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[For or against rhinoplasty in children?]
Insights
Rhinoplasty in young children is complex. Surgeons should exercise caution, prioritizing functional issues and conservative techniques to avoid impacting nasal growth.
Area of Science:
- Pediatric surgery
- Craniofacial surgery
- Otorhinolaryngology
Context:
- Nasal malformations in children present a surgical dilemma, with differing opinions on early intervention versus delayed treatment.
- Existing clinical and animal studies offer limited definitive guidance for operating on very young children.
Purpose:
- To evaluate the optimal timing and approach for surgical correction of nasal malformations in pediatric patients.
- To provide recommendations for rhinoplasty in children, considering growth and functional outcomes.
Summary:
- The role of the nasal septum in facial growth necessitates a cautious approach to pediatric rhinoplasty.
- Recommendations include prioritizing significant functional deficits for surgical indications, delaying surgery when possible, employing ultraconservative techniques (preserving mucoperichondrium, repositioning fragments), and aiming for partial, revisable results over risking growth disturbances.
- Rhinoplasty in young children is inherently challenging and should be reserved for exceptional cases.
Impact:
- This guidance aims to improve surgical decision-making for pediatric nasal deformities, minimizing risks of growth impairment.
- Promotes a conservative, function-first approach to pediatric rhinoplasty, enhancing long-term aesthetic and functional results.
Abstract:
The correction of nasal malformations in children divides surgeons into two groups: those who prefer to operate in order to rapidly restore the altered anatomical structures, and those who prefer to wait and see, to avoid aggravating the initial lesions by operating during the growth period. Clinical findings and animal experiments fail to clearly support either one of these approaches, at least in the case of very young children, but as recent embryological studies have demonstrated the important role of the septum in the growth of the nose, it still seems legitimate to recommend great caution before performing rhinoplasty in children: caution concerning the indications which should take into account major functional problems, caution in deciding the time of operation, which can frequently be delayed, caution in the technique which should be ultraconservative with preservation of the mucoperichondrium, reposition of the displaced fragments and reinclusion in the case of resection, caution in the desired goal of the operation as it is better to obtain a partial result with the possibility of subsequent revision rather than risk serious problems of growth. Rhinoplasty in young children is always difficult and should therefore remain an exceptional procedure.