8.11 Congenital Nasal Obstruction
Key Features
Congenital nasal obstruction can range in severity from a mild irritant to a life-threatening condition with potentially devastating consequences in the neonate.
The most common cause of congenital nasal obstruction is simple inflammation of the nasal mucosa, which may be managed using conservative therapies.
Treatments for congenital nasal obstruction include observation, medications, and surgical interventions.
Congenital nasal obstruction is an uncommon yet important clinical entity to recognize, given the fact that newborns are obligate nasal breathers for the first several months of life. As a result, persistent nasal obstruction requires timely evaluation such that the appropriate medical and/or surgical therapies can be promptly initiated.
Clinical
Signs and Symptoms
Signs include apnea, collapse of lateral nasal wall, cyclical cyanosis, a mass within the nose, mucous crusting, mucosal edema, nasal flaring, poor weight gain, respiratory distress, retractions, septal deviation, and/or stertor.
The timing, onset, and laterality of symptoms can provide clues to the etiology of the observed nasal obstruction. Symptoms include aerophagia, difficulty sleeping, dyspnea, epiphora, failure to thrive, feeding difficulties, grunting, hyponasal cry, rhinorrhea, and snoring.
Differential Diagnosis
Congenital
Choanal atresia (see Chapter 8.18)
Piriform recess stenosis
Midnasal stenosis
Midfacial hypoplasia
Dacryocystocele
Inflammatory
Gastroesophageal reflux
Neonatal rhinitis
Conchal hypertrophy
Infectious
Congenital sexually transmitted diseases
Chlamydia
Gonorrhea
Syphilis
Maternal
Estrogenic stimuli
Metabolic
Hypothyroidism
Midline nasal masses (see Chapter 8.16)
Encephalocele
Glioma
Nasal dermoid
Thornwaldt cyst
Neoplasms
Teratoma
Hamartoma
Hemangioma (see Chapter 8.14)
Lipoma
Lymphangioma (see Chapter 8.14)
Lymphoma
Neurofibroma
Rhabdomyosarcoma
Traumatic
Septal deviation
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
