Download PDF
Facial Plast Surg 2017; 33(01): 009-016
DOI: 10.1055/s-0036-1597949
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Principles of Nasal Reconstruction

Emily Spataro
1   Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
,
Gregory H. Branham
1   Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
› Author Affiliations
Further Information

Publication History

Publication Date:
22 February 2017 (online)

Also available at
    Permissions and Reprints

Abstract

The rise in cutaneous malignancies over the past 20 years has led to significant advances in reconstructing the nose from an aesthetic and functional standpoint. The principles of nasal reconstruction center on application of the nasal subunit principle, three-layered reconstruction, nasal skin characteristics, and patient factors. Reconstructive planning starts with proper defect analysis, followed by application of the reconstructive ladder for soft-tissue repair, adequate structural support, and repair of nasal lining deficits. Optimal reconstructive methods depend on the location and size of the defect. Finally, refinement of the reconstruction is achieved through dermabrasion, scar revision, and flap thinning techniques.

Keywords

skin cancer - nasal reconstruction - nasal subunits - local flaps - soft-tissue defects of the nose
 

  • References

  • 1 American Cancer Society. Skin cancer: basal and squamous cell. 2015 ; Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003139-pdf.pdf . Accessed November 26, 2016
    PubMedGoogle Scholar
  • 2 González-Ulloa M. Regional aesthetic units of the face. Plast Reconstr Surg 1987; 79 (3) 489-490
    PubMedGoogle Scholar
  • 3 Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg 1985; 76 (2) 239-247
    CrossrefPubMedGoogle Scholar
  • 4 Singh DJ, Bartlett SP. Aesthetic considerations in nasal reconstruction and the role of modified nasal subunits. Plast Reconstr Surg 2003; 111 (2) 639-648 , discussion 649–651
    CrossrefPubMedGoogle Scholar
  • 5 Rohrich RJ, Griffin JR, Ansari M, Beran SJ, Potter JK. Nasal reconstruction--beyond aesthetic subunits: a 15-year review of 1334 cases. Plast Reconstr Surg 2004; 114 (6) 1405-1416 , discussion 1417–1419
    PubMedGoogle Scholar
  • 6 Menick FJ. Nasal reconstruction. Plast Reconstr Surg 2010; 125 (4) 138e-150e
    CrossrefPubMedGoogle Scholar
  • 7 Menick FJ. Principles and planning in nasal reconstruction: making a normal face. Plast Reconstr Surg 2016; 137 (6) 1033e-1047e
    CrossrefPubMedGoogle Scholar
  • 8 Thornton JF, Griffin JR, Constantine FC. Nasal reconstruction: an overview and nuances. Semin Plast Surg 2008; 22 (4) 257-268
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Baker SR. Reconstruction of the nose. In: Baker SR, , ed. Local Flaps in Facial Reconstruction. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2014. :415–480
    Google Scholar
  • 10 Branham GH, Moradzadeh A. Nasal reconstruction. In: Branham GH, , ed. Facial Soft Tissue Reconstruction. Shelton, CT: People's Medical Publishing House; 2011: 59-78
    Google Scholar
  • 11 Chang JS, Becker SS, Park SS. Nasal reconstruction: the state of the art. Curr Opin Otolaryngol Head Neck Surg 2004; 12 (4) 336-343
    CrossrefPubMedGoogle Scholar
  • 12 Park SS. Nasal reconstruction in the 21st century--a contemporary review. Clin Exp Otorhinolaryngol 2008; 1 (1) 1-9
    CrossrefPubMedGoogle Scholar
  • 13 Shaye DA, Sykes JM, Kim JE. Advances in nasal reconstruction. Curr Opin Otolaryngol Head Neck Surg 2011; 19 (4) 251-256
    CrossrefPubMedGoogle Scholar
  • 14 Menick FJ. The evolution of lining in nasal reconstruction. Clin Plast Surg 2009; 36 (3) 421-441
    CrossrefPubMedGoogle Scholar
  • 15 Rahman M, Jefferson N, Stewart DA, Oliver R, Walsh WR, Gianoutsos MP. The histology of facial aesthetic subunits: implications for common nasal reconstructive procedures. J Plast Reconstr Aesthet Surg 2010; 63 (5) 753-756
    CrossrefPubMedGoogle Scholar
  • 16 Goldminz D, Bennett RG. Cigarette smoking and flap and full-thickness graft necrosis. Arch Dermatol 1991; 127 (7) 1012-1015
    CrossrefPubMedGoogle Scholar
  • 17 Kinsella JB, Rassekh CH, Wassmuth ZD, Hokanson JA, Calhoun KH. Smoking increases facial skin flap complications. Ann Otol Rhinol Laryngol 1999; 108 (2) 139-142
    CrossrefPubMedGoogle Scholar
  • 18 Weber SM, Baker SR. Management of cutaneous nasal defects. Facial Plast Surg Clin North Am 2009; 17 (3) 395-417
    CrossrefPubMedGoogle Scholar
  • 19 Herford AS, Zide MF. Reconstruction of superficial skin cancer defects of the nose. J Oral Maxillofac Surg 2001; 59 (7) 760-767
    CrossrefPubMedGoogle Scholar
  • 20 Parrett BM, Pribaz JJ. An algorithm for treatment of nasal defects. Clin Plast Surg 2009; 36 (3) 407-420
    CrossrefPubMedGoogle Scholar
  • 21 Konofaos P, Alvarez S, McKinnie JE, Wallace RD. Nasal reconstruction: a simplified approach based on 419 operated cases. Aesthetic Plast Surg 2015; 39 (1) 91-99
    CrossrefPubMedGoogle Scholar
  • 22 Moolenburgh SE, McLennan L, Levendag PC , et al. Nasal reconstruction after malignant tumor resection: an algorithm for treatment. Plast Reconstr Surg 2010; 126 (1) 97-105
    CrossrefPubMedGoogle Scholar
  • 23 Moses HA, Woodard CR. Update on reconstructive options for nasal Mohs defects 1.5 cm or less. Curr Opin Otolaryngol Head Neck Surg 2016; 24 (4) 300-308
    CrossrefPubMedGoogle Scholar
  • 24 Asaria J, Pepper JP, Baker SR. Key issues in nasal reconstruction. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (4) 278-282
    CrossrefPubMedGoogle Scholar
  • 25 Zitelli JA. Wound healing by secondary intention. A cosmetic appraisal. J Am Acad Dermatol 1983; 9 (3) 407-415
    CrossrefPubMedGoogle Scholar
  • 26 van der Eerden PA, Lohuis PJ, Hart AA, Mulder WC, Vuyk H. Secondary intention healing after excision of nonmelanoma skin cancer of the head and neck: statistical evaluation of prognostic values of wound characteristics and final cosmetic results. Plast Reconstr Surg 2008; 122 (6) 1747-1755
    CrossrefPubMedGoogle Scholar
  • 27 Harbison JM, Kriet JD, Humphrey CD. Improving outcomes for composite grafts in nasal reconstruction. Curr Opin Otolaryngol Head Neck Surg 2012; 20 (4) 267-273
    CrossrefPubMedGoogle Scholar
  • 28 Teltzrow T, Arens A, Schwipper V. One-stage reconstruction of nasal defects: evaluation of the use of modified auricular composite grafts. Facial Plast Surg 2011; 27 (3) 243-248
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Woodard CR, Park SS. Reconstruction of nasal defects 1.5 cm or smaller. Arch Facial Plast Surg 2011; 13 (2) 97-102
    CrossrefPubMedGoogle Scholar
  • 30 Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol 1989; 125 (7) 957-959
    CrossrefPubMedGoogle Scholar
  • 31 Ugur MB, Savranlar A, Uzun L, Küçüker H, Cinar F. A reliable surface landmark for localizing supratrochlear artery: medial canthus. Otolaryngol Head Neck Surg 2008; 138 (2) 162-165
    CrossrefPubMedGoogle Scholar
  • 32 Quatela VC, Sherris DA, Rounds MF. Esthetic refinements in forehead flap nasal reconstruction. Arch Otolaryngol Head Neck Surg 1995; 121 (10) 1106-1113
    CrossrefPubMedGoogle Scholar
  • 33 Little SC, Hughley BB, Park SS. Complications with forehead flaps in nasal reconstruction. Laryngoscope 2009; 119 (6) 1093-1099
    CrossrefPubMedGoogle Scholar
  • 34 Park SS. Reconstruction of nasal defects larger than 1.5 centimeters in diameter. Laryngoscope 2000; 110 (8) 1241-1250
    CrossrefPubMedGoogle Scholar
  • 35 Romo III T, Sclafani AP, Jacono AA. Nasal reconstruction using porous polyethylene implants. Facial Plast Surg 2000; 16 (1) 55-61
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Romo III T, Sclafani AP, Sabini P. Reconstruction of the major saddle nose deformity using composite allo-implants. Facial Plast Surg 1998; 14 (2) 151-157
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Park SS, Cook TA, Wang TD. The epithelial ‘turn-in’ flap in nasal reconstruction. Arch Otolaryngol Head Neck Surg 1995; 121 (10) 1122-1127
    CrossrefPubMedGoogle Scholar
  • 38 Yarborough Jr JM. Ablation of facial scars by programmed dermabrasion. J Dermatol Surg Oncol 1988; 14 (3) 292-294
    CrossrefPubMedGoogle Scholar
  • 39 Fischer H. Nasal reconstruction with the paramedian forehead flap--details for success. Facial Plast Surg 2014; 30 (3) 318-331
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Lunatschek C, Schwipper V, Scheithauer M. Soft tissue reconstruction of the nose. Facial Plast Surg 2011; 27 (3) 249-257
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Carminati M, Robotti E. Open rhinoplasty concepts in facilitating tip reconstruction. Facial Plast Surg 2014; 30 (3) 268-276
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Helml G, von Gregory HF, Amr A, Fischer H, Gubisch W. One-stage nasal soft tissue reconstruction with local flaps. Facial Plast Surg 2014; 30 (3) 260-267
    Article in Thieme ConnectPubMedGoogle Scholar