What are nasal deformities?
“Nasal deformity” is a broad term used to describe a large spectrum of nasal differences that occur either at birth or as a result of trauma. There’s an endless range of nasal shapes and sizes that do not necessarily qualify as a deformity. These are hereditary physical features that are passed to each successive generation that can give each person his or her own unique characteristics. A deviated septum may also cause a physical deformity (eg, a crooked nose), but is most notable for affecting breathing. In true deformities of the nose that are present at birth, the process typically involves failure of formation or fusion of certain soft tissue and bone elements. For example, children born with a cleft lip and palate frequently have severe distortion of the nose involving the base and tip. This is the result of a chain reaction whereby the bone and soft tissue elements of the palate and central nose fail to fuse together during development. Other types of nasal deformities can include cleft nose, facial cleft, bifid nose, nasal duplication, glioma, and nasal dermoid.
Alternatively (and more frequently), nasal deformities are the result of trauma. Dog bites, car accidents, blunt trauma, burns and other penetrating trauma can cause mild to significant deformity of the nose.
Why are children born with nasal deformities?
The source of nasal deformities that are present at birth can be quite varied. Most have no traceable cause, while others are related to genetic conditions and syndromes. In addition, the nose can be affected by other craniofacial disorders, such as cleft lips or facial clefts. Rheumatologic problems such as scleroderm and Parry-Romberg syndrome can also cause constriction of the nose. Hemifacial microsomia can affect the jaws and cause shifting of the nose. Nasal gliomas are growths that occur at the top (or, the root) of the nose and can be quite large. They can cause distortion by simply pressing on adjacent nasal structures. Nasal dermoid cysts are benign growths that can cause minor bone erosion near the root of the nose.
What are problems associated with nasal deformities?
The nose is referred to frequently as the “keystone” of the face. It is the center point of facial aesthetics, and is therefore, an important part of self-image, social interaction, and psychological well-being. Small differences in the nasal region can be noticeable to others and can be a source of insecurity.
Aside from aesthetics, the nose is critical for proper breathing. Air flow that is disrupted through the nose can alter speech, smell, taste, and can create unusual whistling or turbulence. In addition, exposed nasal mucous membranes may become chapped and painful.
Can nasal deformities be passed on?
Isolated nasal deformities have no reliable cause to suggest a single source. They usually will follow similar patterns of inheritance as cleft lips and palates and other birth differences of a multifactorial nature. Various chromosomal disorders and syndromes may carry a certain inheritance pattern and can be passed along with some predictability.
There are a large number of excellent options for nasal reconstruction. Depending on the degree of deformity and the nature of missing tissues, surgical solutions can be either simple outpatient procedures or complex, multi-stage surgeries that can last several hours. Graft material (rib or ear cartilage) is frequently necessary to build or reinforce the framework of the nose. Skin and mucous lining are brought in from adjacent areas. Nonetheless, the majority of nasal deformities will require a surgical approach. The key to treatment is a thorough systematic evaluation of the problem, including a close assessment of the functional impairment as well as the physical deformity.
In addition, the human nose will continue to grow into adolescence. When deciding to correct a nasal deformity, it is important to understand the implications of surgery on future growth of the nose. Surgery done too early in life can possibly result in permanent deformity, making correction difficult later on. Dr. Panossian is an expert in all aspects of nasal reconstruction from simple to complex options. His background in pediatrics is vital in formulating a treatment plan with the appropriate timing considerations.
Most nasal surgery is performed on an outpatient basis. Pain is minimal. Donor sites from harvest of ear or rib cartilage generally heal quickly with minimal discomfort. Patients will require 2-4 weeks of limited activity and avoidance of exercise, heavy lifting, rough play, or contact sports. During this time, aspirin and other non-steroidal anti-inflammatory medications (eg, ibuprogen, naprosyn, etc.) must be avoided. Dr. Panossian will discuss the expected postoperative recovery from each of the potential surgical options at the time of your consultation.
The risks of nasal surgery include bleeding, infection, anesthesia problems, or persistent breathing difficulties. Bleeding can create a hematoma that may need to be drained. This can sometimes be done in the office, or more often, under sedation in a surgery suite. A pocket of infection (also known as an abscess) may also need to be drained in similar fashion.
Complications can include contour bumps and divots, asymmetry, and bad scarring. Each of these problems is usually mild and can be corrected with minimal intervention or by simply giving it time (sometimes up to a year or more). In the setting of severe asymmetry, revision surgery may be required. Steroid injections may be used to settle thick scars.