Nasal Obstruction In Children Research Articles

Influence of pharyngeal airway respiration pressure on Class II mandibular retrusion in children: A computational fluid dynamics study of inspiration and expiration.

To examine the influence of negative pressure of the pharyngeal airway on mandibular retraction during inspiration in children with nasal obstruction using the computational fluid dynamics (CFD) method. Sixty-two children were divided into Classes I, II (mandibular retrusion) and III (mandibular protrusion) malocclusion groups. Cone-beam computed tomography data were used to reconstruct three-dimensional shapes of the nasal and pharyngeal airways. Airflow pressure was simulated using CFD to calculate nasal resistance and pharyngeal airway pressure during inspiration and expiration. Nasal resistance of the Class II group was significantly higher than that of the other two groups, and oropharyngeal airway inspiration pressure in the Class II (-247.64Pa) group was larger than that in the Class I (-43.51Pa) and Class III (-31.81Pa) groups (P<.001). The oropharyngeal airway inspiration-expiration pressure difference in the Class II (-27.38Pa) group was larger than that in the Class I (-5.17Pa) and Class III (0.68Pa) groups (P=.006). Large negative inspiratory pharyngeal airway pressure due to nasal obstruction in children with Class II malocclusion may be related to their retrognathia.

Utility of Inferior Turbinoplasty for the Treatment of Nasal Obstruction in Children: A 10-Year Review.

Inferior turbinoplasty (IT) in pediatric patients is a common procedure used to treat childhood nasal obstruction. Most of the published IT studies in this population did not control for concurrent airway procedures. To assess postoperative outcomes in pediatric patients undergoing isolated IT. Ten-year retrospective review of the medical records of 1770 children (aged <18 years) undergoing an IT procedure at Children’s Hospital Colorado from August 1, 2003, through August 1, 2013. Patients with simultaneous procedures involving the upper airway were excluded. The review identified demographic and clinical information, operative technique, and postprocedural follow-up data. The last follow-up was completed on April 21, 2014. A telephone questionnaire was administered to parents to obtain long-term outcome data. Data were analyzed from March 10 to July 23, 2014. Demographics, complications, postoperative outcomes, the need for revision surgery and continued use of medication, and overall parent satisfaction with the procedure. Outcomes were assessed with a 5-point Likert scale of parental perception of their child’s ability to breathe through the nose (nasal patency) preoperatively and currently (1 indicates extremely poor; 5, extremely well) and their overall satisfaction rating for the procedure (1 indicates extremely dissatisfied; 5, extremely satisfied). Of the 1770 children, 107 underwent isolated IT. The mean age of the cohort was 10.5 (range, 1.2-17.9) years. The IT procedures included radiofrequency ablation (72 [67.3%]), microdebridement (19 [17.8%]), and partial turbinate resection (21 [19.6%]). No major complications were observed. Eight revision ITs for persistent nasal symptoms were performed independently of the initial surgical procedure, including 4 of 72 radiofrequency ablations (5.6%), 1 of 19 microdebridements (5.3%), and 3 of 21 partial turbinate resections (14.3%), with no difference among the 3 techniques (P = .10). The parents of 63 patients completed the telephone questionnaire with a mean follow-up of 4.55 (range, 0.63-10.68) years. The combined parental satisfaction on a 5-point Likert scale for the extremely satisfied and satisfied categories was 44 (69.8%), and the nasal patency score improved significantly from 2.0 to 3.4 (95% CI, 1.03-1.65; P < .001), independently of surgical techniques. Thirty-four patients (54.0%) continued to require medical management owing to persistent nasal symptoms. Patients with a history of allergic rhinitis had a greater improvement of nasal patency (2.1 to 3.9; P = .02) and a higher postoperative use of medical therapy (13 of 34 patients [38.2%] vs 21 of 73 [28.8%]; P = .01). Inferior turbinoplasty showed overall utility and was safe and effective in the treatment of nasal obstruction in children for whom medical management had failed. No differences between surgical techniques were found in patient satisfaction, improvement of nasal patency, and recurrence, likely related to sample size. More than half of the patients continued to use medical therapy postoperatively, suggesting that inferior turbinate hypertrophy should not be considered solely as a surgical disease. Allergic rhinitis was identified as a significant comorbidity.

Nasal and bronchial response to exercise in children with seasonal allergic rhinitis out of the pollen season.

Allergic rhinitis is a type I allergic disease of the nasal mucosa, and is characterized by paroxysmal sneezing, watery rhinorrhea, and nasal blockage. In seasonal allergic rhinitis subjects, even subthreshold allergen doses have been found to cause inflammatory cell infiltration in the nasal mucosa. This study aimed to investigate the presence of nasal obstructions and symptoms in seasonal allergic rhinitis subjects by assessing an exercise challenge test (ECT) outside of the pollen season. Twenty patients and 20 healthy children who were admitted to the Osmangazi University Medical School Pediatric Allergy Clinic were included in the study in a pollen free season. The total nasal airflow and visual analog scale (for rhinorrhea, nasal congestion, sneezing, and itching) and pulmonary function tests were evaluated before and after each ECT. The nasal airflow and resistance changes were evaluated with anterior rhinomanometry. Eight patients and one healthy child had nasal obstructions after the ECT. There was a significant difference in the exercise-induced nasal obstructions between the 2 groups (p = 0.02). Eighteen children with exposure to tobacco smoke in the patient and control groups had lower forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and forced expiratory flow 25% to 75% (FEF25-75 ) values than the children without exposure to tobacco smoke. The prevalence of exercise-induced nasal obstruction in children with seasonal rhinitis out of the pollen season is 40%. We showed that minimal persistent inflammation and nasal symptoms can also be diagnosed in rhinitis children in a symptom-free period.

Clinical evaluation of determination of the degree of nasal obstruction in children with otitis media with effusion

Clinical evaluation of determination of the degree of nasal obstruction in children with otitis media with effusion

Nasal obstruction in children

Nasal obstruction is a common complaint in children. It usually is a self-limiting condition and resolves without treatment. Diagnosis is predicated on detailed history and a systematic clinical examination of the child. This article reviews the common causes of nasal obstruction encountered in children.

Assessing the Relationship between Serum Resistin and nasal Obstruction in Children with Allergic Rhinitis

Nasal obstruction has been reported as a "key symptom" of allergic rhinitis (AR) because it is deeply associated with impaired quality of life and it reflects more directly the allergic inflammation in the nasal mucosa. Resistin is known to be involved in inflammatory processes exerting an important role in the regulation of cytokine production even though its effective proinflammatory activity at nasal level has never been fully established. This study investigates the relationship between resistin levels and nasal obstruction assessed by an objective method such as active anterior rhinomanometry. Fifty-three children between 4 and 10 years of age affected by persistent allergic rhinitis (PAR) were enrolled and subdivided in two groups. Serum resistin levels were detected in all children. The same day patients underwent rhinomanometry, which was considered negative (no nasal obstruction) when the fraction of predicted values (p.v.'s) was between 71 and 100% and it was considered positive when the fraction of p.v. was ≤70%. The serum resistin levels were significantly higher in children with moderate-severe PAR than in patients with mild PAR (p < 0.03). Furthermore, serum resistin levels were significantly higher in children with positive rhinomanometry compared with negative rhinomanometry (p < 0.03). The fraction of p.v.'s of nasal flows in patients with nasal obstruction had a significant negative correlation with serum resistin levels (p < 0.001). This study provides evidence that resistin levels are increased in children with severe nasal obstruction measured by an objective and quantitative approach.

Effects of topical sprays on allergy-induced nasal obstruction in children

This study aims to evaluate the efficacy of mometasone furoate nasal spray, intranasal azelastine, and isotonic sea water nasal spray in the management of allergy-induced nasal obstruction. Between October 2007 and August 2008 60 patients (37 males, 23 females; mean age 9.8±2.6 years; range 7 to 16 years) with a history of allergic rhinitis were included in the study. Laboratory assays including the skin prick test, nasal smear, phadiatop, total immunoglobulin E (IgE), and complete blood count test were performed. The patients were classified into three groups including 20 in each, according to the topical treatment administered. Patients in group 1 received azelastine, group 2 received mometasone furoate nasal spray, and group 3 received isotonic sea water nasal spray. Nasal passage volume was calculated using an acoustic rhinometry device. Azelastine and mometasone furoate decreased nasal congestion and increased nasal cavity volume more effectively, compared to isotonic sea water nasal spray. Mometasone furoate and azelastine which decrease nasal congestion and increase nasal volume are effective in the management of allergic rhinitis in children.

Should we perform objective assessment of nasal obstruction in children with chronic rhinitis?

Should we perform objective assessment of nasal obstruction in children with chronic rhinitis?

Objective and subjective assessments of nasal obstruction in children and adolescents with allergic rhinitis

To correlate objective assessment of nasal obstruction, as measured by acoustic rhinometry (volume of the first 5 cm of the nasal cavity) and active anterior rhinomanometry (total nasal airway resistance), with its subjective evaluation (obstruction scores). Thirty patients, aged 7 to 18 years, with persistent allergic rhinitis and thirty controls were enrolled. The obstruction score was reported for the whole nasal cavity and for each nostril separately. The three variables were measured at baseline and after induction of nasal obstruction. There were significant and negative correlations between resistance and nasal volume in all groups and scenarios, except for the most obstructed nostril, in the control group, post-obstruction. For the whole nasal cavity, there was no significant correlation between objective and subjective variables except between score and total nasal cavity volume in the control group, post-obstruction. Regarding the most obstructed nostril, we found a significant negative correlation between score and resistance and a significant positive correlation between score and volume for the total group at baseline. There were no clear differences in the correlation coefficients found in patients and controls. The correlation coefficients did not change after induction of nasal obstruction. Objective assessment of nasal obstruction did not correlate significantly with subjective evaluation for the nasal cavity as a whole, but there was a correlation for unilateral assessments. There was correlation between the objective evaluations. Allergic rhinitis and acute induction of nasal obstruction did not affect the correlation between objective and subjective assessments of nasal obstruction. Addition of an objective method for evaluation of nasal obstruction could be useful in the research setting; if no such method can be used, each nostril should be evaluated separately.

Objective reduction in adenoid tissue after mometasone furoate treatment

ObjectiveChronic rhinitis and adenoid hypertrophy are the main causes of nasal obstruction in children and proper treatment of these factors seem essential for controlling nasal obstructive symptoms. This study aims to evaluate the effects of topical mometasone treatment on symptoms and size of adenoid tissue in children with complaints of nasal obstruction and to compare this approach to continuous nasal saline douching plus environmental control alone. MethodsFifty-one children with nasal obstructive complaints were submitted to a semi-structured clinical questionnaire on nasal symptoms, prick test and nasoendoscopy. Nasoendoscopic images were digitalized, and both adenoid and nasopharyngeal areas were measured in pixels. The relation adenoid/nasopharyngeal area was calculated. Patients were subsequently re-evaluated in two different periods: following 40 days of treatment with nasal douching and environmental prophylaxis alone; and after an subsequent 40 day-period, when topical mometasone furoate (total dose: 100μg/day) was superposed. ResultsNasal symptoms and snoring significantly improved after nasal douching, and an additional gain was observed when mometasone furoate was included to treatment. Saline douching did not influence the adenoid area, whereas a significant reduction on adenoid tonsil was observed after 40 days of mometasone treatment (P<0.0001). ConclusionNasal saline douching significantly improved nasal symptoms without interfering in adenoid dimension. In contrast, mometasone furoate significantly reduced adenoid tissue, and led to a supplementary improvement of nasal symptoms.

Reference values for acoustic rhinometry in children at baseline and after decongestion

Acoustic rhinometry is widely used for objective evaluation of nasal dimensions. However, there is a lack of agreement on the normative values in children at baseline, and especially after decongestion. The purpose of this study was to determine the reference values for Finnish school children for acoustic rhinometry in non-decongested and decongested noses, and to find out which of the potential predictors (age, sex, body surface area (BSA) and height) would be the most useful one(s). The study included 124 children aged between 6.90 and 13.84 years with no permanent nasal symptoms. At baseline, the mean total minimal cross-sectional area (MCA) was 0.752 cm2, and the mean total volume between 0 - 3 cm (VOL) was 4.00 cm3. After decongestion, the total MCA was 0.794 cm2, and the VOL was 4.38 cm3. There was a significant correlation between MCA and age, between VOL and height, and between VOL and BSA at baseline and after decongestion. We found no difference in the values between boys and girls. We conclude that acoustic rhinometry is a suitable objective method to monitor the changes in mucosal swelling and nasal obstruction in children. Age and height or BSA of a child can be suggested as predictive factors.

Correlation between acoustic rhinometry and visual analogue scale in children with no nasal symptoms: a prospective cohort study

Acoustic rhinometry is an objective tool to evaluate nasal obstruction. The aim of this study was to evaluate the usefulness of visual analogue scale (VAS) as a subjective tool for nasal obstruction and the correlation between acoustic rhinometry and VAS in children with no nasal symptoms. Unilateral acoustic values and VAS were measured at baseline and after decongestion of the nose. Tertiary academic hospital. The study included 124 children aged between 7 and 14 years with no permanent nasal symptoms. At baseline, the mean minimal cross-sectional area on the right side was 0.392 cm(2) (sd 0.094), and on the left side 0.360 cm(2) (sd 0.093), whereas the mean VAS on the right side was 7.43 (sd 2.50) and on the left side 6.81 (sd 3.01). After decongestion, the mean minimal cross-sectional area on the right and left sides were 0.421 cm(2) (sd 0.087) and 0.373 cm(2) (sd 0.11), respectively, whereas the mean VAS on the right and left sides were 8.77 (sd 2.02) and 8.54 (sd 2.14), respectively. At baseline, a significant correlation was found between VAS and minimal cross-sectional area, but no correlation was found between VAS and acoustic values after decongestion. We conclude that VAS shows potential as a subjective tool to investigate nasal obstruction in children over 7 years of age. There was a correlation between VAS and acoustic rhinometry in children with no nasal symptoms at baseline. No correlation was found in children with decongested normal nasal airways.

Adenoidectomy: Conventional or Endoscopic Assisted?

ABSTRACT Objectives Adenoid hypertrophy is known as the most common cause of nasal obstruction in children; thus, adenoidectomy is one of the most commonly performed surgical procedures in the pediatric population. We performed both conventional and endoscopic-assisted adenoidectomies in 54 patients. Our objectives were to compare the efficacy of both methods in terms of subjective and objective relief of symptoms, safety, recurrence, and postoperative morbidity. Materials and methods Fifty-four patients were studied and were diagnosed depending upon clinical examination and radiological investigation. The patients were operated by either conventional or endoscopic-assisted adenoidectomy (EAA). Intraoperative and postoperative complications were looked for. After discharge from the hospital, the patients were called for follow-up on 1st week, 3rd week, 2nd and 4th month, and patients were asked for relief of symptoms and examined for nasal disease and for recurrence. Results Adenoid hypertrophy was seen commonly in children and the most common presenting complaints were nasal obstruction, mouth breathing, and snoring. The patients were diagnosed to have chronic adenoiditis, chronic adenotonsillitis, with or without chronic suppurative otitis media. More number of patients became symptom free with EAA as compared with conventional adenoidectomy. Conclusion Conventional adenoidectomy and EAA both have comparable success rates. Endoscopic-assisted adenoidectomy allows complete removal of adenoid tissue, thereby reducing the chances of developing recurrent adenoid obstructive symptoms and reducing the bacterial reservoir in the nasopharynx. How to cite this article Goel AK. Adenoidectomy: Conventional or Endoscopic Assisted? Clin Rhinol An Int J 2017;10(2):74-77.

Cochrane review: Intranasal corticosteroids for nasal airway obstruction in children with moderate to severe adenoidal hypertrophy

AbstractBackgroundAdenoidal hypertrophy is generally considered a common condition of childhood. When obstructive sleep apnoea or cardio‐respiratory syndrome occurs, adenoidectomy is generally indicated. In less severe cases, non‐surgical interventions may be considered, however few medical alternatives are currently available. Intranasal steroids may be used to reduce nasal airway obstruction.ObjectivesTo assess the effectiveness of intranasal corticosteroids for improving nasal airway obstruction in children with moderate to severe adenoidal hypertrophy.Search strategyOur search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2008), MEDLINE (1951 to 2008) and EMBASE (1974 to 2008). All searches were initially performed in May 2007 and updated in April 2008.Selection criteriaRandomised controlled trials comparing intranasal corticosteroids with placebo or no intervention or other treatment in children aged 0‐12 years with moderate to severe adenoidal hypertrophy.Data collection and analysisData from the included trials were extracted and trial quality was assessed by two authors independently. Meta‐analysis was not applicable and data were summarised in a narrative format.Main resultsFive randomised trials, including a total of 349 patients, met the inclusion criteria of the review. All trials except one showed significant efficacy of intranasal corticosteroids in improving nasal obstruction symptoms and in reducing adenoid size. The first eight‐week cross‐over study showed that treatment with beclomethasone (336 micrograms/day) yielded a greater improvement in mean symptom scores than placebo (‐18.5 vs. ‐8.5, P &lt; 0.05) and a larger reduction in mean adenoid/choana ratio than placebo (right, ‐14% vs. +0.4%, p=0.002; left, ‐15% vs. ‐2.0%, p=0.0006) between week 0 and week 4. The second four‐week cross‐over study demonstrated that the nasal obstruction index decreased by at least 50% from baseline in 38% of patients treated with beclomethasone (400 micrograms/day) between week 0 and week 2, whereas none of the patients treated with placebo had such improvement (p&lt;0.01). The third randomized, parallel‐group trial showed that 77.7% of patients treated with mometasone (100 micrograms/day) for 40 days demonstrated an improvement in nasal obstruction symptoms and a decrease in adenoid size, such that adenoidectomy could be avoided, whereas no significant improvement was observed in the placebo group. The fourth randomized, parallel‐group trial showed that eight‐weeks of treatment with flunisolide (500 micrograms/day) was associated with a lager reduction in adenoid size than isotonic saline solution (p&lt;0.05). In contrast, one randomised, parallel‐group trial did not find significant improvement in nasal obstruction symptoms and adenoid size after eight weeks of treatment with beclomethasone (200 micrograms/day).Authors' conclusionsLimited evidence suggests that intranasal corticosteroids may significantly improve nasal obstruction symptoms in children with moderate to severe adenoidal hypertrophy, and this improvement may be associated with a reduction of adenoid size. The long‐term effect of intranasal corticosteroids in these patients remains to be defined.Plain Language SummaryTopical steroids for nasal airway obstruction in children with moderate to severe enlarged adenoidsAdenoidal hypertrophy is generally considered a common condition of childhood, and represents one of the most frequent indications for surgery in children. In less severe cases, non‐surgical interventions may be considered, however few medical alternatives are currently available. This review was conducted to assess the effectiveness of intranasal corticosteroids for improving nasal airway obstruction in children aged 0‐12 years with moderate to severe adenoidal hypertrophy. Limited evidence derived from the five randomised controlled trials included in this review suggests that intranasal steroids may significantly improve symptoms of nasal obstruction in children with adenoidal hypertrophy and that this improvement may be associated with the reduction of adenoid size. Further large and high quality randomised controlled trials are warranted.

Pediatric turbinate reduction by coblation

Enlargement of the inferior turbinates is a common cause of nasal obstruction in children. Inferior turbinate reduction by coblation is an effective, safe, and minimally invasive surgical procedure in children. The indications for this surgery are being evaluated and expanded. It can be performed in addition to an adenoidectomy, adenotonsillectomy, functional endoscopic sinus surgery, or septoplasty. It can also be performed as an isolated procedure for nasal obstruction due to chronic rhinitis after medical treatment has failed to provide adequate relief. This article will provide the reader with a detailed description of the current indications and the technique of inferior turbinate reduction by coblation.

Nasal Obstruction in Children with Sleep-disordered Breathing

Nasal obstruction secondary to pathological enlargement of inferior nasal turbinates contributes to sleep-disordered breathing (SBD) in prepubertal children, but treatments designed to address turbinate enlargement are often not performed. The aims of these studies are: (1) to appreciate the contribution to SDB of untreated enlarged nasal turbinates in prepubertal children; and (2) to report our experience with treatment of enlarged nasal turbinates in young children with SDB. Children with enlarged nasal turbinates who underwent adenotonsillectomy (T&A) had significantly less improvement in postoperative apnoea-hypopnoea index (AHI) compared to those treated with concomitant turbinate reduction. Children in the untreated turbinate hypertrophy group subsequently underwent radiofrequency ablation of the inferior nasal turbinates; following this procedure, AHI was no different than AHI of those without hypertrophy. In an analysis of safety and effectiveness of radiofrequency treatment of the nasal turbinates, we found the procedure to be a well-tolerated component of SDB treatment. We conclude that radiofrequency (RF) treatment of inferior nasal turbinates is a safe and effective treatment in young prepubertal children with SDB. When indicated, it should be included in the treatment plan for prepubertal children with SDB. However, the duration of effectiveness is variable and therapy may need to be repeated if turbinate hypertrophy recurs.

R452 – Nasopharyngeal Yolk Sac Tumors: A Rare Pediatric Occurrence

Problem To report the rare occurrence of a yolk sac tumor of the nose and nasopharynx presenting as acute sinusitis and bilateral complete blindness. Methods The clinical presentation, pathologic features, and management of this 2-year-old infant girl is reviewed. We also performed a medical literature search in English using PUBMED and OVID databases. We then analyzed the literature with respect to clinical presentation, manifestations and therapies for other extra-gonadal yolk sac tumors presenting in the head and neck. Results The patient was treated with 4 courses of high dose cis-platinum, etoposide, bleomycin repeated every 3 weeks along with surgery. She had initial mild improvement in visual perception along with shrinkage of her tumor. The yolk sac malignancies of the head and neck are often, large, aggressive lesions on presentation that once treated have a tendency to recur. Conclusion Yolk sac tumors (endodermal sinus tumors) represent 3–5% of pediatric malignancies. They are rare malignancies in the head and neck, of germ cell origin. Successful treatment usually requires a combination of chemotherapy and surgical extirpation followed by postoperative chemotherapy. Significance Recurrent sinusitis and nasal obstruction in children should be evaluated carefully and with a high level of suspicion for rare nasal and nasopharyngeal malignancies. Early diagnosis and prompt treatment may alleviate many of the presenting symptoms and prolong life.

Evaluation of adenoidal obstruction in children: clinical symptoms compared with roentgenographic assessment

Obstructive adenoid enlargement is commonly implicated as the major cause of chronic nasal obstruction in children. Although clinical assessment is considered essential, there is little consensus over its reliability. This study was conducted to determine the correlation between graded symptomatology assessment and roentgenographic assessment of adenoidal obstruction. Symptoms assessed included snoring, mouth-breathing and obstructive breathing during sleep. Each symptom was rated on a four-point scale (absent = zero, mild = one, moderate = two and severe = three). We summed the ratings for each child to obtain the symptomatology score. We used an adenoidal-nasopharyngeal ratio parameter to classify roentgenographic assessment into minimal, moderate or marked obstruction. Sixty-four children, 42 boys and 22 girls, aged one to 12 years were enrolled. The clinical symptomatology scores correlated significantly with the roentgenographic ratings of nasopharyngeal airway obstruction (r = 0.419; p = 0.001). The correlation was significant at roentgenographic ratings of minimal obstruction (p < 0.05) and gross obstruction (p < 0.001). Both the symptomatology score and the roentgenographic rating showed significant correlations with patient age (r = -0.657, p < 0.01 and r = -0.340, p < 0.01, respectively). Clinical rating of adenoidal symptoms in children provides a reasonably reliable assessment of the presence and severity of nasopharyngeal airway obstruction. This technique of assessment is easy to use and is particularly valid when obstruction is either minimal or gross.

Pediatric meningoencephaloceles and nasal obstruction: A case for endoscopic repair

Congenital anterior skull base defects with meningoencephaloceles causing nasal obstruction are rare clinical entities. Nasal obstruction in children may also be a symptom of multiple benign nasal and allergic disorders, making the initial diagnosis of meningoencephalocele difficult. Traditionally, skull base defects have been repaired via a bifrontal craniotomy approach. With the advent of pediatric endoscopic instrumentation, more of these lesions are accessible via an intranasal endoscopic approach, even in the infant population. However, owing to the rarity of these lesions, there is a paucity of data demonstrating successful adaptation of endoscopic skull base techniques to the pediatric population. Retrospective review of two cases of endoscopic repair of anterior skull base defects with meningoencephaloceles at a tertiary care medical center. Two children, ages 15 months and 6 years, underwent successful endoscopic closure of their anterior skull base defects and resection of their intranasal meningoencephalocele with resolution of their nasal obstruction and cerebrospinal fluid rhinorrhea. Pediatric nasal meningoencephaloceles with anterior skull base defects can be successfully repaired via a transnasal endoscopic technique, thus minimizing the complications associated with craniotomy and frontal lobe retraction. Triplanar computed tomographic and magnetic resonance imaging is paramount to evaluate the caliber of the skull base defect, consistency of the herniated intracranial contents, as well as the presence of cerebral vasculature.

Endoscopic adenoidectomy in children with submucosal cleft palate

To determine the safety and effectiveness of endoscopic partial adenoidectomy for the treatment of nasal obstruction in children with submucosal cleft palate. The medical files of children with symptoms of nasal obstruction and submucosal cleft palate who underwent partial transnasal endoscopic adenoidectomy from January 1993 to December 2003 were reviewed. Operative complications, relief of nasal obstruction, presence of postoperative velopharyngeal insufficiency were recorded. There were no operative complications. All the children had relief of nasal obstruction. Velopharyngeal insufficiency was not observed during the postoperative follow-up. Endoscopic partial adenoidectomy is a safe and effective procedure for the treatment of nasal obstruction in children with submucosal cleft palate.