Nasal continuous positive airway pressure (nCPAP) is commonly used as a non-invasive alternative to endotracheal intubation and tracheotomy, to provide respiratory support to very low birth weight (VLBW) (<1500g) neonates. Nasal injury is a well recognised complication and figures quoted are as high as 13.2-50%. This is a single institution, retrospective audit over 33 years. Eleven patients were identified, who sustained nCPAP injury and were subsequently evaluated later in adolescent or adult years. The most common injuries recorded were involving the nasal soft triangle and columella. Secondary presenting deformities included obstruction, lack of projection and deviation of the nasal tip. All patients required corrective surgery and two a minimum of two procedures. Most patients had tissue loss and necrosis and required staged repair with grafts strong enough to counter secondary scar contracture. This study confirms most common site for nCPAP injury and the sequlae. It highlights the need for close monitoring and prevention in this subset of patients requiring CPAP. It also highlights the difficulties in achieving correction for deformities sustained in the growing phase.

Late presenting nasal deformities after nasal continuous positive airway pressure injury: 33 year experience.
Li Y, Seulveda A, Buchanan EP.
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