title: Pediatric rhinoplasty: A discussion of perioperative considerations and systematic review.
abstract: OBJECTIVE
  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 approaches, 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 specified 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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA. Electronic address: Amar.gupta21@gmail.com.
authors.forename: Amar
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Hani
authors.initials: H
authors.lastname: Rayess
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA; Division of Pediatric Otolaryngology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Sheyn
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, NJ, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Zuliani
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Carron
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery; D004954:Esthetics; D006801:Humans; D007223:Infant; D015508:Nasal Obstruction / Q000209:etiology; D009666:Nose / Q000293:injuries; D009667:Nose Deformities, Acquired / Q000601:surgery; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D012086:Reoperation; D012225:Rhinoplasty / Q000009:adverse effects* / Q000379:methods* / Q000523:psychology; D055815:Young Adult
keywords: Adolescent rhinoplasty; Pediatric rhinoplasty; Rhinoplasty in children; Systematic review