What is the youngest age for my child to have an operation on their nose?
This is a commonly asked question amongst parents which depends on several factors. I like to first determine if the surgery is for functional (improve breathing) or cosmetic purposes.
Functional nose surgery in children is fairly uncommon. The most common cause of nasal obstruction in children is enlarged adenoids. Clinically, deviated septums are really not seen as common causes of nasal obstruction until at least seven or eight. I performed a radiologic study which confirms that nasal deviation is not seen until after the ages of five. (See Radiologic Study). Most children would respond to surgery to fix either their adenoid pads or reduce their turbinates.
Why many surgeons do not jump at the opportunity on children under 14 with deviated septums?
If the septum is determined to be the cause of nasal obstruction in a child, a clinical dilemma arises. The main reason why septoplasty is performed uncommonly in a child is that their hypothesized growth centers within the nasal septum. If these growth centers are disrupted, it is thought that there may be the potential for change in nasal shape.
On the other hand, if a child is having significant decrease in breathing which is effecting his or her ability to sleep at night, receive oxygen, exercise, etc. In addition, chronic mouth breathing can lead to skeletal changes in the face often called the adenoid facies, but can occur with any nasal obstruction.
So, in summary either way it seems the surgeon and patient seem to be trading one problem for another. So what can be done. First of all, if surgery is determined to be beneficial for the patient it can be done in a specialized format. The growth centers of the nose can be avoided if possible. Now no one really knows where the growth centers are humans but it has been studied in animals. Extrapolation from that data, has lead most scientists to believe that the growth centers are located along the nasal floor posteriorly. If the surgeon can avoid disrupting this center, long term cosmetic nasal issues will theoretically be minimized. In addition, if the surgeon replaces the crooked portion of the septum after straightening it, the cartilage of the nose is now straighter but still intact.
Cosmetic issues are a completely different story altogether. Due to the potential for disruption of growth centers of the nose (see link), surgeons need to determine when has the nose stopped growing. A simple, yet surprisingly accurate method is to determine when the patient’s shoe size has changed last. If it has been over two years, there is a strong likelihood that the patient’s nose has also stopped growing and that a nasal operation would be possible.
However, the physical component of changing a patient’s nasal appearance is not the only factor. Emotional and mental maturity are probably the rate limiting factor in most teenagers. Patients must be the driving force behind wanting the rhinoplasty and not parents. The surgeon should explain to the patient that this is surgery and is a permanent action. The evaluation of teenagers at this point is extraordinarily complex. Some are highly mature and are very clear about what portions of their nose they wish to change. Others bring in pictures of the latest pop star and explain that this is the nose that they desire. The surgery is not intended to create a trendy nose, but a nose which will continue to look good with age.
“The nose should fit the face”
A strong jawline would suggest a stronger nose.