Pediatric Rhinoplasty: A national surgical quality improvement program analysis

Abstract

Objectives Rhinoplasty is commonly performed in children with congenital anomalies and resultant nasal deformity causing airway obstruction. Little is known regarding patient factors or perioperative sequelae. We define demographic characteristics and perioperative complications for children undergoing rhinoplasty within a large national cohort. Study Design Retrospective cohort study of children aged ≤ 18 years undergoing rhinoplasty utilizing data from the 2012 to 2015 American College of Surgeons National Surgery Quality Improvement Program‐Pediatric public use file. Methods All children who underwent rhinoplasty were identified. Postoperative complications were defined as 30‐day postoperative infection, unplanned readmission and reoperation, and death. Multivariate logistic regression was used to identify predictors of complications. Subgroup analysis was performed based on child age (age < 5 years vs. 5–13 years vs. ≥ 14 years). Results Of 1,378 children undergoing rhinoplasty, 21(1.52%) children experienced complications, with the most common being unplanned readmission. Younger children were more likely to experience complications (3.79% aged < 5 years vs. 0.66% aged ≥ 14 years; P = 0.001). Using multivariate logistic regression analysis, we observed a 61% decreased odds of complication with each age group (odds ratio 0.39, 95% confidence interval 0.19, 0.77; P = 0.007). Younger children were more likely to be male (56.2% male aged < 5 years vs. 46.6% male aged ≥ 14 years; P = 0.011), have developmental delay (11.7% aged < 5 years vs. 3.65% aged ≥ 14 years; P < 0.001), and have craniofacial abnormalities (73.2% aged < 5 years vs. 42.1% aged ≥ 14 years; P < 0.001). Conclusion Children undergoing rhinoplasty experience few major complications, with the most common being unplanned readmission. Younger children are at greater risk and are more likely to be male with craniofacial abnormalities. Level of Evidence 4 Laryngoscope, 129:494–499, 2019

Reporting of Complications in Rhinoplasty Randomized Controlled Trials: An Analysis Using the CONSORT Extension for Harms Checklist

“…For example, 1 review of pediatric rhinoplasties found that children under 5 were more likely to have unplanned reoperations, surgical site infections, and composite complications. 37 Since its development, the CONSORT Statement has been widely adopted by well-known otolaryngology publishers including JAMA-OTO, laryngoscope, and the White Journal. [38][39][40] However, despite being published almost 2 decades ago, studies assessing the quality of reporting before and after the publication of the CONSORT-Harms extension and found that there was minimal to no significant change in the reporting of harms.…”

Rhinoplasty in a 3 Week Old: Surgical Challenges in the Setting of Severe Congenital Frontonasal Dysplasia

“…Pediatric rhinoplasty is uncommon but indicated in certain circumstances including trauma, cleft lip nasal deformity, and reconstruction after excision of a nasal mass. 7,8 Rhinoplasty during primary cleft lip repair is common and has been found to have no interference in overall nasal growth with improved outcomes. 9 This case is unique with additional complexity from the typical cleft nasal deformity and adds to the limited body of literature on CFND, in that a deformity this severe was not encountered on review.…”

Utilizing Age of Menarche to Optimize Pediatric Rhinoplasty

“…Although several previous studies have assessed the impact of rhinoplasty on facial growth in the pediatric population, they have varied perspectives on when patients reach facial maturation. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Walker et al 10 suggested that facial growth, nasal height, facial height, and nasal tip protrusion cease growth at variable timepoints: 18 years old or the appearance of third molar teeth, 12 years old, 13 years old, and 14 years old respectively in females. In a study of 64 Korean children, Bae et al 11 affirmed that nasal maturation occurs at the age of 16 in females.…”

“…The decision to pursue rhinoplasty in a young patient has been historically controversial, as it remains unclear when facial and nasal maturation occurs. Although several previous studies have assessed the impact of rhinoplasty on facial growth in the pediatric population, they have varied perspectives on when patients reach facial maturation 9–23 . Walker et al 10 suggested that facial growth, nasal height, facial height, and nasal tip protrusion cease growth at variable timepoints: 18 years old or the appearance of third molar teeth, 12 years old, 13 years old, and 14 years old respectively in females.…”