On this page we cover:
- Nasal Endoscopy
- Control of Nose Bleeds
- Turbinate Reduction
- Septoplasty
- Nasal Fracture
Nasal Endoscopy
A nasal endoscopy is a procedure that is performed in the office. The most common reason that we perform the exam is to determine the cause of nasal obstruction, with enlarged adenoids the most common finding in young children. We also may perform this after sinus surgery to examine the nasal passages and the sinuses. We utilize a flexible scope that is attached to a camera. Your child is administered a local anesthetic and decongestant into the nose prior to the procedure to make it more comfortable. The scope is placed atraumatically into the nasal passage, and the images are shown on video monitors so that the parents and child are able to view the findings.
Control of Nose Bleeds (Epistaxis)
Children who have had repeated nosebleeds that have not improved with medical therapy may benefit from a procedure to control the bleeding. The most common source of nosebleeds in children are exposed blood vessels on the surface of the front (anterior) part of the nasal septum (the central cartilage dividing the nasal passages).
Nasal cautery involves cauterizing the exposed blood vessels on the surface of the septum. It can be done in the office or as an outpatient procedure under a general anesthetic.For performing nasal cautery in the office, we first administer a local anesthetic/decongestant combination in the nose. The blood vessels are cauterized using a chemical agent (silver nitrate). The nose is rinsed of any excess chemical, and antibiotic ointment is applied. The procedure takes about 5 minutes, and is tolerated by most older children.
For younger children and children who are reluctant to have this done in the office, the procedure is performed in the operating room under a general anesthetic. The procedure is similar to the office procedure, but besides chemical cautery, electrocautery can be used in the operating room. Recovery from the outpatient procedure is typically one day.
Turbinate Reduction
Nasal turbinates are mucosal covered bones inside the walls of a child’s nose that humidify inhaled air. They can enlarge and produce nasal airway obstruction. Allergies play a role in their enlargement, and an allergy evaluation may be of benefit initially. If medical therapy with the use of nasal steroids and/or nasal saline irrigations does not improve symptoms, inferior turbinate reduction is a consideration.
Inferior turbinate reduction is a day surgery procedure requiring a general anesthetic in children. The procedure involves using instruments that reduce the volume of the turbinate by shrinking the tissue within the turbinate. Children initially afterwards will have improvement in their nasal obstruction, but may have swelling to the turbinates during the recovery that may have the nasal obstruction return some temporarily.
Septoplasty
Nasal obstruction may also be the result of a deviated (crooked) septum. Some children are born with it, but most are due to nose trauma experienced after birth. The deviated septum can cause blockage of the nasal passage, causing breathing difficulties through the nose on just one side. Repair of the deviated septum is typically performed in older teenagers, and is not usually recommended for younger children due to potential disruption of the nasal growth centers. Surgery involves removal of the crooked or deviated portion that is causing the obstruction. The procedure is a day surgery procedure and requires a general anesthetic. Your child may have “stents” placed in the nose (pieces of silicone with tubes within to allow for breathing through the nose) during surgery, and are kept in place for 5-7 days. They are removed in the office.
Repair of Nasal Fracture
Children sustain nasal fractures due to falls or during sporting activities. The nasal fracture can produce a noticeable deformity to the shape of the nose, and cause nasal breathing difficulties. They may have a septal deformity in conjunction with the nasal bone fracture. Reduction of the nasal fracture requires a general anesthetic, and is done as an outpatient surgery. We prefer to perform the surgery within 2 weeks of the injury. The procedure involves re-positioning the nasal bones and, if needed, the nasal septum. A splint is placed over the nose to reduce swelling and to keep the bones in position and is removed 5-7 days after surgery.