FIRST OF ALL, I would agree with Manning that it is unusual to need to perform a septoplasty in a 3-year-old child with a severely deviated septum and symptomatic nasal obstruction resulting from blunt trauma 4 months previously. In the 13 years since 1986 (Dr Manning makes reference to an article1 documenting a retrospective review of experience prior to that date), we have performed 248 septoplasties in children (Figure 1). Articles outlining the impact of this surgery (particularly external septoplasty) on growth,2,3 patient selection,4 and surgical techniques5 used in this patient group have been published over the years. None of these children was younger than 6 years. I usually defer surgery until age 6 years for many reasons: First, at that age, one is able to perform a complete examination (including flexible endoscopy) to determine the exact cause of the nasal obstruction. Second, hospitalization, packing removal, and suture removal are all better tolerated at that age. Also, if an external approach is being used, the medial crura are more easily identified at that age. If the obstruction is causing obstructive sleep apnea syndrome as confirmed by a sleep study, one would feel compelled to do surgery in such a young child.
Crysdale WS. Septoplasty in Children—Yes, but Do the Right Thing. Arch Otolaryngol Head Neck Surg. 1999;125(6):701-702. doi:10.1001/archotol.125.6.701