Physiology and Pathophysiology of the Growing Nasal Skeleton
The outcome of surgical interventions is largely depending on the quality of wound healing of the tissues. In children, a second aspect of paramount importance is the effects on further growth.
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Henriette L. Verwoerd-Verhoef, Gerjo J.V.M. van Osch, and Carel D.A. Verwoerd
Keywords
Nasal growth • Midfacial growth • Nasal disorders • Septum deformities • Cartilage wound healing • Septoplasty • Rhinoplasty • Tissue engineering
Core Messages
• The outcome of surgical interventions is largely dependent on the quality of wound healing of the tissues. However, in children, a second aspect of paramount importance is the impact on further growth. • The knowledge of the anatomy of the nasal skeleton from birth to adolescence and current data concerning the ‘normal’
H.L. Verwoerd-Verhoef, MD, PhD (*) C.D.A. Verwoerd, MD, PhD Department of Otorhinolaryngology, Erasmus MC Rotterdam, Kroeskarper 36, Bergschenhoek 2661, KL, Rotterdam, The Netherlands e-mail: [email protected] G.J.V.M. van Osch, PhD Department of Otorhinolaryngology and Orthopaedics, Erasmus MC, University Medical Center Rotterdam, dr Molewaterplein 50, Rotterdam, The Netherlands e-mail: [email protected]
development of the midfacial profile are mandatory for physicians working in this field. • Surgery of the nasal skeleton in children at different ages should restore form and function, optimise further growth and minimise the risks for abnormal development. As to restoring normal growth, clinical observations have currently not produced convincing evidence. • Results of animal experiments have largely contributed to understanding developmental mechanisms of the nasal/ midfacial skeleton, the way they are influenced by various surgical interventions, partial resections and fractures of the cartilaginous and bony nasal skeleton, and finally the possibilities to restore growth by surgery. • Key issues seem to be (1) the dominant role of specific growth zones in the cartilaginous septum, the connection with the premaxilla (via the anterior nasal spine) and the connection of the upper lateral cartilages with the nasal bones and (2) the poor wound healing capacity
T.M. Önerci (ed.), Nasal Physiology and Pathophysiology of Nasal Disorders, DOI 10.1007/978-3-642-37250-6_35, © Springer-Verlag Berlin Heidelberg 2013
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of growing and maturing nasal cartilage and its deformation due to the release of interlocked stresses. • The clinical long-term results as far as nasal growth is concerned after surgery at different ages, and studies on in vivo and ex vivo methods to enhance wound healing of growing hyaline (nasal) cartilage will improve clinical success rate.
35.1
Physiology of the Growing Nasal Skeleton
35.1.1 Introduction Rhinosurgical procedures are common in the adult patient group, and techniques have been developed and improved based on the experience with large numbers of patients. Most common is the septoplasty which is performed to correct a symptomatic deviated septum of congenital, developmental or traumatic etiology. Performing such procedures in the paediatric age group is controversial because of concerns about retarding or otherwise altering nasal and midfacial growth patterns (Wong et
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