2017 Sec 1 Green Book

Sagi

et al.

/ International

Journal

of Pediatric Otorhinolaryngology

79

(2015)

690–693

L.

Table 1 Patients’

Table

3

age

at

surgery

and

now

(chronological

order).

.

No.

Age

at

surgery

Age

today

Time

from

r Value

p Value

Line measured

(years)

(years)

(years)

surgery

at

surgery

diff_mo diff_lo diff_lpa

0.162

0.759 0.955 0.551 0.803 0.691 0.887 0.691 0.447 0.447 0.819

Age

1 2 3 4 5 6

10

23

13

0.03

3 7 3 9 4

12.5 12.5

9.5 5.5 6.5 6.5

0.309 0.132 0.209 0.076 0.209 0.388 0.388 0.121 0.299 0.746

diff_mzmd_div_mo

9.5

today

diff_mo diff_lo diff_lpa

Age

15.5

13

9

diff_mzmd_div_mo

from

surg

diff_mo diff_lo diff_lpa

Years

3. Results

0.56

diff_mzmd_div_mo

0.088

Eighteen the study period. Excluded were 2 who were no operated upon by the same surgeon and 5 more who were lost to follow-up and could not be reached. Out of the remaining 11 children, 5 strongly refused to have further imaging and hence were also excluded. A total of 6 patients were finally recruited for this study (3 females and 3 males), all between the ages of 3 and 10 at the time of surgery, and between 9.5 and 23 years of age today ( Table 1 ). Four of the children had surgery on the right side and 2 on the left. Table 2 shows the AP cephalometric combined means, standard deviations, medians, and minimum and maximum values of eight linear transverse measurements (right and left four transverse planes) for all 6 subjects. The mean distance between the MO reference point and the mid-sagittal plane on the right was 10.67 mm and on the left 12.17 mm. There was no significant statistical difference between the sides in all patients ( p = 0.447). The mean distance between the LO reference point and the mid- sagittal plane on the right was 45.33 mm and on the left 45.00 mm. There was no significant statistical difference between the sides in all patients ( p = 0.819). The mean distance between the LPA reference point and the mid-sagittal plane on the right was 11.17 mm and on the left 14.00 mm. There was no significant statistical difference between the sides in all patients ( p = 0.56). The mean distance between the ZFMA reference point and the MO reference point on the right was 38.67 mm and on the left 42.0 mm. again, there was no statistical difference between the sides in all patients ( Table 3 ). It is important here to emphasis that out of the 6 patients, 4 were operated on the right and 2 on the left. All measurements except LPA measured on the left in both cases that were operated on the left and LO measured on the right for 1 case operated on the right, showed that the transverse plane on the side that was operated on was smaller than the other side; however, these changes were not found to be statistically significant. No statistically significant difference was found when evaluat- ing the differences for all four planes according to age at surgery, age today and years from surgery. We did find a non-significant difference ( p = 0.088) between the two sides when measuring the children underwent evacuation of SPOA during

planes when

considering

the

years

from

surgery

–

the

ZFMA/MO

the

time

that passed

from

surgery –

the

less

the difference.

longer

4. Discussion

in

the pediatric populations is

becoming more

common

in

ESS

years,

but

concern

has

been

raised

regarding

the

possible the bony

recent

facial growth due sinuses. While

to

the disturbance of

influence on mid

of

the

evidence

of mal

development

of

structures

mid

facial

region

in

animal possible

studies

has

been

reported,

the

exists

as

to

development

alterations

in

controversy

[10,13] .

humans

the

craniofacial

skeleton

in

the

growing

child

is

Although

by

some

to

be

responsive

to

changing

functional

suggested demands

and

environmental

factors,

several

studies

have

shown

significant

changes

of

mid-facial

growth

in

children

even

no

ESS

[2] .

In

the

latter

study, Wolf

et

al.

documented

the

following

thus

far of 124 children who underwent ESS.

largest series reported

though

the

follow-up varied

(4–14 years), and cephalometric

Even

not

taken,

they

concluded

that

no

clinically develop-

measurements were

disturbances

were

observed

in

facial

bone

significant

ment. Bothwell et al. children with a mean age of 3.1 years, 46 who had ESS and 21 children who did not. Quantitative and qualitative analyses showed no statistical significance in facial growth between children who underwent ESS and those who did not [3] . In this study, we present quantitative evidence that unilateral sinus surgery can be performed safely in the pediatric patient without causing significant facial asymmetry. All of our subjects were young children at the time of the surgery (ages 3–10), and today (time of evaluation), at least 6 years after surgery, in the age range of 9.5–23 years. We report no statistically significant differences in the measured transverse planes on cephalometry radiographs between the operated and non-operated sides. Although there are a reasonable number of studies on the impact of ESS on facial growth in the pediatric population, using different methods of measurements and comparisons, none reported a 13.2 year follow-up of 67

Table

2

values

of

the

anatomic

landmarks measured.

The

Anatomic

landmark

side

mo

lo

lpa

zfma_div_mo

Rt

Lt

Rt

Lt

Rt

Lt

Rt

Lt

Mean

10.67

12.17

45.33

45

11.17

14

38.67

42

SD

1.37

1.72

3.5

2.83

1.94

3.41

3.88

6.69

Lo

lpa

zfma_div_mo

mo

non-operated

(NO)

O

NO

O

NO

O

NO

O

NO

Operated(O),

Mean

10

13

45

46

12

13

36.8

43.8

94