Cleft-lip nose fix OK at 16 for girls, 17 for boys

NEW YORK (Reuters Health) - Girls with facial clefts can safely undergo surgical reshaping of the nose at age 16, when nasal growth is mature in most individuals; for boys the operation can be performed at 17, Dutch researchers report.

Dr. Perry van der Heijden and colleagues from the University Medical Center Groningen note that most specialists in treating cleft palate and cleft lip put off nose reshaping, known as rhinoseptoplasty, until young people are 18. At this age, growth is thought to have slowed enough that it will not affect the results of the operation, they explain in the Archives of Otolaryngology–Head and Neck Surgery.

“However, the dogma stating that nasal surgery in growing individuals must be avoided is coming under question,” they add. Earlier surgery may be particularly beneficial to adolescents with cleft palate, who are often unhappy with their appearance and report being teased, the researchers point out.

To examine when rhinoseptoplasty could be performed safely in younger people, van der Heijden and his team reviewed the medical literature on several measures of nasal growth. For girls, they found, growth accelerates the most between 8 and 12 years, while for boys growth velocity peaks at around age 13. While it would be ideal to perform the surgery when the nose growth curve levels off, the researchers note, this is impossible because people’s noses continue to grow all their lives.

But by combining the data on nasal growth rate with information on height growth patterns and skeletal maturity, van der Heijden and his team were able to calculate that nose growth is mature in 98 percent of girls by age 15.8 years of age, and in 98 percent of boys by 16.9 years.

“Because the results of nasal interventions performed after maturation age are not likely to be disturbed by nasal growth, rhinoseptoplasty can be performed safely, in most cases, in adolescent girls after the age of 16 years and in adolescent boys after the age of 17 years,” they conclude.

SOURCE: Archives of Otolaryngology–Head and Neck Surgery, December 2008.


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