Pediatric septorhinoplasty: A cohort study utilizing the pediatric health information system (PHIS) database.

Background: Pediatric rhinoplasty and septoplasty are performed for both functional and reconstructive indications, including airway obstruction, trauma, and orofacial cleft (OFC)-associated nasal deformities. Despite increasing national case volume, limited data exist on utilization patterns, procedural trends, and healthcare costs in this population. Methods: Using the Pediatric Health Information System (PHIS) database, we conducted a retrospective cohort study of patients 3-17 years old who underwent septoplasty, rhinoplasty, or septorhinoplasty between 2015 and 2022. Patients were stratified by OFC diagnosis and age group (3-14 vs. 15-17 years). Sub-analyses were performed for septoplasty-only and rhinoplasty/septorhinoplasty cohorts. Results: A total of 10,762 cases were identified; 24% had OFC. Septoplasty was nearly exclusive to non-cleft patients (98%) and increased with age, reflecting deferral until skeletal maturity. Septorhinoplasty showed a sharp volume increase after age 14, with earlier use in cleft patients as part of staged reconstruction. Graft use was significantly higher in OFC cases (21% vs. 5.5%, p < 0.0001), especially for auricular and dermal/fascial grafts. Turbinate reduction was more common in non-cleft patients. Complication and readmission rates were low across all groups (<2%). Total costs were higher in the OFC cohort but were comparable between cleft and non-cleft patients undergoing rhinoplasty/septorhinoplasty, suggesting procedure type was the primary cost driver. Conclusion: Pediatric septoplasty and rhinoplasty are safe, low-complication procedures across cleft and non-cleft populations. Trends reflect ongoing caution around timing of intervention, greater surgical complexity in cleft patients, and the need for standardized care pathways that balance functional, aesthetic, and developmental goals.