Nasal vestibular stenosis after birth trauma during caesarean section

Abstract

Introduction: Iatrogenic trauma includes injury due to intubation, trauma during nasal examination, management of epistaxis or surgery of nose. As the maternal and child care is improving, the iatrogenic trauma during child birth is becoming very rare. We present a unique case that had nasal vestibular stenosis due to injury during caesarian section. As the treatment of vestibular stenosis is difficult, we reviewed the literature for the management of vestibular stenosis and present our surgical technique for managing this particular case. Patient and surgical method: A two and half year male child was brought to our department with complaint of left nostril obstruction since birth. The child had received multiple cut injuries on the face at the time of lower segment caesarian section of the mother at a peripheral hospital. This deformity was corrected by surgery and nasal stent. Discussion: We searched ‘Pubmed’ and ‘Scopus’ with no keywords limit and found only one case of iatrogenic nasal deformity due to birth trauma in English literature. The surgical correction of vestibular stenosis is very difficult due to small surgical field and high recurrence rate. There are number of techniques described in the literature for correction of vestibular stenosis. We reviewed them and compared our experience in managing this deformity. Conclusion: The very initial management in terms of proper suturing of flaps and nasal stents or referral to a specialist following nasal trauma can avoid this type of deformity. We concluded that the management of vestibular stenosis is very difficult and the result of surgery is influenced by not only the surgical technique but also by cooperation of the patient and family members.