Total Nasal Reconstruction

Abstract

Background: Total nasal defects present daunting challenges to the reconstructive surgeon. The nasal skeleton can be successfully fabricated with bone and cartilage. Reconstruction of the nasal skin with a forehead flap produces an excellent color match for nasal skin. Resurfacing of the internal lining is the most difficult of the 3 layers. Local tissue is often unsatisfactory in amount and/or vascular supply.Methods: A patient requiring total nasal reconstruction was prospectively examined. Intraoperative technique was recorded, and postoperative function was determined.Results: A paramedian forehead flap was used to resurface the external defect. Split calvarium and conchal cartilage were used to reconstruct the nasal skeleton. A fascial flap harvested from the forearm was used to replace the intranasal lining. Turbinate grafts were placed to line the flap. Postoperative breathing was excellent. Conclusions:The intranasal portion of a total nasal defect can be successfully reconstructed with a fascial forearm flap. Placement of a turbinate or mucosal graft allows for a thin mucosalized lining with an excellent functional outcome.

Nasal and Upper Lip Reconstruction of a Case of Squamous Cell Carcinoma Nose Stage IV—A Case Report

“…Winslow et al used free radial forearm fascial flap for the nasal lining and split calvarial bone and auricular cartilage to make frame for the nose [8]. Nasal frame reconstruction by using costal grafting, the use of 3-dimentional laser surface scanning and the use of titanium mesh or other alloplastic materials are all prescribed techniques [9]- [11].…”

Reconstructive Approach to an Acquired Absence of Multiple Facial Components: A Case Report

“…We began the first stage of nasal reconstruction on August 15, 2012 with a radial forearm free flap to create the nasal lining and columella with microsurgical anastomosis to the left facial artery and vein, which has been well described in the literature. 1–3 The raw surface was temporarily covered with a full-thickness skin graft. On October 4, 2012, she underwent the second-stage nasal reconstruction with a forehead flap, rib cartilage grafting for nasal framework, and a full-thickness skin graft to cover the raw surface underneath the forehead flap.…”

Current Strategies in Reconstruction of Maxillectomy Defects

“…Reconstructions need to take into account replacement of the covering skin, bony or cartilaginous skeletal support, and epithelial or mucosal lining. 46 As a result, prosthetic rehabilitation is often used to attain excellent aesthetic result for total rhinectomy defects and can eliminate the need for multiple surgical procedures. A prosthesis may also be a good temporary solution while allowing reasonable time to rule out a recurrence or while adjuvant therapy is being given since multistaged reconstruction might delay timely treatment, and radiation-associated tissue changes will compromise the final reconstructive result.…”