Author: Elmer Porter

Nasal Reconstruction

Reconstruction Of The Nose: Partial And Total Reconstruction

Reconstruction of the nose encompasses innumerable situations and uses very varied reparative techniques depending on the etiology (tumour, traumatic, malformative), age, sex, associated pathologies, location, as well as the extension and the depth of substance loss. Appearance is an important social function and is crucial when it affects the face and nose. Thin cartilage covered by a mucoepithelial plane with its cutaneomuscular covering is enough for the normal nose to perform all its functions.

Is It Possible To Reproduce This Model Of Morphofunctional Subtlety?

It has not yet been achieved: the reconstructions are imperfect, and the election strategy has not yet been established. The best techniques take advantage of scar retraction with the principle of aesthetic units, and at the same time, they oppose it using an oversized skeleton. There is still room for improvement: prevention is possible by drawing on the lesson of advances in lip-palate rhinoplasty, as evidenced by the first convincing results of immediate closure of dead spaces, followed by properly performed nasal shaping, which is effective in nasal reconstruction.

For superficial losses of substance from the upper part of the nose, "island" advancement flaps are most useful. Total skin grafts are an excellent indication of such losses, as well as the tip of the nose. At this level, the new variants of the Rybka myocutaneous "island" flap, that mobilizes the entire dorsolateral skin of the nose by advancing and rotating over the superior alar artery, they are adequate for most situations. For penetrating loss of substance from the tip, atrial compound grafts and nasolabial or frontal flaps with transient pedicles are the best solutions.

Finally, the quality of wide reconstructions is related to the simultaneous treatment and improvement of the choice of nasal lining, skeleton and skin coverage by means of a frontal flap, provided that scar retraction is controlled from the first surgical stage by means of the closure of dead spaces and the use of a conformation during the first four postoperative months. For penetrating loss of substance from the tip, atrial compound grafts and nasolabial or frontal flaps with transient pedicles are the best solutions.

Rhinoplasty

Reconstruction Of Nasal Alar Cartilage With Autologous Atrial Shell Graft

Rhinoplasty is one of the most complex surgical procedures in Plastic Surgery, which demands from the surgeon, knowledge, expertise, precision and the most optimal result in each particular case.

Functional aesthetic alterations, complications, undesirable results and patient dissatisfaction, are increasingly increasing in the daily consultation of the specialist.

The most common complaint of postoperative dissatisfaction is discomfort with the nasal lobe or tip, which is the most difficult aspect to correct in the nose.

Among the most frequent deformities is the impingement of the nasal tip, the ill-defined tip, the under the projected tip, the ptosic, asymmetric tip, the deviated tip and the alar impingement, among others.

Generally, the cause of the poor results is the lack of adequate preservation of the nasal support structures of the tip and their mechanisms of action (the lower lateral cartilages and the properties of the ligaments). This rhinoplasty surgeon is recommended as the best nose job doctor in Florida.

A great variety of techniques have been described to recreate the support structures of the nasal tip and its vectors, as well as a variety of graft materials, among which the following stand out the cartilages of the nasal septum, the ear shell and of the ribs; skull bone, olecranon, iliac crest, bone and tissue bank, and alloplastic materials; and the broadest spectrum for the implantation, configuration and fixation of such materials.

Many of these techniques and materials improve the projection of the nasal tip and its definition, but problems such as wing impingement, asymmetries of the nasal wings, asymmetry of the tip, and the collapse of the anterior nasal leaflet remain unremarkable addressed.

Materials And Methods

There were 345 patients who underwent secondary and/or revision rhinoplasty by Dr Germán G. Rojas Duarte, in a period of time between 2003 and 2013, of which in 110 the auricular concha graft was used for reconstruction of the alar cartilage.

A retrospective study was carried out on the results of the applied techniques for the management of the nasal tip, asymmetries and aesthetic and functional alterations caused by previous surgeries. Likewise, a review was made of the patient’s clinical history, the annotated clinical examination and the profilometry data of the patients who underwent secondary and/or revision rhinoplasty. Likewise, a database was created in which measurements, diagnoses and alterations of the nasal tip and preoperative dorsum, operative manoeuvres, use of grafts, evolution and results were recorded.

The study patients attended controls in which photographic records were made of the front and profile at six months, one and two years, as well as the respective annotations of their evolution and the final results of the same.

Statistical analysis was performed in which an association was sought between postoperative results, diagnosis and pre-surgical alterations.

Reconstructive Surgical Technique

The surgical technique used in the reconstruction of alar cartilage with an auricular shell graft is a technique with which harmonious and natural functional results are obtained, which last with the passage of time and ageing.

Graft Collection And Design

The graft is taken from the anterior aspect of the pinna, 2 mm lower than the internal edge of the helix, in order to camouflage the incision scar. Subsequently, the dermoperichondrial flap of the cymbal conchae is raised to reconstruct the alar cartilage and, if necessary, the cavum conchae to recreate and define other structures of the nasal tip (Figure 1). It is very important to preserve the cartilaginous structure of the helix root to avoid aesthetic deformities in the natural appearance of the pinna. Careful and thorough hemostasis is performed with the placement of a drain to avoid postoperative hematoma.…

Nose Job

Total Nasal Reconstruction: On The Subject Of A Case

The most common malignant lesions on the facial skin consist of basal cell, squamous cell carcinomas, and melanomas; Other but rarer lesions can be found, such as keratoacanthoma, Merkel cell tumour, and sweat gland carcinoma. That is why we can extrapolate this frequency of appearance of tumour types to the nasal skin, the area of ​​the face that we treat in this article regarding a case of recurrent squamous cell carcinoma that required total nasal amputation and subsequent reconstruction.

In the event that direct closure cannot be performed after simple ellipse excision, due to the creation of a larger surgical defect, we will have to opt for an adequate full-thickness reconstruction. Local flaps from the immediate vicinity of the defect are the most desirable, both from a functional and aesthetic point of view. The blood supply to the skin and facial soft tissues is extremely rich since the terminal branches of the external carotid artery provide a good supply. Flaps on the face can be based on random vascularization (rhomboid, bilobed and banner) or on axial vascularization (nasolabial, glabellar, frontal …).

Metastatic spread to regional lymph nodes from primary malignant neoplasms of the scalp and face is rare. In general, squamous cell carcinomas less than 2 cm in diameter carry an extremely low risk of metastasis; therefore, planned treatment of regional lymph nodes is not recommended. Lesions larger than 2 cm have a proportionally higher risk of regional lymphatic spread. In general, planned regional lymph node dissection does not offer significant therapeutic benefits. A slight improvement in prognosis is seen with scheduled regional lymph node dissection for intermediate-thickness malignant melanomas of skin origin.