Nasal Surgery

What Is Nasal Surgery?

Discomfort from problems that occur in the nose can often be relieved with medication. But in some cases, this doesn’t work, and surgery may be necessary. At ENT for Children, we’ll discuss your child’s symptoms and previous treatments you’ve tried to determine if one of these procedures is the right option for you.

Nasal Endoscopy

Your pediatric ENT surgeon may suggest a nasal endoscopy to better examine and assess your child’s nasal passages. Common issues that require a nasal endoscopy include:

• Nasal obstruction/mouth breathing (blocked breathing through the nose)
• Chronic sinus infections or nasal drainage
• Concern for nasal polyps or other lesions
• Evaluate for snoring or enlarged adenoids
• Septal deviation
• Evaluate healing after septum, sinus or choanal atresia surgery

The endoscopy can be performed using a small, fine, flexible camera or a thin, rigid one. At ENT for Children, we do everything possible to keep your child informed and comfortable during the procedure. We will spray a grape-flavored medicine inside your child’s nose to help decongest and numb it.

The procedure is very interactive and is shown live for the child and parents to observe. Most endoscopies are very brief and take less than a few minutes. The information obtained from the short endoscopy can be very helpful in diagnosing and treating your child’s problem.

Inferior Turbinate Reduction

The nasal turbinates are pockets of tissue and bone in the nasal passages that play important roles. One possible cause of nasal blockage is that the inferior turbinates are too enlarged, which can obstruct breathing through the nose.

When treating enlarged inferior turbinates, we always try a non-surgical approach first. Managing sinus infections or allergies can often improve breathing. Nasal sprays are also commonly used, especially if the enlargement is mainly due to tissue rather than bone.

If these methods do not help your child, your child’s surgeon will discuss surgery to reduce the size of the turbinates. Because of their essential functions, the turbinates are not removed but only decreased in size. Your surgeon will explain different techniques to reduce the turbinates, which may include removing some bone, shrinking the tissue, or both. The procedure is performed through the nostrils using special instruments and cameras. It is usually done on an outpatient basis, and recovery typically takes 2-4 weeks.

Septoplasty

The nasal septum is the wall that separates the two sides of the nose. It starts at the front of the nose and runs the entire length of the nasal passages to the back. A deviated septum is a condition where the septum isn’t straight, which can block one or both sides of the nose. It can develop gradually over time or result from trauma to the nose.

Surgery is often the best long-term treatment for a deviated septum. However, depending on your child’s age and the severity of the deviation, your child’s surgeon may not recommend surgery. This is because your child’s septum and nose will continue to grow, and we want to avoid interfering with that growth. If surgery is advised, it is performed under anesthesia and entirely through the nostrils. The deviated bone or cartilage is either straightened or removed. After the procedure, plastic splints are placed inside the nose to keep the septum straight and support healing. These splints are typically removed in the office 7-14 days later. Complete recovery usually takes 4-6 weeks.

Nasal Fracture

Treatment of nasal fractures includes initial and later procedures. The initial step involves ensuring there is no other serious head injury, that bleeding has stopped, and that there is no septal hematoma which would require drainage. If a nasal fracture is suspected, your child’s doctor may refer your child to a pediatric ENT surgeon. If a fracture is confirmed, treatment depends on the severity of the injury. Some nasal fractures do not require surgery if there is no external or internal deformity and if breathing is unaffected. However, if there is a deformity or blocked breathing, your child’s surgeon may recommend surgery.

The timing of surgery is very important. Due to swelling early after the trauma and the fractured bones beginning to heal later, surgery is usually recommended 7-14 days after the injury. Most surgeries are performed to manipulate the bones back into position without making any incisions. An external splint or cast is applied after surgery and removed 7-10 days later.

Complete healing of the nasal bones takes 6-8 weeks, so it is important to protect the nose from further trauma during this period, such as from sports. If the fractures are allowed to heal naturally, surgery may need to be delayed at least 6 months and may require a more formal, “open rhinoplasty” performed by a facial plastic surgeon.

Choanal Atresia Repair

Choanal atresia is a congenital disorder where the back of the nose is blocked from the throat. This condition can cause complete obstruction of one or both sides of the nose, impairing breathing and normal drainage of secretions. It is believed to occur when tissue or bone between a child’s nose and mouth remains during fetal development.

Children born with this disorder often show one of the following signs:

• Bilateral Choanal Atresia: Both nasal passages are blocked in children with bilateral choanal atresia. The condition is immediately noticeable after birth because it causes severe difficulty in breathing.
• Unilateral Choanal Atresia: Only one nasal passage is blocked in a child with this condition. It is more common than bilateral atresia and may go unnoticed until later in childhood. Infants born with this condition can still breathe through the open side but usually experience constant one-sided nasal drainage.

Your provider at ENT for Children will likely order a CT scan to plan for surgery. This provides a clearer picture of the atresia and helps assess the overall nasal anatomy. Your pediatric ENT surgeon will choose one of two approaches to repair the blockage based on the nasal passage’s anatomy. The procedure may involve making an incision at the roof of the mouth or directly accessing the blockage through the nostrils with very small instruments and cameras.

Your surgeon might place temporary nasal stents or nasal drops into your child’s nasal passages during healing. Healing from atresia surgery typically takes 4-6 weeks. Short follow-up procedures may be needed to dilate the newly opened passages and maintain their openness over the long term.