Nasal Deformation

GENESIS

A small or short nose may result from constraint-related limitation of nasal growth in a face presentation, transverse lie, or from compression resulting from a small uterine cavity. During delivery the delicate structures of the face are predominantly exposed to external force effects, and hence deformities on the nose can emerge as a birth-related trauma in newborns.

A compressed nose is also a feature of oligohydramnios and severe crowding, such as can occur in a bicornuate uterus ( Fig. 21.1 ). Infants born to mothers with a bicornuate uterus have about a fourfold greater risk of congenital defects, and nasal hypoplasia and limb deficiencies occur more frequently in infants born to mothers with a bicornuate uterus. Nasal deformities consisting of columellar necrosis, flaring of nostrils, and snubbing of the nose have been reported in very low-birth-weight infants after prolonged application of flow-driver nasal prongs for continuous positive airway pressure. Midfacial hypoplasia also has been reported in preterm infants with bronchopulmonary dysplasia who were subjected to prolonged nasotracheal intubation for 68–243 days.

Among 3425 children born between 1980 and 1981, 29 neonates (0.86%) showed a deviation of the bony and cartilaginous nose. After 11–12 years, nine children had a straight nose and five children (36%) showed a deviation of the nasal pyramid to the same side as found at birth. CT images of 105 spontaneously aborted fetuses aged between 12 and 40 weeks of gestation revealed nasal septal deviations in 15 (14.3%) fetuses, and among 4090 consecutive newborns investigated for nasal septal deviations over a 2-year period, there was a 0.93% incidence of anterior nasal septal cartilaginous dislocation. This nasal septal dislocation was treated shortly after birth, and among treated infants followed for a 3-year period, there was no recurring septal deformity. Nasal septal deviations ( Fig. 21.2 ) occur in as many as 17–22% of newborns examined immediately after vaginal delivery, and it is less frequent in infants delivered by cesarean section; therefore nasal septal deviations are thought to be related to passage through the birth canal. Among 273 newborns examined at 12-hour intervals, the septum straightened spontaneously during the first 3 days of life. Newborns delivered from a left occipitoanterior presentation were more prone to anterior nasal septal deviations to the right, whereas newborns delivered from a right occipitoanterior presentation had deviations directed to the left. During left occipitoanterior presentation, the head turns in a clockwise direction and the nasal cartilage moves to the right as the nasal tip is directed to the left; the reverse is true for infants delivered from a right occipitoanterior presentation. Gray is generally credited with attributing anterior nasal septum deviations to deformation from maxillary pressure during pregnancy or birth, noting a 4% incidence of anterior nasal cartilage deformity among 2380 neonates. More severe deviation of the nasal septum can result in frank nasal septum dislocation. About 2–4% of neonates have an anterior dislocation of the nasal septum, and about 17–22% of neonates have some type of septum deformation.