Septorhinoplasty in an Asian-Caucasian pediatric patient with neglected nasal deviation from previous traumatic injury: a case report

Abstract

Background: Numerous studies present evidence of the association between nasal-septal deviation and impaired breathing that led to a multisystem disorder, nasal-midface growth alteration, and gets worse with facial growth. However, the extent of the traumatic septal injury is often neglected. Here, we summarized the clinical experience in treating a pediatric patient with those problems. Case Presentation: A case of a 10-year-old girl with type C-IIB nasal deviation and type IVb septal deviation with left obstructive nasal breathing and snoring is presented. A nasal injury history at the age of four was reported. She had divergent dorsal lines, hump irregularity, lower lateral cartilage (LLC), columella/septum deviation, drooping-indented-boarded tip, asymmetrical nostrils, and internal valve incompetence. We conducted corrections on nasal bones by bilateral osteotomies, c-shaped anteroposterior caudal septum by scorings, mattress suture techniques and batten grafts, upper lateral cartilage by dorsal septal manipulation, tip/columella by LLC manipulation, dorsal long spreader graft, columellar strut grafts, and septum repositions. A crushed cartilage was placed on the hump. Improvements, complications, and patient satisfaction were documented. No complications were reported after the surgery. The patient was satisfied with the final result. Snoring and left nostril breathing obstructions no longer existed. Corrections on dorsal, columella and septal deviation, hump, nasal tip shape and projection, and asymmetrical nostril were observed. Conclusion: Septorhinoplasty's philosophy on pediatric patients highlighted the importance of weighing its risks. Findings suggest studies of the pediatric anatomy and surgical technique to minimize the risks. Thorough observation is also advised until the cessation of facial growth.