Pediatric rhinoplasty: A discussion of perioperative considerations and systematic review

Int J Pediatr Otorhinolaryngol. 2017 Jan:92:11-16. doi: 10.1016/j.ijporl.2016.10.027. Epub 2016 Oct 26.

Abstract

Objectives: Pediatric rhinoplasty has traditionally raised numerous concerns, including its impact on growth as well as the psychological sequelae of undergoing a potentially appearance-altering procedure. Our objective was to critically evaluate available individual patient data relevant to pediatric rhinoplasty, and further discuss perioperative considerations.

Methods: A systematic review was conducted using PubMed/MEDLINE databases. Data extracted and analyzed from included studies included patient demographics, surgical indications, operative approaches, outcomes, complications, revision rates, and other clinical considerations.

Results: Seven studies encompassing 253 patients were included, with age ranging from 7 months to 19 years. Two-thirds of patients were male. 41.7% reported antecedent trauma, and common overall surgical indications included "functional aesthetic" (24.5%) followed by cleft lip nasal deformity (15.8%). The majority (79.1%) underwent open approaches, and 71.1% of patients underwent concomitant septal intervention. The most frequently used grafting materials were septal cartilage (52.8%) and conchal cartilage (16.5%). Surgical outcomes were heterogeneous among these studies. Complication rates were only specified in 5 of the 7 studies and totaled 57 patients (39.6%). Aesthetic dissatisfaction (11.8%) and postoperative nasal obstruction (5.6%) were the most commonly reported complications. Revisions were performed in 13.5%.

Conclusion: Rhinoplasty is safe in the pediatric population, although revisions rates appear greater than those reported in adults. This study of 253 represents the largest pooled sample size to date; nonetheless, non-standardized outcome measures, minimal long-term followup data, and lack of discussion regarding psychological sequelae all contribute to the need for further high-quality studies evaluating this topic.

Keywords: Adolescent rhinoplasty; Pediatric rhinoplasty; Rhinoplasty in children; Systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cleft Lip / surgery
  • Esthetics
  • Humans
  • Infant
  • Nasal Obstruction / etiology
  • Nose / injuries
  • Nose Deformities, Acquired / surgery
  • Outcome Assessment, Health Care
  • Patient Satisfaction
  • Reoperation
  • Rhinoplasty / adverse effects*
  • Rhinoplasty / methods*
  • Rhinoplasty / psychology
  • Young Adult