Fuller Jennifer C, Levesque Patricia A, Lindsay Robin W
Department of Otolaryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
Department of Otolaryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
Int J Pediatr Otorhinolaryngol. 2018 Aug;111:97-102. doi: 10.1016/j.ijporl.2018.06.003. Epub 2018 Jun 5.
To describe pediatric and adolescent patients undergoing functional septorhinoplasty and to analyze both subjective and objective outcomes.
Retrospective review of prospective cohort study of patients ≤18 years old undergoing functional septorhinoplasty between 2013 and 2016 at a tertiary care center. Patient demographics, nasal exam, procedure, and pre- and postoperative nasal obstruction symptom evaluation (NOSE) score, EuroQOL 5-dimension (EQ5D), and peak nasal inspiratory flow (PNIF) scores were analyzed.
39 patients, 48.7% male, mean age 15.9 years (range 7-18), with nasal obstruction underwent functional septorhinoplasty with mean follow up of 8.5 months. Patients reported a history of allergies (46.5%), nasal fracture (59.0%), and previous nasal surgery (25.6%). Most common exam findings included internal nasal valve narrowing (92.3%), superior/dorsal septal deviation (74.4%), external nasal valve narrowing (43.6%), caudal septal deviation (35.9%), and a narrow middle vault (33.3%). Septal cartilage grafts were placed in 79.5% of patients and PDS plate was used in 28.2%. Most common procedures included spreader grafts (84.6%), columellar strut graft (30.8%), and swinging door (23.1%). Of patients with both baseline and postoperative scores, at last follow up NOSE scores (SD) decreased from 59.0 (23.7) to 21.2 (8.8) (n = 26, p < 0.001), EQ5D VAS scores increased from 76.2 (17.7) to 85.8 (13.5), (n = 19, p = 0.056), and PNIF scores increased from 66.2 (25.3) to 90.8 (46) L/min, (n = 13, p < 0.01); all mean differences met the minimal clinically important difference for each score. 2 patients underwent revision surgery and there was one complication of a nasal abscess.
Functional septorhinoplasty is safe and effective in select pediatric and adolescent patients with significant nasal obstruction and results in significant improvements in both subjective and objective outcomes measures.
描述接受功能性鼻中隔成形术的儿科和青少年患者，并分析主观和客观结果。
对2013年至2016年在一家三级医疗中心接受功能性鼻中隔成形术的18岁及以下患者的前瞻性队列研究进行回顾性分析。分析患者的人口统计学特征、鼻腔检查、手术过程以及术前和术后鼻塞症状评估（NOSE）评分、欧洲五维健康量表（EQ5D）和鼻腔最大吸气流量（PNIF）评分。
39例患者，男性占48.7%，平均年龄15.9岁（7 - 18岁），因鼻塞接受功能性鼻中隔成形术，平均随访8.5个月。患者报告有过敏史（46.5%）、鼻骨骨折史（59.0%）和既往鼻腔手术史（25.6%）。最常见的检查发现包括鼻内瓣膜狭窄（92.3%）、鼻中隔上/背侧偏曲（74.4%）、鼻外瓣膜狭窄（43.6%）、鼻中隔尾侧偏曲（35.9%）和中鼻道狭窄（33.3%）。79.5%的患者放置了鼻中隔软骨移植片，28.2%的患者使用了聚对二氧环己酮板。最常见的手术包括撑开移植片（84.6%）、鼻小柱支撑移植片（30.8%）和摇门手术（23.1%）。在有基线和术后评分的患者中，末次随访时NOSE评分（标准差）从59.0（23.7）降至21.2（8.8）（n = 26，p < 0.001），EQ5D视觉模拟评分从76.2（17.7）升至85.8（13.5）（n = 19，p = 0.056），PNIF评分从66.2（25.3）升至90.8（46）L/分钟（n = 13，p < 0.01）；所有平均差异均达到各评分的最小临床重要差异。2例患者接受了修复手术，发生了1例鼻脓肿并发症。
功能性鼻中隔成形术在选定的有严重鼻塞的儿科和青少年患者中是安全有效的，并且在主观和客观结果指标方面都有显著改善。
