Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Imaging Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Pediatr Otorhinolaryngol. 2020 May;132:109918. doi: 10.1016/j.ijporl.2020.109918. Epub 2020 Feb 1.
To illustrate the clinical and radiological presentation of a rare etiology of nasal obstruction in neonates, midnasal stenosis (MNS), including a comparison of nasal dimensions with those of normal infants.
We retrospectively reviewed medical charts and computerized tomography (CT) imaging of neonates with nasal obstruction diagnosed as stenosis in the midnasal area in a tertiary pediatric medical center. MNS was defined clinically by inability to visualize the middle turbinate with an endoscope despite the absence of stenosis of the anterior aperture or any gross septal deviation. CT measurements of the midnasal width were taken by an experienced neuroradiologist. We compared widths between the bony inferior turbinate to the bony septum in the narrowest area of symptomatic patients, to widths in a control group of asymptomatic children.
Nine neonates from birth to three months old presenting with nasal obstruction, severe stertor, and blocked nasal passage at the midnasal level in endoscopic examination, were diagnosed with MNS. 6/9 had CT scans. Four had isolated unilateral stenosis, two unilateral MNS and contralateral choanal atresia, and three bilateral MNS. All patients were managed conservatively, initially with nasal saline irrigation and local steroids and topical antibiotics; Median time to resolution of symptoms was 14 days. When comparing the dimensions at the midnasal narrowest area of the stenotic group with a control group of 139 healthy children, the median bony width was 1.7 mm vs. 3.2 mm, respectively (p < 0.00001). Average dimensions according to age groups until the age of 12 months are given.
In neonates with nasal obstruction, when choanal atresia and pyriform aperture stenosis are excluded, stenosis of the midnasal area should be considered. Most of these neonates can be managed conservatively.
阐述一种罕见的新生儿鼻塞病因——鼻中隔狭窄（MNS）的临床和影像学表现，并将其与正常婴儿的鼻腔尺寸进行比较。
我们回顾性分析了一家三级儿科医学中心诊断为中鼻区狭窄的鼻塞新生儿的病历和计算机断层扫描（CT）图像。中鼻甲无法通过内镜观察到，但前鼻孔或任何明显鼻中隔偏曲无狭窄时，临床上可定义为 MNS。有经验的神经放射科医生对中鼻宽度进行 CT 测量。我们比较了症状性患者最狭窄部位的下鼻甲骨性至骨性鼻中隔的宽度与无症状儿童对照组的宽度。
9 名出生至 3 个月大的新生儿因鼻塞、严重打鼾和内镜检查时中鼻道阻塞而就诊，被诊断为 MNS。9 例中有 6 例行 CT 扫描。4 例为单侧狭窄，2 例单侧 MNS 伴对侧后鼻孔闭锁，3 例双侧 MNS。所有患者均接受保守治疗，最初采用鼻腔盐水冲洗和局部类固醇及局部抗生素；症状缓解的中位时间为 14 天。将狭窄组中鼻最狭窄部位的尺寸与 139 名健康儿童的对照组进行比较，狭窄组的骨性宽度中位数为 1.7mm，对照组为 3.2mm（p<0.00001）。给出了直到 12 个月大的年龄组的平均尺寸。
在有鼻塞的新生儿中，当排除后鼻孔闭锁和梨状孔狭窄时，应考虑中鼻区狭窄。这些新生儿大多可以保守治疗。
4 级。
