Nose, skin tumor, nasal reconstruction, flap, graft introduction the nose is located in the middle of the face. Having nasal surgery and finding the right surgeon to perform your procedure can be stressful. The latest twovolume textbook from the worlds leading authority on nasal reconstruction, frederick j. Soft tissue defects of the nose result from trauma, infections and after tumor resection. For the plastic surgeon, nasal reconstruction is the most frequent and most challenging referral after mohs micrographic surgery. Autologous and synthetic nasal and auricular frameworks require skin coverage. Occasionally a 3 rd procedure is needed to make the final result look cosmetically appealing. Nasal and upper lip reconstruction of a case of squamous. Nasal reconstruction with composite chondrocutaneous grafts dr sumer yadav plastic surgery 2. Comparison of the mechanical properties of different skin sites for auricular and nasal reconstruction m.
Nasal reconstruction is one of the most challenging and rewarding procedures performed by the plastic surgeon. Functional nasal reconstruction using structural reinforcement. To succeed in nasal reconstruction, the surgeon must first realize how the various visually distinct areas of the nose contribute to the noses overall appearance. Nasal reconstruction using a paramedian forehead flap is a surgical technique to reconstruct different kinds of nasal defects. Because of its ideal quality, color, and texture, the forehead skin is recognized as the best donor site for resurfacing of the nose. Generally speaking, a nasal reconstruction will consist of a graft whether this is a skin graft or a skin and cartilage graft is dependent on individual circumstances. There is a need for a rapid reconstructive technique in nasal deformity where the tissue loss is less than total.
Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety. Using these bones, artists and forensic anthropologists work together to reconstruct facial appearance through the process of forensic facial reconstruction. The laterally based bilobed flap is commonly used for the reconstruction of small to mediumsized defects of the distal portion of the nose. Azizzadeh leads a team of plastic surgeons and otolaryngologists to provide some of the most advanced nasal reconstruction results available. Costal cartilage from two ribs, specifically the left seventh and eighth ribs, were harvested in order to repair her nose.
In ancient india, nasal amputation was a common form of punishment for adulterers, creating a broad need for nasal reconstruction. Nasal reconstruction surgery is a procedure frequently performed after removing skin cancer on the nose. The nose is the central feature that defines ones face. Pdf nasal reconstruction continues to be a formidable challenge for most plastic surgeons. Nasal reconstruction following soft tissue resection. Rhinoplasty with nasal reconstruction is covered for one of the medical conditions listed in the medical criteria.
Some researchers have investigated the air flow characters in nasal cavity to try to find the correla tion between the nasal structure and the nasal disease 2. Primary reconstruction with open rhinoplasty can j plast surg vol 19 no 3 autumn 2011 109 intercartilaginous sutures were used for the reconstruction of the fracture of the quadrangular septal cartilage posteriorly along with sutures securing the mucosal flaps vicryl 4. Aesthetic nasal reconstruction principles and practice. In this study, our clinical approach for nasal defects reconstruction is presented, which is based on frequently performed local flaps and skin grafting. Nasal reconstruction orange county since the nose is the most prominent feature on the face it follows that injury to the nose is the most common form of facial trauma. Case report a 77 years old thin underweight gentleman presented to mafraq hospital accident and emergency department for the first time with bleeding from a big fungating mass of his nose. Nasal reconstruction using the inferior turbinate mucosal. Nasal reconstruction in orange county nasal fracture. Dorsal nasal flap, glabellar flap, forehead and full thickness skin graft may be preferred for reconstruction of this region.
Principles of nasal reconstruction pdf free download epdf. Nasal reconstruction is a complex plastic surgery procedure designed to restore both the form and function of the nose. In modern times, the practice of reconstruction has been advanced by the work of surgeons such as burget and menick, who proposed the subunit principle of nasal reconstruction. Nasal reconstruction using a paramedian forehead flap. Recovering from nasal septal reconstruction backwoods mama. The method of numerical simulation for airflow is help. Nasal reconstruction occupies a special position in facial plastic surgery because of the complex threedimensional surface of the nose, the varying thickness of the skin covering it, its varying types of scaffolding ranging from rigid bone to flexible cartilage, and its inner epithelial lining. Reconstruction of the nose again emerged in 1597 when tagliacozzi published a technique of a staged transfer of skin from the arm to. I had the operation two days ago and was told that i cant play my saxophones for twothree weeks. Below is a description of my own experience and things i found helpful as i recovered from the surgery. In a remarkably detailed and rational book written at the time of vedic medicine, perhaps b. Eckert, dds, msc mayo graduate school of medicine, rochester, minn total or neartotal rhinectomy during tumor ablative surgery creates a large postsurgical defect.
Nasal reconstruction with a prefabricated free flap. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. There are two types of plastic surgery used reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that improves the appearance of the nose. Listing a study does not mean it has been evaluated by the u. Any wound will heal by secondary intention or can be closed with a skin graft or a local or regional flap.
Comparison of the mechanical properties of different skin. Nasal reconstruction in the 21st century clinical and. Nasal septal reconstructionsubmucous resection of turbinates its suppossed to help me breathe easier when i sleep. Support of the nasal base was achieved with an extended columellar strut, carved from costal cartilage. The vast majority of skin cancers of the nose are treated surgically by plastic. The location of the defect impacts the preferred method of reconstruction. Clinical report of two patient treatments michael d. In this operation a reconstructive surgeon uses skin from the forehead above the eyebrow and pivots it vertically to replace missing nasal tissue. Singlestage forehead flap in nasal reconstruction gary m. Tyler hollmig, md,c and joel cook, mda charleston, south carolina. We have found the inferior turbinate mucosal flap to be a reliable and effective flap in a series of 16 patients undergoing nasal reconstruction or repair of septal perforations.
Acquired nasal defects arise from a variety of pathologic and traumatic etiologies and reconstructive surgeons may be called upon to restore form and function when the nose has been altered in some way. Constantine loves to perform the most delicate and demanding plastic surgery procedures. If you have not already been given an appointment, call our office to obtain one. Composite graft described by konig 1887 phase i cut graft dead white phase ii 6 hours postop pale pink phase iii 12 24 hours postop deep cyanosis phase iv 3 6 days graft acquires healthy color the wider the surface contact, the more rapid the revascularization. Original article the management of nasal defects after non. In general, the face can be divided into aesthetic units, areas in which the skin has its own unique color, texture, porosity, and surface contour.
Therefore, all forehead flaps, regardless of their vascular pedicle, are thicker than nasal skin. Characteristic size research of human nasal cavity and the. The major aspects of nasal reconstruction are included. Every person is unique so it follows that recovering from nasal septal reconstruction will be different for each person. The defects were in the nasal tip, nasal wing, lateral nasal wall, and supratip. Plastic and oral surgerv unit, canniesburn hospital, bearsden, glasgow g6r iql, u. Contemporary nasal reconstruction embraces concepts of aesthetic units, a robust forehead flap, lib eral structural grafting, and a diligent and meticulous repair. Nasal reconstruction and lengthening with local flaps. They found that changes in soft tissue and bony contours of the nose resulted in distinct, consistent nasal subunits, including the dorsum, tip, columella, 2 lateral. A paramedian forehead flap has been a very useful flap for reconstruction of nasal defects. Skin grafts can be taken from areas of the body such as thighs, forehead and buttocks, whereas cartilage is often taken from elsewhere in the nose, the ear or the ribs. Nasal stent fabrication involved in nasal reconstruction.
Instructions this is an informedconsent document which has been prepared to help inform you ear about. Asymmetry the human face and nose is normally asymmetrical. Fadi constantine trained at some of the most rigorous programs in the country, dr. Nasal reconstruction using a customized 3dprinted nasal. Such defects may result from trauma, tumor resection, prior aesthetic rhinoplasty, or congenital deformities. To help such patients recover with minimal nasal deformity, dr. Despite some advocacy in the literature for using structural reinforcement to achieve both functional and aesthetic outcomes in softtissue reconstruction, no study has validated this claim by comparing reconstruction with and without structural support. Reconstruction of nasal defects is a common procedure for facial plastic surgeons. Reconstruction of the nasal ala requires meticulous planning and customization of a procedure suitable to the patients specific anatomy. Nasal reconstruction was achieved with a free helical rim flap for the right ala and a staged prefabricated radial artery forearm free fascial flap. Reconstruction of nasal skin cancer defects with local flaps.
Nasal surgery rhinoplasty only is considered cosmetic in nature and noncovered as contract exclusion when performed solely to improve the patients appearance in the absence of any signs andor symptoms of functional abnormalities. Throughout history the technique has been modified and adjusted by many. The classic procedure involves a secondstage operation to divide and inset the external pedicle. However, if the goal is the restoration of normal, principles of regional unit repair are applied. However, this flap has to remain attached to its base for 3 weeks and then a second procedure is performed to release the flap. Reconstruction of the nasal columella clinic of facial. Nyc nose reconstruction reconstructive rhinoplasty. A nasal reconstruction was performed via an open rhinoplasty approach. The history of nasal reconstruction mirrors the history of plastic surgery, beginning with what commonly is believed to be the earliest plastic surgery procedure recordednasal reconstruction by sushruta in india during 600700 bc, as reported by rogers. An overview and nuances article pdf available in seminars in plastic surgery 224. Many times a graft of skin with extra support is needed to reconstruct the alar region of the nose.
Nasal reconstruction is a challenging task because of its notable prominence and aesthetic concern 1. Principles of nasal reconstruction, second edition, is a comprehensive. There can be a variation from one side to the other in the results obtained from reconstructive nasal surgery. Complex deformities of the nose that require nasal reconstruction can result from many causes, including the removal of cancer or traumatic injuries. Defects resulting from tumor excision are usually difficult to restore, especially. The pathology of 17 patients was basal cell carcinoma, and keratoacanthoma in 1 patient. Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. Informed consent nasal reconstruction surgery page 1 of 8 patient initials 080114 version 2005 american society of plastic surgeons. Nasal reconstruction is most often needed after skin cancer, accidents, nasal collapse, or trauma to the nose, to name a few.
When planning for reconstruction of distorted or missing tissues of the. Reconstruction of nasal defects can be a difficult task if large amounts of nasal mucosa are missing. Reconstruction of nasal defects continues to challenge facial reconstructive surgeons. A facial fracture usually involves the nose, and a nasal fracture typically includes a deviated septum and other distortions, which hinder normal nasal function and create. The reconstructive technique is determined by the size and depth of the defect on the nose. Dermatologic surgery the superiorly based bilobed flap for nasal reconstruction michael kellysell, md,a,b s. We report a case of a 61yearold patient who presented to us for nose and cheek reconstruction post multiple excisions of an extensive recurrent basal cell carcinoma bcc of the right cheek and most of the nose. Understand the appropriate use and advantages and disadvantages of the two and threestage vertical paramedian forehead flap. In patients with thick sebaceous skin especially over the nasal tip and ala, a full thickness. Nasal reconstruction reconstruction is about choices. Nasal deformity can adversly affect ones overall facial appearance and can be a great source of concern to the affected person. Reconstruction of small and mediumsized nasal defects. A prominent and defining feature of the face, the nose is a composite structure composed of skin, lining, cartilage, muscular subcutaneous tissue, septum, and bone. Baker, md sam naficy, md professor and chief, facial plastic and recon.
Nasal reconstruction using a customized 3dprinted nasal stent for congenital arhinia the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Reconstruction involving the nose is particularly delicate given the visibility of this area and its impact upon ones appearance, breathing and social interaction. In this article, several local flaps are described and illustrated, including nasolabial flaps, dorsal nasal flaps, bilobed flaps, glabellar flaps, midline forehead flaps, and cheek and cervicofacial flaps. Small defects less than 5mm may be repaired by a primary closure. Your nose is a sensitive structure which plays an essential role in your everyday quality of life, which is why the decision for surgery to correct breathing difficulties to enhance the appearance of the nose is not one that should be taken lightly. Nasal septal reconstructionsubmucous resection of turbinates.
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