Pediatric Nasal Deformities

What is considered a nasal deformity?

Nasal refers to the nose. A nasal deformity is any abnormal variation of the normal appearance of the nose.

This topic will cover some of the obvious visible abnormalities of the nose, as well as deformities affecting the structure inside the nose that may not be obvious when looking at the patient.

Are there any symptoms associated with a nasal deformity?

The symptoms would depend on the reason for the nasal deformity. Many times a nasal deformity may be associated with symptoms of NASAL OBSTRUCTION. EPISTAXIS (nosebleeds) may also be noticed with some of the deformities.

What are some common causes of nasal deformity?

These can be divided into congenital (at birth) and acquired causes.

What are some congenital (at birth) causes?

1. Probably the most common is a traumatic nasal deformity at birth. Because the nose is mostly cartilage at this time, little or no treatment is necessary.
2. Your child may also have a nasal deformity associated with a CLEFT LIP and/or CLEFT PALATE.
3. Congenital abnormalities of the nasal septum: The nasal septum is a partition in the center of the nose that divides the nose into two passages. It is made up of both cartilage and bone. Rarely, an infant may be born with a very twisted (deviated) nasal septum. More often this twist may be acquired during the infant’s birth. If the deviation is acquired during the birth itself and is noticed early, correction may be achieved by gently moving the nose back into its normal position. Later in life, if the septum remains deviated, especially if it causes difficulties breathing, surgery (septoplasty) may be used to straighten the deviation. Rarely, an infant may also be born with a perforation (hole) in the septum.

   Most often, this hole is can be repaired.

4. Congenital Masses or Bumps on the nose: An infant may also be born with a mass or bump on the nose. Various types of masses may be the cause and some of them may extend into the nose, face, or brain. Treatment for these is surgical removal; however, the type and length of the surgery would depend on the cause of the mass.
5. Pyriform aperture stenosis is a narrowing or blockage of the bony opening at the entrance of the nose – The nose itself may look normal, so this deformity is usually noticed by symptoms of NASAL OBSTRUCTION. This abnormality can be confirmed with a computed tomography (CAT) scan and needs to be surgically repaired.
6. CHOANAL ATRESIA – This is a blockage of the nose by membranes or bones located in the back of the nose where it meets the throat. The nose will appear normal. Please see under NASAL OBSTRUCTION for more information.

What are some acquired causes of nasal deformities?

1. Facial trauma – Trauma resulting in fractures of the nose or face could alter the outward appearance of the nose. Repair of these fractures is best performed within a week of the injury. Depending on the severity of the damage or associated symptoms, the type of surgery required is very individualized. Please see REPAIR OF TRAUMATIC FACIAL AND NECK INJURIES for additional information.
2. Nasal septum perforation is a hole in the partition that separates the two nasal passages. This can be a result of trauma, drug use, or infections, among other things. These perforations can be treated by surgical repair using tissue or, in some cases silastic “buttons” to seal the opening.

When would you be referred to an ear, nose, and throat specialist for a nasal deformity?

Referral to an ear, nose, and throat specialist should be done quickly once the deformity is discovered because some repairs are time-dependent. If you have any questions regarding possible referral, please contact your primary care provider as soon as possible after an injury.