplasty) surgery.

Should surgery be performed on septum deviation in children?

Nasal septum surgery in children has been taboo for many years, with the concern that it will prevent the growth of the growing septum and even lead to deformity. In addition, important points in the growth of the septum have been identified with histology and animal studies conducted in recent years and it has been reported that early correction of the nasal septum affects the growth of the nose and face with the development of protective surgical techniques. As the development of the nose normally determines the nasal septum, the curve not only in the inner part of the nose but in the outer shape

It is observed that the external image of the nose improves in some cases an average of one year after the operation.

At what age can nasal septal curvature surgeries be performed in children?

Cartilage septum grows very fast in the first 2 years of life, then the growth rate slows down and almost stops around 3-5 years old. One of the study is emphasized that "if there is a severe breathing problem related to the septal deviation in patient who younger than 18 yeas old, septoplasty should be performed. However, if necessary, septum deviation correction surgery may be performed in younger children and even at birth" (source link > Septoplasty in children). Other literature review is emphasized about this subject that "despite the majority advocating the timing of septum deviation surgery to be 6 years and older, more clinical studies are needed that may provide further evidence about correction of septal deviations in younger children, perhaps even at birth" (source: Pediatric septoplasy: a review of the literature).

There is consensus that surgery for cartilage septum can be performed in children from 5 years of age when appropriate indication is given.

The more postponed the intervention, the child will have to bear the negative effects of nasal congestion and the problems we have mentioned above will arise. In children with severe nasal obstruction, the earliest septoplasty operation is usually 17 years old. It is the most correct practice to wait until the height extension is possible and the growth is completed. Although limited septoplasty can be performed in severe cases younger than 18 years old. 

Growth usually continues in boys until the age of 22 and in girls until the age of 18.

Is surgery performed in children the same as in adults?

As in adults, this surgery can be performed with closed technique by using endoscopes in children and the results are pleasing.

In order not to harm the child's nasal development, only certain parts are intervened and as little cartilage tissue as possible is removed.

What are the risks of septoplasty surgery in children?

Although safer anesthesia is possible with modern anesthetic drugs, the risk of death from anesthesia is reported as 1 in two hundred percent of the world. It is reported that approximately 1/3 of the children who underwent septum surgery in childhood should be re-operated in adulthood. Our main goal here is to facilitate the child's respiratory function in the period up to adulthood, prevent possible growth retardation and abnormal nose-face development and improve the quality of life.

Since most of the nasal development is completed after adolescence, these children have less chance of success.

The idea of ​​performing this surgery after adolescence is still valid unless it is mandatory. However, children with severe respiratory distress should not be kept stubbornly until adulthood.

In children who cannot get enough oxygen due to nasal curvature and therefore lag growth and development, correct growth and proper surgery can accelerate the growth and development of children and increase school success.

You can find details about "septoplasty in İstanbul" at >> Septoplasty in Istanbul / Open Techique Septoplasty Operation in İstanbul ... / Frequently Asked Questions About Septoplasty Operation in İstanbul ...

Bosphorus - Istanbul - Turkey - ENT Doctor Istanbul - ENT Specialist Istanbul - Nose Job Istanbul - Rhinoplasty Istanbul - ENT Office Istanbul - Dr.Murat Enoz - ENT Clinic Istanbul - ENT Doctor in Istanbul - Nose Job in Turkey

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:

Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul

Appointment Phone: +90 212 561 00 52

E-Mail: muratenoz@gmail.com
Mobile phone: +90 533 6550199

Fax: +90 212 542 74 47