Purpose: Nasal reconstruction in children is an uncommon event. Unknown are the optimal age for nasal reconstruction, which flaps and grafts may be used, the growth potential of the new nose and how to assure a permanent functional and aesthetic result.
Methods: I retrospectively examined nasal reconstructions in 19 children. Average age was 7.8 years (range 3.0 -15.8 yrs). Etiology of the deformities: dog bite (9), vascular hamartoma (7), surgical injury (2) and congenital deformity (1). Reconstruction commenced between ages 3.0 and 15.8 years. Surgical stages averaged 3.9 (range 2-7). Average follow-up was 4.2 years (range 0.1 to 19.5). All patients had surgical reconstruction of the external nose with a paramedian forehead flap and ear or costal cartilage grafts. Six patients (32%) presented with a significant loss of nasal lining.
Results: 16 patients completed their reconstructions and had a normal appearance. In 9 patients (48%) who could be followed for >3 years, the nose grew in step with the patientÃѢââ⑬~Ѭâ,,Ñ¢s body growth. 16 patients exhibited functionally normal airways. Two children disrupted their wounds postoperatively requiring secondary repair. Three patients had compromised nasal airways requiring further surgery.
Conclusions: Reconstruction with a forhead flap can restore a childÃѢââ⑬~Ѭâ,,Ñ¢s nose to a normal appearance. There is no need to delay the reconstruction beyond 3.5 years of age. In truth, such delay is harmful. The reconstructed nose grows generally in step with the patient. Restoration of a functional airway may require anatomic restoration of the nasal lining element as a separate event. Normal form and function of the nose are restored in children with reconstruction starting as young as 3 years of age.