September 2019 HSC Section 1 Congenital and Pediatric Problems

A. Gupta et al. / International Journal of Pediatric Otorhinolaryngology 92 (2017) 11 e 16

adults. Future inquiry into the impact of rhinoplasty from a psy- chological and emotional perspective on younger patients may be of great value to both surgeons as well as patients and their guardians. Although this analysis represents the fi rst systematic review on this topic, there are several limitations inherent to the nature of this topic. Importantly, there was great heterogeneity in the studies that were reviewed and this was seen in almost all the factors which were analyzed. The largest study of 106 patients did not provide information on detailed indications for surgery or on surgical out- comes. This was a major shortcoming of our review as the patients represented 41.9% of our total study population. While our review provides the fi rst systematic review on the topic of pediatric rhi- noplasty, the need for further study is underscored. Information in the literature is not presented in a standardized manner and there is much information, such as the indications for revision surgery, that is still not evident. Follow up is not consistent among different studies and factors such as psychological effects of nasal surgery on children are not discussed. Further high quality and prospective inquiry would be invaluable in advancing our understanding of unique considerations speci fi c to this population. Rhinoplasty is safe in the pediatric population, with no major effects on craniofacial growth reported. Furthermore, this proced- ure can be effectively used to address a wide range of pathologies. Nonetheless, this review notes a revision rate (13.5%) greater than reported in many adult series, and aesthetic dissatisfaction plays a signi fi cant role. Speci fi c surgical approaches, outcomes, and com- plications reported in this analysis may be invaluable for discussion as part of a comprehensive pre-operative counseling process. Importantly, although this study of 253 represents the largest pooled sample size to date, several factors (including non- standardized outcome measures, minimal long-term followup data, and lack of discussion regarding psychological sequelae) contribute to the need for further high-quality studies. 5. Conclusion

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References

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