Plastic Surgery, Yale School of Medicine, New Haven.
Division of Orthodontics, University of Connecticut, Farmington, CT.
J Craniofac Surg. 2022;33(2):444-448. doi: 10.1097/SCS.0000000000008132.
BACKGROUND/PURPOSE: Pediatric septorhinoplasty has sparked controversial debate amongst craniofacial surgeons, particularly due to its potential growth disturbances of the face and nose. The purpose of this study is (1) to conduct a systematic literature review that explores unique considerations and limitations associated with performing rhinoplasty in the pediatric population; (2) to discuss objective indicators for determining craniofacial skeleton maturation; (3) to perform a case series to further understand whether the age of menarche serves as a good proxy for estimating the time of facial growth maturation, and by extension, whether a post-menarchal patient is a suitable candidate for rhinoplasty.
Systematic literature review was performed in order to assess unique considerations and limitations of pediatric rhinoplasty. Retrospective chart review and anthropometric (9 linear, 3 angular, 6 indices) measurements were performed for ten pediatric female patients who underwent open septo-rhinoplasty. Follow-up times ranged from 66 to 103 weeks. Patients were separated into 2 cohorts according to age at the time of menarche. Cohort 1 consisted of patients who had undergone menses for longer than 2 years at the time of rhinoplasty, whereas Cohort 2 comprised of patients who either had menses within 2 years of rhinoplasty or did not have menses at the time of rhinoplasty. Data included demographic factors, procedural variables, revision surgeries, and complications. Measurements were conducted using VECTRA software (Canfield Scientific, Parsippany, NJ). Differences in measurements between the 2 postoperative timepoints were compared.
Literature review yielded 17 articles, which had conflicting opinions regarding pediatric rhinoplasty and ultimately, highlighting the need for a more objective tool for guiding the decision to perform rhinoplasty.Patients in Cohort 1 had minimal deviations in measurements over time, within the exception of an increase in nasal tip projection and a decrease in nasolabial angle and facial width. Patients in Cohort 2 had decreases in facial height, upper facial height, nasal tip angle, and nasofrontal angle. Nasolabial angle decreased for both cohorts. Of the ten patients, 1 in Cohort 2 underwent revision rhinoplasty.
Our case series suggests that anthropometric measurements remain relatively more stable for patients who have undergone menses for more than 2 years, compared to those who have not. Although this study has limitations, further investigation is warranted in order to determine whether age of menarche may serve as a useful tool for craniofacial surgeons in guiding the decision to perform rhinoplasty.
背景/目的：小儿鼻中隔成形术在颅面外科医生中引发了争议，尤其是因为它可能对面部和鼻子的生长发育造成干扰。本研究的目的是：(1)进行系统的文献回顾，探讨在小儿人群中进行鼻整形术的独特考虑因素和限制；(2)讨论确定颅面骨骼成熟度的客观指标；(3)进行病例系列研究，以进一步了解初潮年龄是否可以作为评估面部生长成熟时间的良好指标，以及初潮后的患者是否适合进行鼻整形术。
为了评估小儿鼻整形术的独特考虑因素和限制，我们进行了系统的文献回顾。对 10 名接受开放式鼻中隔-鼻成形术的小儿女性患者进行了回顾性图表审查和人体测量学（9 项线性，3 项角度，6 项指数）测量。随访时间从 66 周到 103 周不等。患者根据初潮时的年龄分为两组。第 1 组为初潮后已持续 2 年以上的患者，第 2 组为初潮后 2 年内或初潮时无月经的患者。数据包括人口统计学因素、手术变量、翻修手术和并发症。测量使用 VECTRA 软件（Canfield Scientific，Parsippany，NJ）进行。比较了两个术后时间点的测量值之间的差异。
文献综述得出了 17 篇文章，这些文章对小儿鼻整形术的看法存在冲突，最终强调需要更客观的工具来指导鼻整形术的决策。第 1 组患者的测量值随时间的变化很小，除了鼻尖突出度增加和鼻唇角及面宽减小外。第 2 组患者的面部高度、上面高、鼻尖角和鼻额角减小。两组患者的鼻唇角都减小了。在 10 名患者中，有 1 名第 2 组患者需要进行鼻整形术翻修。
我们的病例系列研究表明，与尚未初潮的患者相比，已经初潮 2 年以上的患者的人体测量值相对更稳定。尽管本研究存在局限性，但需要进一步研究，以确定初潮年龄是否可以作为颅面外科医生指导鼻整形术决策的有用工具。
