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Less Is More in Congenital and Pediatric Nasal Lesions

Wolfswinkel, Erik M. MD*; Fahradyan, Artur MD*,†; Tsuha, Michaela BS; Goel, Pedram BS; Starnes-Roubaud, Margaret MD; Howell, Lori K. MD*,†; Hammoudeh, Jeffrey A. MD, DDS*,†; Urata, Mark M. MD, DDS*,†; Magee, William III MD, DDS*,†

doi: 10.1097/SCS.0000000000005442
Clinical Study: PDF Only

Congenital and pediatric nasal lesion resection and their reconstructive outcomes are not well studied. A surgeon must consider the site, size, depth, etiology, age, and effect on future function (including growth). As such, it is important to contrast the differences between the adult's and child's nose. The authors propose that more conservative resection and reconstructive methods may better serve congenital and pediatric nasal lesions. An Internal Review Board approved study of congenital and pediatric nasal lesions using a defect only approach from 2005 to 2017 was performed. Lesions, type of surgeries, complications, aesthetic outcome, and additional interventions were reviewed. One hundred twenty-seven patients met the study criteria with a median age at surgery of 5.4 years with follow-up of 1.4 years (1 week–11.3 years). The most common diagnosis was congenital melanocytic nevus (47, 37%). The lesions were located on more than 1 subunit in 34 (27%) patients with an average surface area of 3.7 (0.04–32) cm2. The most common primary procedure was excision and primary closure with adjacent tissue undermining/rearrangement (73, 57.4%) followed by full-thickness skin graft (23, 18.1%). The aesthetic outcome was considered acceptable in a high number of patients 117 (92%), while 10 (8%) patients had unacceptable aesthetic outcomes, mostly due to scarring. The authors’ data supports the concept of minimal healthy tissue excision or lesion only excision when treating pediatric and congenital nasal lesions.

*Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California

Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, CA

Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.

Address correspondence and reprint requests to Erik M. Wolfswinkel, MD, Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033; E-mail:; Pedram Goel, BS, Keck School of Medicine of the University of Southern California, Los Angeles, CA, 90033; E-mail:

Received 16 October, 2018

Accepted 15 January, 2019

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.