September 2019 HSC Section 1 Congenital and Pediatric Problems

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Reprinted by permission of Int J Pediatr Otorhinolaryngol. 2017; 92:11-16.

International Journal of Pediatric Otorhinolaryngology 92 (2017) 11 e 16

Contents lists available at ScienceDirect

International Journal of Pediatric Otorhinolaryngology

journal homepage: http://www.ijporlonline.com/

Pediatric rhinoplasty: A discussion of perioperative considerations and systematic review Amar Gupta a , * , Peter F. Svider a , Hani Rayess a , Anthony Sheyn b , c , Adam J. Folbe a , Jean Anderson Eloy d , e , f , g , Giancarlo Zuliani a , h , Michael A. Carron a , h a Department of Otolaryngology e Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA b Department of Otolaryngology e Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA c Division of Pediatric Otolaryngology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA d Department of Otolaryngology e Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA e Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA f Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, NJ, USA g Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA h Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology e Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA

a r t i c l e i n f o

a b s t r a c t

Article history: Received 19 August 2016 Received in revised form 24 October 2016 Accepted 24 October 2016 Available online 26 October 2016

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 ap- proaches, 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 speci fi ed 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. © 2016 Elsevier Ireland Ltd. All rights reserved.

This has been presented as a poster pre- sentation at the 2016 Annual ARS Meeting, San Diego, September 2016.

Keywords: Pediatric rhinoplasty Rhinoplasty in children Adolescent rhinoplasty Systematic review

1. Introduction

and sphenopsinal zones are the growth centers of the nose and work to increase the length and height of the nasal bones and outgrowth of the maxilla, respectively. Multiple studies, including those in monozygotic twins, have supported this idea by demon- strating growth inhibition of the nasal skeleton and maxilla when trauma has been sustained to these areas [1 e 3] . Nasal growth continues until early adulthood with speci fi c windows of acceler- ated growth, the two most signi fi cant of which are in the fi rst 2 years of life and during puberty [4] . The end of nasal growth is at

Nasal maturation occurs from designated growth centers and with speci fi c periods of accelerated growth. The sphenodorsal zone

* Corresponding author. Department of Otolaryngology e Head and Neck Sur- gery, Wayne State University School of Medicine, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201, USA. E-mail address: Amar.gupta21@gmail.com (A. Gupta).

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