Pediatric septoplasty and functional septorhinoplasty: A survey of ASPO members

Pediatric septoplasty and functional septorhinoplasty remain controversial due to concerns for the effect of surgery on the developing nose. We aimed to assess practice patterns among pediatric otolaryngologists who perform pediatric septoplasty and septorhinoplasty.

A cross-sectional survey was distributed to members of the American Society of Pediatric Otolaryngology (ASPO). Descriptive statistics were employed to summarize the typical indications and the most common techniques used in pediatric septoplasty and septorhinoplasty.

Eighteen percent (105/577) of ASPO members completed the survey. Of respondents, 91 (87.0%) performed septoplasty, while 29 (27.9%) performed septorhinoplasty. Those who did not perform septorhinoplasty most commonly referred to Facial Plastics and Reconstructive Surgery (74.7%). Impacts on patient-reported quality of life were the most common criterion for both septoplasty and septorhinoplasty (82.2% and 76.4%, respectively). The NOSE was the most common patient-reported outcome instrument utilized. Among respondents, 38.9% did not use a strict age cutoff to perform septoplasty and 24.1% for septorhinoplasty. The most common techniques reported were columellar strut grafts for caudal septal deviation (66.7%), spreader grafts for internal nasal valve collapse (86.7%), alar batten grafts for external nasal valve collapse (55.2%), and lateral osteotomies for external bony deviations (85.2%). Spreader grafts only are used more than spreader flaps only to treat internal nasal valve collapse (62.1% vs 3.4%), while lateral osteotomies are used more than transverse osteotomies for bony deformity (85.7 vs 0%).

Diminished patient-reported quality of life was the most common indication for pediatric septoplasty and functional septorhinoplasty among respondents. Columellar strut grafts, spreader grafts, alar batten grafts, and lateral osteotomies were common techniques used. Further work is needed to develop guidelines on septoplasty and functional septorhinoplasty in children and adolescents.