Rhinosurgery in children: developmental and surgical aspects of the growing nose
The cartilaginous nasal septum of the child is often involved in trauma or congenital deformation. In perspective of its role in postnatal growth of the midface, the wound healing of septal cartilage in reaction to various surgical procedures was studied in young rabbits. It was concluded that (1) elevation of mucoperichondrium does not induce significant histologic reactions in the septal cartilage and (2) the wound reaction of cut edges includes only a +/- 0.8-mm-deep zone and lasts no longer than 2 weeks, resulting in a stump, encapsulated by fibrous tissue. Reconnection of separated parts occurs 2 weeks after surgery, mostly by merging of the perichondrial layers. Reimplantation of resected cartilage does not lead to normalisation of septal growth. This is not caused by extensive necrosis, loss of morphological organisation or decreased growth potential of the reimplanted cartilage. The essential factor seems to be dislocation (duplication, angulation) of the implant versus the non-mobilised parts of the septum preventing the growth of the implant to contribute fully to the lengthening of the total septum.