116 / 232
3. Results
Eighteen
children
underwent
evacuation
of
SPOA
during
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
ZFMA/MO
planes when
considering
the
years
from
surgery
–
the
longer
the
time
that passed
from
surgery –
the
less
the difference.
4. Discussion
ESS
in
the pediatric populations
is
becoming more
common
in
recent
years,
but
concern
has
been
raised
regarding
the
possible
influence on mid
facial growth due
to
the disturbance of
the bony
structures
of
the
sinuses. While
evidence
of mal
development
of
the
mid
facial
region
in
animal
studies
has
been
reported,
controversy
exists
as
to
possible
development
alterations
in
humans
[10,13]
.
Although
the
craniofacial
skeleton
in
the
growing
child
is
suggested
by
some
to
be
responsive
to
changing
functional
demands
and
environmental
factors,
several
studies
have
shown
no
significant
changes
of
mid-facial
growth
in
children
even
following
ESS
[2]
.
In
the
latter
study, Wolf
et
al.
documented
the
largest series reported
thus
far of 124 children who underwent ESS.
Even
though
the
follow-up varied
(4–14 years), and cephalometric
measurements were
not
taken,
they
concluded
that
no
clinically
significant
disturbances
were
observed
in
facial
bone
develop-
ment. Bothwell et al.
reported a 13.2 year
follow-up of 67
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
Table
1
Patients’
age
at
surgery
and
now
(chronological
order).
No.
Age
at
surgery
(years)
Age
today
(years)
Time
from
surgery
(years)
1
10
23
13
2
3
12.5
9.5
3
7
12.5
5.5
4
3
9.5
6.5
5
9
15.5
6.5
6
4
13
9
Table
2
The
values
of
the
anatomic
landmarks measured.
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
mo
Lo
lpa
zfma_div_mo
Operated(O),
non-operated
(NO)
O
NO
O
NO
O
NO
O
NO
Mean
10
13
45
46
12
13
36.8
43.8
Table
3
.
Line measured
r
Value
p
Value
Age
at
surgery
diff_mo
0.162
0.759
diff_lo
0.03
0.955
diff_lpa
0.309
0.551
diff_mzmd_div_mo
0.132
0.803
Age
today
diff_mo
0.209
0.691
diff_lo
0.076
0.887
diff_lpa
0.209
0.691
diff_mzmd_div_mo
0.388
0.447
Years
from
surg
diff_mo
0.388
0.447
diff_lo
0.121
0.819
diff_lpa
0.299
0.56
diff_mzmd_div_mo
0.746
0.088
L.
Sagi
et al.
/
International
Journal
of
Pediatric Otorhinolaryngology
79
(2015)
690–693
94