A study of anthropometric measures before and after external septoplasty in children - A preliminary study

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 ha d significant nasal obstruction and cosmetic disfigurement secondary to ske letal septal deformities. Intervention: Nasal septal surgery (using an external approach), in which t he quadrilateral cartilage was removed, remodeled, and reinserted as a free graft. Outcome Measures: Anthropometric linear measurements and indexes of the fac e and nose preoperatively and postoperatively; nasal dorsum length, nasal h eight, 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 measur ements were transformed into ordered categories with reference to normative data. Data were analyzed using Wilcoxon signed rank sum test (alpha 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 a t postoperative measurement, 12.5 years; mean follow-up, 3.1 years. Only na sal 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-app ropriate norms, the dimensions of the nose and midface and their proportion ality did not change after surgery. Conclusions: Appropriate nasal septal surgery involving excision and subseq uent 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.