Septoplasty and Turbinate Reduction in Children

  • Christian P. Soneru
  • Charles A. Riley
  • David A. Gudis


Nasal obstruction in the pediatric patient can lead to decreased quality of life and contribute to sleep disordered breathing. In severe cases with prolonged obligate mouth breathing, it may even lead to dental and craniofacial abnormalities. In children who present with nasal obstruction, a thorough physical exam and nasal endoscopy should be performed with particular attention to the nasal septum and inferior turbinates. If symptoms persist despite appropriate medical therapy, surgery should be considered. A septoplasty may be performed safely and effectively with good evidence that the procedure does not affect craniofacial development if performed with meticulous surgical techniques. Inferior turbinate reduction may be performed in a variety of ways, although most modern techniques avoid destruction of the overlying mucosa.


Septoplasty Inferior turbinate reduction Turbinoplasty Pediatrics 


  1. 1.
    Linder-Aronson S. Adenoids: their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the dentition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids. Acta Otolaryngol Suppl. 1970;265:1–132.PubMedGoogle Scholar
  2. 2.
    Luzzi V, Di Carlo G, Saccucci M, et al. Craniofacial morphology and airflow in children with primary snoring. Eur Rev Med Pharmacol Sci. 2016;20(19):3965–71.PubMedGoogle Scholar
  3. 3.
    Bresolin D, Shapiro PA, Shapiro GG, Chapko MK, Dassel S. Mouth breathing in allergic children: its relationship to dentofacial development. Am J Orthod. 1983;83(4):334–40.CrossRefGoogle Scholar
  4. 4.
    D’ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N, Manzini M. Craniofacial growth in children with nasal septum deviation: a cephalometric comparative study. Int J Pediatr Otorhinolaryngol. 2010;74(10):1180–3.CrossRefGoogle Scholar
  5. 5.
    Pentz S, Pirsig W, Lenders H. Long-term results of neonates with nasal deviation: a prospective study over 12 years. Int J Pediatr Otorhinolaryngol. 1994;28(2–3):183–91.CrossRefGoogle Scholar
  6. 6.
    Brietzke S, Shin J, Choi S, et al. Clinical consensus statement: pediatric chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2014;151(4):542–53.CrossRefGoogle Scholar
  7. 7.
    Van Loosen J, Van Zanten GA, Howard CV, Verwoerd-Verhoef HL, Van Velzen D, Verwoerd CD. Growth characteristics of the human nasal septum. Rhinology. 1996;34(2):78–82.PubMedGoogle Scholar
  8. 8.
    Mynatt RG, Sindwani R. Surgical anatomy of the paranasal sinuses. In: Stucker FJ, de Souza C, Kenyon GS, Lian TS, Draf W, Schick B, editors. Rhinology and facial plastic surgery. Berline: Springer; 2009.Google Scholar
  9. 9.
    Kohlberg GD, Stewart MG, Ward RF, April MM. Evaluation and management of pediatric nasal obstruction: a survey of practice patterns. Am J Rhinol Allergy. 2016;30:274–8.CrossRefGoogle Scholar
  10. 10.
    Izquierdo-Dominguez A, Valero AL, Mullol J. Comparative analysis of allergic rhinitis in children and adults. Curr Allergy Asthma Rep. 2013;13:142–51.CrossRefGoogle Scholar
  11. 11.
    Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update. Allergy. 2008;63:8–160.CrossRefGoogle Scholar
  12. 12.
    Montoro J, Del Cuvillo A, Mullol J, et al. Validation of the modified allergic rhinitis and its impact on asthma (ARIA) severity classification in allergic rhinitis children: the PEDRIAL study. Allergy. 2012;67:1436–42.CrossRefGoogle Scholar
  13. 13.
    Marino-Sanchez FS, Valls-Mateus M, Ruiz-Echevarria K, Alobid I, Cardenas-Escalante P, Jimenez-Feijoo R, Lozano-Blasco J, et al. Nasal obstructive disorders induce medical treatment failure in pediatric persistent allergic rhinitis (the NODPAR study). Pediatr Allergy Immune. 2017;28:176–84.CrossRefGoogle Scholar
  14. 14.
    Suratt PM, Turner BL, Wilhoit SC. Effect of intranasal obstruction on breathing during sleep. Chest. 1986;90:324–9.CrossRefGoogle Scholar
  15. 15.
    Lipton AJ, Gozal D. Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev. 2003;7:61–80.CrossRefGoogle Scholar
  16. 16.
    Fick L. Uber die Ursachen der Knochenforman: Experimental Untersuchung. Wigand GH: Gottingen; 1858.Google Scholar
  17. 17.
    Landsberger R. Die triebende Krafte zur Dehnung und Streckung des Gesichtschadels. Zahnarztliche Runschau. 1929;23:978–90.Google Scholar
  18. 18.
    Sarnat BG, Wexler MR. Growth of the face and jaws after resection of the septal cartilage in the rabbit. Am J Anat. 1966;118:755–67.CrossRefGoogle Scholar
  19. 19.
    Bernstein L. Early submucous resection of nasal septal cartilage: a pilot study in canine pubs. Arch Otolaryngol. 1973;97(3):273–8.CrossRefGoogle Scholar
  20. 20.
    Cupero TM, Middleton CE, Silva AB. Effects of functional septoplasty on the facial growth of ferrets. Arch Otolaryngol Head Neck Surg. 2001;127(11):1367–9.CrossRefGoogle Scholar
  21. 21.
    Jugo SB. Total septal reconstruction through decortication (external) approach in children. Arch Otolaryngol Head Neck Surg. 1987;113(2):173–8.CrossRefGoogle Scholar
  22. 22.
    Triglia JM, Cannoni M, Pech A. Septorhinoplasty in children: benefits of the external approach. J Otolaryngol. 1990;19(4):274–8.PubMedGoogle Scholar
  23. 23.
    Bejar I, Farkas LG, Messner AH, Crysdale WS. Nasal growth after external septoplasty in children. Arch Otolaryngol Head Neck Surg. 1996;122:816–21.CrossRefGoogle Scholar
  24. 24.
    El-Hakim H, Crysdale WS, Abdollel M, Farkas LG. A study of anthropometric measures before and after external septoplasty in children: a preliminary study. Arch Otolaryngol Head Neck Surg. 2001;127:1362–6.CrossRefGoogle Scholar
  25. 25.
    Tasca I, Compadretti GC. Nasal growth after pediatric septoplasty at long-term follow-up. Am J Rhinol Allergy. 2011;25:e7–e12.CrossRefGoogle Scholar
  26. 26.
    Christophel JJ, Gross CW. Pediatric Septoplasty. Otolaryngol Clin N Am. 2009;42:287–94.CrossRefGoogle Scholar
  27. 27.
    Crysdale WS, Walker PJ. External septorhinoplasty in children: patient selection and surgical technique. J Otolaryngol. 1994;23:28–31.PubMedGoogle Scholar
  28. 28.
    Sooknundun M, Kacker SK, Bhatia R, Deka RC. Nasal septal deviation: effective intervention and long term follow-up. Int J Pediatr Otorhinolaryngol. 1986;12(1):65–72.CrossRefGoogle Scholar
  29. 29.
    Chivukula S, Koutourousiou M, Snyderman CH, Fernandez-Miranda JC, Gardner PA, Tyler-Kabara EC. Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr. 2013;11:227–41.CrossRefGoogle Scholar
  30. 30.
    Dispenza F, Saraniti C, Sciandra D, Kulamarva G, Dispenza C. Management of nasoseptal deformity in childhood: long-term results. Auris Nasus Larynx. 2009;36:665–70.CrossRefGoogle Scholar
  31. 31.
    Yilmaz MS, Guven M, Akidil O, Kayabasoglu G, Demir D, Mermer H. Does septoplasty improve the quality of life in children? Int J Pediatr Otorhinolaryngol. 2014;78:1274–6.CrossRefGoogle Scholar
  32. 32.
    Lee VS, Gold RM, Parikh SR. Short-term quality of life outcomes following pediatric septoplasty. Acta Otolaryngol. 2017;137(3):293–6.CrossRefGoogle Scholar
  33. 33.
    Segal S, Eviatar E, Berenholz L, Kessler A, Shlamkovitch N. Inferior turbinectomy in children. Am J Rhinol. 2003;17(2):69–73.CrossRefGoogle Scholar
  34. 34.
    Nurse LA, Duncavage JA. Surgery of the inferior and middle turbinates. Otolaryngol Clin N Am. 2009;42(2):295–309.CrossRefGoogle Scholar
  35. 35.
    Janda P, Stroka R, Baumgartner R. Laser treatment of hyperplastic inferior nasal turbinates: a review. Lasers Surg Med. 2001;28:404–14.CrossRefGoogle Scholar
  36. 36.
    Utley DS, Goode RL, Hakim I. Radiofrequency energy tissue ablation for the treatment of nasal obstruction secondary to turbinate hypertrophy. Laryngoscope. 1999;109:683–6.CrossRefGoogle Scholar
  37. 37.
    Bhattacharyya N, Kepnes LJ. Clinical effectiveness of coblation inferior turbinate reduction. Otolaryngol Head Neck Surg. 2003;129:365–71.CrossRefGoogle Scholar
  38. 38.
    Bitar MA, Kanaan AA, Sinno S. Efficacy and safety of inferior turbinate coblation in children. J Laryngol Otol. 2014;128(Suppl 2):S48–54.CrossRefGoogle Scholar
  39. 39.
    Friedman M, Tanyeri H, Lim J, Landsberg R, Caldarelli D. A safe, alternative technique for inferior turbinate reduction. Laryngoscope. 1999;109(11):1834–7.CrossRefGoogle Scholar
  40. 40.
    Acevedo JL, Camacho M, Brietzke SE. Radiofrequency ablation turbinoplasty versus microdebrider-assisted turbinoplasty: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2015;153(6):951–6.CrossRefGoogle Scholar
  41. 41.
    Leong SC, Kubba H, White PS. A review of outcomes following inferior turbinate reduction surgery in children for chronic nasal obstruction. Int J Pediatr Otorhinolaryngol. 2010;74:1–6.CrossRefGoogle Scholar
  42. 42.
    Cheng PW, Fang KM, Su HW, Huang TW. Improved objective outcomes and quality of life after adenotonsillectomy with inferior turbinate reduction in pediatric obstructive sleep apnea with inferior turbinate hypertrophy. Laryngoscope. 2012;122(12):2850–4.CrossRefGoogle Scholar
  43. 43.
    Arganbright JM, Jensen EL, Mattingly J, Gao D, Chan KH. Utility of inferior turbinoplasty for the treatment of nasal obstruction in children: a 10-year review. JAMA Otolaryngol Head Neck Surg. 2015;141(10):901–4.PubMedGoogle Scholar
  44. 44.
    Jiang ZY, Pereira KD, Friedman NR, Mitchell RB. Inferior turbinate surgery in children: a survey of practice patterns. Laryngoscope. 2012;122:1620–3.CrossRefGoogle Scholar
  45. 45.
    Langille M, El-Hakim H. Pediatric inferior turbinoplasty with or without adenoidectomy: preliminary report on improvement of quality of life, symptom control, and safety. Otolaryngol Head Neck Surg. 2011;40:420–6.Google Scholar
  46. 46.
    Yuen SN, Leung PP, Funamura J, Kawai K, Roberson DW, Adil EA. Complications of turbinate reduction surgery in combination with tonsillectomy in pediatric patients. Laryngoscope. 2017;127:1920–3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Christian P. Soneru
    • 1
  • Charles A. Riley
    • 1
  • David A. Gudis
    • 1
  1. 1.Department of Otolaryngology - Head and Neck SurgeryColumbia University Irving Medical CenterNew YorkUSA

Personalised recommendations