Physiology and pathophysiology of the growing nasal skeleton

The outcome of surgical interventions is largely depending on the quality of wound healing of the tissues. In children, a second aspect of paramount importance is the effects on further growth. Current data concerning the 'normal' development of the midfacial profile and the anatomy of the nasal skeleton from birth to adolescence are reviewed with an emphasis on surgical aspects. Surgery of the nasal skeleton in children at different ages should restore form and function, optimise further growth and minimise the risks for abnormal development. As to restoring normal growth, clinical observations have currently not produced convincing evidence. Results of animal experiments have largely contributed to understanding developmental mechanisms of the nasal/midfacial skeleton, and the way they are influenced by various surgical interventions, partial resections and fractures of the cartilaginous and bony nasal skeleton, and finally the possibilities to restore growth by surgery. Key issues seem to be (1) the dominant role of specific growth zones in the cartilaginous septum, the connection with the premaxilla (via the anterior nasal spine) and the connection of the upper lateral cartilages with the nasal bones and (2) the poor wound healing capacity of growing and maturing nasal cartilage and its deformation due to the release of interlocked stresses. What may be expected for the future? Clinicians should publish the long-term results as far as nasal growth is concerned after surgery at different ages; clinical anatomists should explore in vivo and ex vivo methods to enhance wound healing of growing hyaline (nasal) cartilage.

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