Sinus and Facial Growth After Pediatric Endoscopic Sinus Surgery

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Abstract
Objective: To determine the effect of functional endoscopic sinus surgery (FESS) on facial skeletal growth in children. Design: Prospective randomized controlled animal study; retrospective histopathologic study of pediatric FESS specimens. Setting: Academic tertiary referral medical center. Participants: Eight newly weaned piglets; uncinate and ethmoid bone of FESS specimens from 84 children. Interventions: The piglets underwent unilateral FESS. When they had developed to nearly adult size, computed tomography was used to compare facial and sinus development between the surgical and nonsurgical sides. The paranasal sinus contents from children were histologically examined to analyze bone types with respect to patient age. Outcome Measures: Sinus development and facial skeletal growth after FESS in piglets; histologic maturity of sinus bone in children. Results: Facial growth in piglets was significantly reduced on the side treated by FESS. When compared with the side that did not undergo the operation, growth reached only 57% in the maxillary sinus and 65% in the ethmoid region. Children younger than 9 years had woven (immature) bone; children 9 years and older had predominantly lamellar (mature) bone. Conclusions: This preliminary study shows that even limited surgery in the anterior ethmoid region can affect sinus and facial growth in the piglet. Review of corresponding human histologic specimens suggests that further investigation is warranted to rule out the possibility of facial and sinus growth disturbance after this surgery in children. (Arch Otolaryngol Head Neck Surg. 1995;121:547-552)