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In their article Béjar et al1 state that they perform external septoplasty on children with severe nasal obstruction caused by septal deviation anterior to the nasal spine. They conclude that external septoplasty does not affect most aspects of nasal and facial growth, except growth of the nasal dorsum. I believe that external approach does not provide any additional benefit over hemitransfixion-transfixion incision in case of septal deviation anterior to the nasal spine, and that it is a more traumatic approach to the growing nose. It may only be indicated in case of severe nasal tip deformity combined with septal deviation. The existence of septal deviation only does not justify external approach, especially in the growing and delicate nose of a child. Even in the absence of intraoperative trauma to the lower and/or upper lateral cartilages, the disturbed vascularization and accompanying fibrosis after surgery may certainly influence the growth of
Yilmaz T. Septoplasty in Children. Arch Otolaryngol Head Neck Surg. 1997;123(4):449. doi:10.1001/archotol.1997.01900040101015
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