Rhinoplasty in Children

This issue of Facial Plastic Surgery is dedicated to rhinoplasty in children. Traditionally, septorhinoplasty in children was postponed until after the pubertal growth spurt. The traditional reluctance to operate on the growing nose diminished during the last decades, influenced by the use of more conservative surgical techniques, especially in septal surgery (septoplasty instead of septal resection) with reports of positive postoperative results in the literature.

Unfortunately, the follow-up period seldom extended until after the pubertal growth spurt. Experimental work (specially from the Verwoerd group in Rotterdam, the Netherlands), however, shows the importance of an intact nasal septum and intact T-bar structure of septum and upper laterals for normal nasofacial growth. Nevertheless, there are distinct indications for septorhinoplasty in the growing nose, especially in severe functional/aesthetic pathology. In these cases, the surgeon has to weigh functional/aesthetic problems against possible growth disturbance of the nose and midface. More than 30 years of experimental work and clinical observation, especially from the Verwoerd group, resulted in guidelines for the least disturbing surgical procedures in the growing nose and stressed keeping a conservative attitude to pediatric septorhinoplasty and our obligation to follow our patients until after the pubertal growth spurt.

This issue starts with basic concepts by Carel Verwoerd and Jetty Verwoerd-Verhoef and proceeds to Miriam Bönish and colleagues’ outcomes of experimental septal reconstruction in the growing nose with the use of polydioxanone foil. Next is an article by Menger and coworkers and Shandilya and associates dedicated to septal abscesses in children, with guidelines for surgical treatment to ensure outgrowth of the nose, followed by an overview of children operated upon in the Academic Medical Center in Amsterdam by Shandilya and coworkers, emphasizing outcomes and long-term results. In the last article, by Dennis and colleagues, especially, indications for the open approach with case reports and treatment modalities are discussed. I really hope that this issue on “Rhinoplasty in Children” gives you surgical guidelines that will benefit our growing patients.