Pediatric septorhinoplasty: A cohort study utilizing the pediatric health information system (PHIS) database

Pediatric rhinoplasty and septoplasty are performed for both functional and reconstructive indications, including airway obstruction, trauma, and orofacial cleft (OFC)-associated nasal deformities. Despite increasing national case volume, limited data exist on utilization patterns, procedural trends, and healthcare costs in this population.

Using the Pediatric Health Information System (PHIS) database, we conducted a retrospective cohort study of patients 3-17 years old who underwent septoplasty, rhinoplasty, or septorhinoplasty between 2015 and 2022. Patients were stratified by OFC diagnosis and age group (3-14 vs. 15-17 years). Sub-analyses were performed for septoplasty-only and rhinoplasty/septorhinoplasty cohorts.

A total of 10,762 cases were identified; 24% had OFC. Septoplasty was nearly exclusive to non-cleft patients (98%) and increased with age, reflecting deferral until skeletal maturity. Septorhinoplasty showed a sharp volume increase after age 14, with earlier use in cleft patients as part of staged reconstruction. Graft use was significantly higher in OFC cases (21% vs. 5.5%, p < 0.0001), especially for auricular and dermal/fascial grafts. Turbinate reduction was more common in non-cleft patients. Complication and readmission rates were low across all groups (<2%). Total costs were higher in the OFC cohort but were comparable between cleft and non-cleft patients undergoing rhinoplasty/septorhinoplasty, suggesting procedure type was the primary cost driver.

Pediatric septoplasty and rhinoplasty are safe, low-complication procedures across cleft and non-cleft populations. Trends reflect ongoing caution around timing of intervention, greater surgical complexity in cleft patients, and the need for standardized care pathways that balance functional, aesthetic, and developmental goals.