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CURRENT ISSUEITALIAN JOURNAL OF MAXILLOFACIAL SURGERY

A Journal on Maxillofacial Surgery


Official Journal of the Italian Society of Maxillofacial Surgery


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Rivista Italiana di Chirurgia Maxillo-Facciale 2003 August;14(2):87-91

language: English

Nasal reconstruction using a combination of local flaps. A case report

Messi M. 1, Piedimonte A. 2, Lupi E. 1, Ascani G. 1, Balercia P. 1

1 Maxillofacial Surgery Unit Umberto I Hospital, Torrette (Ancona), Italy
2 Department of Plastic and Reconstructive Surgery University of Ancona Umberto I Hospital, Torrette (Ancona), Italy


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Nasal ­defects ­most com­mon­ly­may be due to trau­ma or ­tumor resec­tion. Cutaneous malig­nan­cies con­trib­ute sig­nif­i­cant­ly to the eti­ol­o­gy of ­nasal ­defects. Basal ­cell car­ci­no­ma is the ­most com­mon fol­lowed by squa­mous ­cell car­ci­no­ma. A 67-­year-old ­white wom­an pre­sent­ed ­with a ­basal ­cell car­ci­no­ma involv­ing ­nasal tip and ­paired ­alae. The sur­gi­cal cor­rec­tion ­involved muco­sa, car­ti­lag­i­nous struc­tures and ­full-thick­ness ­skin of the low­er 2/3 of the ­nose, ­with ­parts of the pro­ject­ing sep­tum and ­nasal ­bones at the ­radix pre­served. In the ­present ­case, we ­have uti­lized a fore­head ­flap and 2 nas­o­la­bi­al ­flaps in asso­ci­a­tion ­with auric­u­lar car­til­age to recon­struct dor­sum, tip, ­alae, side­walls, and the struc­tu­ral sup­port in a sub­to­tal ­loss of the ­nose due to onco­log­i­cal abla­tion. A com­pos­ite ­crus of the ­helix ­graft is har­vest­ed and insert­ed ­into ­small lat­er­al pock­ets of nas­o­la­bi­al ­flaps to ­recreate ­paired ­alae, remod­el­ing as a ­shield to recon­struct the ­nasal tip and sub­sti­tute allo­plas­tic mate­ri­al to recon­struct the ­nasal sep­tum. The fore­head ­flap and the nas­o­la­bi­al ­flaps ­have ­been ­raised to recon­struct exter­nal cov­er­ing of the ­nasal pyr­a­mid. Color and tex­ture match­es are esthet­i­cal­ly ­good ­because all ­flaps are ­raised ­from adjoin­ing ­skin. All ­scars are posi­tioned at the bor­ders of esthet­ic sub­units and in nas­o­la­bi­al ­folds. All the ­suture ­lines ­match the boun­dar­ies of esthet­ic ­units, so our meth­od ­does not pro­duce notice­able scar­ring or ­scar con­trac­ture. The ­flaps ped­i­cles sep­ar­a­tion and remod­el­ing to recon­struct ­nasal ­valve and esthet­ic sub­units of the low­er ­third of the ­nose ­give a ­good func­tion­al and esthet­ic ­result. The aim of ­nasal recon­struc­tion is not ­only the func­tion­al res­to­ra­tion, but ­also the reshap­ing of esthet­ic ­forms. Our tech­nique is a sim­ple meth­od to ­restore func­tion and esthet­ic ­form of the ­nose ­after sur­gi­cal cor­rec­tion involv­ing mul­ti­ple sub­units accord­ing to Burget’s esthet­ic prin­ci­ple.

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