Bae Ji Seon, Kim Eun-Sook, Jang Yong Ju
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Songpa-gu, Seoul 138-736, Republic of Korea.
Int J Pediatr Otorhinolaryngol. 2013 Oct;77(10):1701-10. doi: 10.1016/j.ijporl.2013.07.030. Epub 2013 Aug 9.
Performing rhinoplasty in children has been an issue of some debate due to concerns about potential harmful effects on nasoseptal growth. However, there is a paucity of evidence describing the outcomes of pediatric rhinoplasty. This study presents our experience of performing this procedure in children of 17 years of age and younger.
The study population consisted of 64 Korean children between 4 and 17 years of age who underwent rhinoplasty between May 2003 and August 2011. Forty-six of the patients were boys and 18 were girls with a mean follow-up period of 59 months. The diagnosis of the patients, the extent of the surgical maneuver performed, and the surgical outcomes were reviewed. Subjective satisfaction of the patients was investigated by telephone interview. Surgical outcomes, which were judged by two independent ENT surgeons, were evaluated by comparing preoperative and postoperative photographs. Satisfaction scores were graded using a visual analog scale (from 1 = satisfied, to 4 = dissatisfied). Anthropometric measurements of nasal parameters were performed preoperatively and postoperatively.
Rhinoplasty was performed in our patient cohort due to a deviated nose (32.8%), nasal bone fracture (18.8%), flat nose (6.3%), nasal mass (4.7%), hump nose (3.1%), nasal dermoid sinus cyst (1.6%), and additional cosmetic rhinoplasty for planned septoplasty (32.8%). The median patient satisfaction score was 2.09 compared with a median doctor satisfaction score of 1.81. Anthropometric measurements showed statistically significant improvements in nasal tip projection, nasal length, dorsal height, and radix height after rhinoplasty. Seventeen patients (26.6%) experienced esthetic dissatisfaction such as deviation, tip depression, bulbous tip, short nose, and nostril asymmetry. Eight patients (12.5%) experienced postoperative difficulty in nasal breathing, and two patients (3.1%) complained of transient nasal pain after rhinoplasty. Six patients (9.4%) underwent revision surgery, and four patients (6.3%) were seriously considering a revision operation.
The outcome analysis in our series reveals that rhinoplasty in children is complicated by a high rate of revision and esthetic dissatisfaction. The results of this study may indicate that surgeons should have a conservative attitude and apply strict indication in selecting pediatric rhinoplasty candidates.
由于担心对鼻中隔生长有潜在有害影响，儿童鼻整形术一直存在一些争议。然而，描述小儿鼻整形术结果的证据很少。本研究介绍了我们在17岁及以下儿童中进行该手术的经验。
研究人群包括2003年5月至2011年8月间接受鼻整形术的64名4至17岁韩国儿童。其中46例为男孩，18例为女孩，平均随访期为59个月。回顾了患者的诊断、手术操作范围和手术结果。通过电话访谈调查患者的主观满意度。由两名独立的耳鼻喉科医生判断手术结果，通过比较术前和术后照片进行评估。满意度评分采用视觉模拟量表（从1=满意到4=不满意）进行分级。术前和术后进行鼻参数的人体测量。
我们的患者队列中进行鼻整形术的原因包括鼻偏曲（32.8%）、鼻骨骨折（18.8%）、扁平鼻（6.3%）、鼻肿物（4.7%）、驼峰鼻（3.1%）、鼻皮样囊肿（1.6%）以及计划行鼻中隔成形术时额外进行的美容性鼻整形术（32.8%）。患者满意度中位数为2.09，而医生满意度中位数为1.81。人体测量显示，鼻整形术后鼻尖突出度、鼻长度、鼻背高度和鼻根高度有统计学意义的改善。17例患者（26.6%）存在美学不满意，如鼻偏曲、鼻尖凹陷、鼻尖圆钝、鼻短和鼻孔不对称。8例患者（12.5%）术后存在鼻呼吸困难，2例患者（3.1%）抱怨鼻整形术后有短暂的鼻痛。6例患者（9.4%）接受了修复手术，4例患者（6.3%）正在认真考虑进行修复手术。
我们系列的结果分析表明，儿童鼻整形术因修复率高和美学不满意而复杂化。本研究结果可能表明，外科医生在选择小儿鼻整形术候选人时应持保守态度并应用严格的适应症。
