Nasal Reconstruction

Question 1

What are goals of nasal reconstruction

Answer 1

• maintain patent airway
• restrore missing layers
• optimize aesthetics

Question 2

What is critical about the subunits (convex vs concave)

Answer 2

CONCAVE

• sidewalls
• soft triangles

CONVEX

• tip
• columella
• ala-nostril sills
• dorsum

If more than 50% of subunit is involved, whole subunit should be excised and reconstructed if CONVEX. The concave subunits dont follow this b/c jx lines dot show in shadowed area and dorsum

Question 3

What is DDx of Nasal defect

Answer 3

Congenital

• Agenesis (arhinia)
• Hypoplasia (nasal cavity stenosis/atresia)

Acquired

• Inflammatory (wegeners granulomatosis, rhinophyma)
• Iatrogenic (post septorhino)
• trauma
• neoplastic
• drugs (cocaine)

Question 4

How do you decide TIMING of nasal reconstruction

Answer 4

Delayed if

• perineural invasion or bone invasion
• postive margins
• RTx required in short term
• infected/dirty wound

Question 5

What are the three componenets for nasal recosntruction

Answer 5

1. Nasal Lining
2. Nasal support
3. Nasal soft tissue coverage

Question 6

What are the options for reconstruction of nasal lining?

Answer 6

1. Septal mucoperichondrial flap (Millard)
2. Septal pivot flap
3. Septal trapdoor flap (De Quervains)
4. Bipedicle mucosal advancement flap
5. Skin graft
6. Turn-in flap
7. Modification of forehead flap
8. Nasolabial flap
9. Buccal mucosal flap
10. Free flap (RFFF, FDMA, composite rib/serratus)