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Background
Nasal continuous positive airway pressure (nCPAP) is used in intensive care units (ICUs) as a form of respiratory support for premature babies. Robertson et al 1 have previously described nasal deformities resulting from nCPAP. Within a period of 6 months, these authors found traumatic nose changes in seven cases or 20% of their entire sample, varying from columella to septum necrosis to flaring of nostrils and snub-nosed deformity.
Yong et al 2 compared the incidence of nasal trauma due to nasal prongs or nasal masks for nCPAP in a randomised control trial. The incidence of nasal trauma was 29% and 35% for nasal mask and nasal prong, respectively (p=0.5). Whereas in the former group traumatic changes occurred at the junction between the nasal septum and philtrum, the latter group suffered more frequently from trauma of the nasal septum only. There were no cases of columella necrosis in either group.
In 2010 Fischer et al 3 classified nasal trauma secondary to nCPAP into three stages: (1) stage I: non-blanching erythema on an otherwise intact skin; (2) stage II: superficial ulcer or erosion with partial thickness skin loss and (3) stage III: necrosis, resulting in full thickness skin loss. In their series of 989 babies, 420 (42.5%) developed traumatic nose changes secondary to nCPAP with only three patients (0.7%) presenting a stage III defect. They further stated that risk of trauma increased in neonates (1) <32 weeks of gestational age, (2) <1500 g at birth weight, (3) with >5 days under nCPAP or (4) with >14 days' stay in the neonatal ICU.
Apart from discomfort and potential risk of infection nCPAP might lead to nasal trauma with long-term functional or cosmetic impairments. 3 Although rare, surgical repair of a necrotic columella is challenging but mandatory to re-establish anatomical architecture of the nose. Although instances of columella necrosis secondary to nCPAP have been reported, the reconstructive strategies for such cases are not well documented. This article describes a technique of reconstruction in a baby with columella necrosis due to nCPAP treatment.
Case presentation
A 21-month-old baby was referred to the oral and maxillofacial unit of the Wilgers Private Hospital, Pretoria, Republic of South Africa, to reconstruct a columella defect. According to the mother, the baby was born...