Nose Reconstruction Views
The reconstruction of the nose goes back thousands of years. The ancient Hindus are credited with the first nasal reconstruction attempts. In ancient India, punishment involved having one's nose cut off, and such a defect was reportedly first repaired by transposing a cheek flap. The Italians also used reconstructive techniques for the nose during the Renaissance. The Branca family and Tagliacozzi experimented with flaps and rhinoplasty techniques. However, the British documented the Indian techniques of reconstruction they saw during their time in the subcontinent. Gillies, of England, formulated rules and techniques for nasal reconstruction. These efforts were passed on, expanded, and refined to form the multitude of reconstructive options available today.
Planning an operation involves not only the examination of the operative defect but also a discussion concerning the patient’s wishes for reconstruction. Several important aspects must be developed in the reconstructed nose. As described by Burget, contour, color, texture, and function are all important aspects in the reconstructed nose.[1, 2, 3]
Before determining how to properly perform nasal reconstruction, the aesthetic and anatomical breakdown of the nose must be understood. Anatomically, the nose is made up of a vascular lining, alar tip cartilages (sculptured cartilage), bone braces that buttress the dorsum and sidewalls of the nose, and thin skin that matches the rest of the face. Thus, when a deformity is present, the actual tissue missing must be delineated, whether it be the cover (skin), lining (mucosal lining, septal mucosa), or framework (septal hard tissue, alar cartilages, upper lateral cartilages, nasal bones, alar fibrofatty tissue). Also, the anatomical location of the defect and the surface extent of the defect must be examined.
The general indication for nasal reconstruction is a defect or loss of function of the nose that results from trauma or surgical excision of neoplasm. The preferred method for tumor removal is Mohs micrographic surgery. This technique is best suited for the removal of malignancies such as basal cell carcinoma and squamous cell carcinoma that may have poorly defined margins or may be recurrent or aggressive in nature. Biopsy samples of all tumors should be collected beforehand for confirmation. Mohs micrographic surgery then allows for careful review of peripheral and deep margins using horizontal frozen sections of the specimen, allowing for accurate identification and excision of clinically inapparent tumor.
Nose Reconstruction Images
