Facial Plast Surg 2007; 23(4): 219-230
DOI: 10.1055/s-2007-995814
© Thieme Medical Publishers

Rhinosurgery in Children: Basic Concepts

Carel D.A Verwoerd1 , Henriette L. Verwoerd-Verhoef1
  • 1Department of Otorhinolaryngology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
Further Information

Publication History

Publication Date:
18 December 2007 (online)


In newborns, the main supporting structure of the nose is the dorsoseptal cartilage, a T-bar-formed complex of septum and upper lateral cartilages, which is essentially an external extension of the cartilage of the anterior cranial base. Later the anatomic situation gradually changes-a potential pitfall for surgeons and radiologists. The vulnerability of various processes underlying postnatal development of the facial skeleton is discussed. The cartilaginous septum is the dominant growth center. Loss of septal cartilage at different ages leads to different facial syndromes involving nose, maxilla, and orbita. The septal cartilage in children demonstrates thinner fracture-prone areas next to thicker growth zones. Septum fractures have a preference for the thinner regions, corresponding with the most frequent septum deviations observed in growing children. The essential problem in pediatric rhinosurgery is not the age-specific anatomy but the poor wound-healing capacity: fractured or transected septum cartilage will not heal, and disconnected ends tend to overlap, resulting in increasing or recurrent deviations. Based on clinical and experimental evidence, indications and “safe” and “unsafe” techniques of rhinosurgery are presented for children of various age groups.


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Carel D.A Verwoerd

Kroeskarper 36, 2661 KL Bergschenhoek

The Netherlands