A principal approach to indications and contraindications for septoplasty in children (literature review)

Objective. To determine the evidence-based indications and contraindications for performing septoplasty in children, taking into account age-related anatomical and physiological characteristics and current clinical protocols. Materials and Methods. A review of domestic and international literature, analysis of current clinical guidelines, and a comparative assessment of clinical cases were conducted. Results. Indications and contraindications for pediatric septoplasty were systematized. Key aspects of treatment strategy selection were identified, emphasizing the importance of a comprehensive approach in cases of combined pathologies. Conclusions. Septoplasty in children is an effective method for restoring nasal breathing in cases of nasal septal deviation. A minimally invasive surgical approach through a skin incision in the mobile part of the septum allows for preservation of the mucosal lining. Due to the biomechanical properties of the perichondrium in children, spontaneous cartilage realignment is often achieved after elevating the mucoperichondrial flap from the concave side, with additional cartilage incisions if necessary. Silicone splints are recommended to prevent postoperative complications. In the presence of concomitant dentoalveolar anomalies (narrowing, shortening, or retroposition of the maxilla), the optimal age for surgical intervention is 6–8 years, which helps reduce the need for subsequent orthodontic treatment. In children under 12 years of age, additional crestotomy (removal of the nasal crest) is performed; in those over 12 years — crestosuturotomy (removal of the nasal crest with osteotomy of the median palatine suture), which reduces the risk of recurrent dentoalveolar anomalies observed in 43% of cases after isolated orthodontic treatment without prior otorhinolaryngological intervention (septoplasty). In combined surgical cases, referral to an orthodontist is recommended on the 7th postoperative day