A variety of scenarios may require nasal reconstruction in the pediatric population. The most common surgical problems include congenital malformations and skin lesions, acquired defects from trauma or tumors, hemangiomas and vascular malformations, and nasal and columellar injury from oxygen cannulas in the neonatal period. The shape of an infant's nose is different than that of an adult, as there is less frontal projection in addition to having a shorter nasal dorsum and columella. One must consider the growth of the nose when planning reconstruction. The nasal septum is the growth center of the face.
Congenital malformations include nasal encephaloceles, gliomas, and dermoid cysts which can be found at any area of the nose including the dorsum, nasal tip, and columella. These are congenital malformations that are the result of in utero maldevelopment in the first 12 weeks of pregnancy.
Acquired nasal defects after tumor resection or trauma in children should be reconstructed in pre-school or early school age to mitigate negative psychosocial effects on the child, as early as 3-5 years of age.
Reconstruction of the nose requires three main elements: lining, support, and cover. The inner lining consists of the nasal mucosa, support consists of bone and cartilage, while cover is the external skin envelope. The inner lining can be reconstructed with skin or buccal mucosal grafts. The cartilaginous frame may be reconstructed with cartilage from the ear or rib. The external skin may be reconstructed with local transposition flaps or a paramedian forehead flap. In most cases of reconstruction, several stages will be required. Reconstruction is carried out by trained plastic and craniofacial surgeons who have specific expertise in the pediatric population.