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Nasal surgery has traditionally been a procedure that has been reserved for later teenagers and adults when the development of the nose is complete. Since the septum of the nose is the main driving force for the growth of the nose, any manipulations were felt to result in subsequent deviations or arrest of nasal development.

But to those plastic surgeons that treat cleft nasal deformities, we know that is not absolutely true. Many septal and nasal tip deformities are treated at very early ages without observable long-term growth disturbances. While these are noses that are not completely normal and have their own built-in abnormalities, long-term follow-up into adulthood (which is common in cleft patients) does not show any signs of growth arrest.

In the Online First edition of the February 2014 issue of JAMA Facial Plastic Surgery, an article appeared titled ‘Corrective Nasal Surgery in the Younger Patient’. In this paper, the authors reviewed their experience in corrective nasal surgery in pediatric patients. A total of 54 patients (teenage males younger than 16, females younger than 14) who had either septoplasty or corrective nasal surgery over a 16 year period were reviewed. The most common reasons for surgery were posttraumatic deformities (36) and significant airway obstruction. (48) Five patients underwent a staged  procedure and no patients had any revisions for unsatisfactory results.

The authors conclude that children with nasal airway obstruction can safely have nasal corrective surgery before the nose is fully developed. They emphasize the preservation of normal structures and the judicious use of grafts. The key being is that there is no reason that nasal surgery can not be done on children and teens as long as there is a good reason (significant airway obstruction) and that radical removal of septal and turbinates is not done. More elective external nose reshaping (rhinoplasty) should still be reserved untila age 14 and older.

Dr. Barry Eppley

Indianapolis, Indiana

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