El-Hakim H, Crysdale W S, Abdollel M, Farkas L G
Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Arch Otolaryngol Head Neck Surg. 2001 Nov;127(11):1362-6. doi: 10.1001/archotol.127.11.1362.
To test the hypothesis that surgery on the growing nasal septum does not adversely affect nasal and midfacial dimensions.
Paired study.
Tertiary care center.
Children treated consecutively during a 4-year period; all had significant nasal obstruction and cosmetic disfigurement secondary to skeletal septal deformities.
Nasal septal surgery (using an external approach), in which the quadrilateral cartilage was removed, remodeled, and reinserted as a free graft.
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 (alpha level of.05) and by applying the Bonferroni adjustment for multiple testing.
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.
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.
验证关于对生长中的鼻中隔进行手术不会对鼻腔及面中部尺寸产生不利影响这一假说。
配对研究。
三级医疗中心。
在4年期间连续接受治疗的儿童；所有患儿均因鼻中隔骨骼畸形继发严重鼻塞及外观毁损。
鼻中隔手术（采用外部入路），术中切除四边形软骨，重塑后作为游离移植物重新植入。
术前及术后面部和鼻部的人体测量线性指标及指数；鼻背长度、鼻高、鼻背指数、鼻尖突出度、鼻小柱长度、面高、面宽、上面高、面部指数、鼻 - 上面高指数以及鼻小柱长度 - 鼻尖突出度指数。根据标准数据将连续测量值转换为有序类别。采用Wilcoxon符号秩和检验（α水平为0.05）并应用Bonferroni校正进行多重检验分析数据。
共研究了26名儿童（12名女性和14名男性）；手术年龄为4.5至15.五岁（平均年龄9.5岁）；术后测量的平均年龄为12.5岁；平均随访3.1年。在Bonferroni校正前，仅鼻背长度（P = 0.007）和鼻尖突出度（P = 0.04）有统计学意义的降低。这种变化不被认为具有临床意义。因此，相对于年龄匹配的标准值，术后鼻子和面中部的尺寸及其比例没有改变。
涉及切除并随后重新植入重塑的四边形软骨段的适当鼻中隔手术对鼻子和面中部的发育没有有害影响。我们对儿童鼻部手术必须始终避免这一绝对教条提出质疑。
