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Management of composite defects of the nose, cheek, eyelids and upper lip

Published online by Cambridge University Press:  22 May 2009

N S Jones  and
U Raghavan
N S Jones*
Affiliation:
Departments of Otorhinolaryngology, Head and Neck Surgery, the University Hospital, Nottingham, UK
U Raghavan
Affiliation:
Doncaster Royal Infirmary, Doncaster, UK
*
Address for correspondence: Prof N S Jones, Department of Otorhinolaryngology, University Hospital, Nottingham NG7 2UH, UK. E-mail: [email protected]
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Abstract

Aim:

To assess the results of reconstruction of composite defects involving the nose which extend to involve the cheeks, eyelids or upper lip.

Study design:

Retrospective observational study.

Material:

Sixteen patients with defects of the nose extending to the adjoining cheek, upper lip or eyelid.

Method:

A combination of flaps and grafts were needed to reconstruct these defects so that the aesthetic subunits were replaced and joined at their junctions wherever possible.

Results:

Where the defect required three or four flaps, there was some unpredictable cicatrisation at their junction that resulted in some asymmetry. This problem primarily occurred at the alar base, and was compounded if there was tissue loss of the premaxilla or maxilla.

Conclusion:

If a defect that involves the nose, cheek and upper lip is repaired with a combination of cheek advancement, nasolabial, paramedian forehead and/or septal flaps, there can be unpredictable cicatrisation at their junction, particularly at the alar base. In these circumstances, we recommend replacing the nasal and other defects with a slightly more generous amount of tissue than would be taken to repair a similar, but solitary, defect. It is important to replace any loss of the facial skeleton, in order to provide support for overlying flaps.

Keywords

Nasal ReconstructionFacial Plastic SurgeryFlapsBasal Cell CarcinomaSquamous Cell Carcinoma
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 123 , Supplement S32 , May 2009 , pp. 1 - 38
Copyright
Copyright © JLO (1984) Limited 2009

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References

1Menick, FJ. Defects of the nose, lip, and cheek: rebuilding the composite defect. Plast Reconstr Surg 2007;120:887–98CrossRefGoogle ScholarPubMed
2Larrabee, WF Jr, Sherris, DA, Murakami, CS, Cupp, CL, Hefferman, JT. Soft tissue biomechanics and physiology. In: Larrabee, WF Jr, Sherris, DA, Murakami, CS, Cupp, CL, Hefferman, JT, eds. Principles of Facial Reconstruction. Philadelphia: Lippinscott-Raven, 1995;2–9Google Scholar
3Gonzalez-Ulloa, M, Castillo, A, Stevens, E. Preliminary study of the total restoration of the facial skin. Plast Reconstr Surg 1954;13:151–9CrossRefGoogle ScholarPubMed
4Menick, FJ. Reconstruction of the cheek. Plast Reconstr Surg 2001;108:496–504CrossRefGoogle ScholarPubMed
5Baker, SR. Nasal lining flaps in contemporary reconstructive rhinoplasty. Facial Plastic Surgery 1998;14:133–44CrossRefGoogle ScholarPubMed
6Burget, GC, Menick, FJ. Aesthetics, visual perception, and surgical judgement. In: Burget, GC, Menick, FJ, eds. Aesthetic Reconstruction of The Nose. St Louis: Mosby, 1994;15–16Google Scholar
7Tollefson, TT, Murakami, CS, Kriet, JD. Cheek repair. Otolaryngol Clin North Am 2001;34:627–46CrossRefGoogle ScholarPubMed
8Danahey, DG, Hilger, PA. Reconstruction of large nasal defects. Otolaryngol Clin North Am 2001;34:695–711CrossRefGoogle ScholarPubMed
9Burget, G, Menick, F. Aesthetics, visual perception, and surgical judgment. In: Burget, G, Menick, F, eds. Aesthetic Restoration of the Nose. St Louis: Mosby, 1984;1–55Google Scholar
10Dowley, A, Allibone, R, Jones, NS. Squamous cell carcinoma of the nasal vestibule, a 20 year case series and review of the literature. J Laryngol Otol 2008;122:1019–23CrossRefGoogle Scholar
11Branham, GH, Thomas, JR. Skin grafts. Otolaryngol Clin North Am 1990;23:889–97CrossRefGoogle ScholarPubMed
12Shaida, AM, Kenyon, GS. The nasal valves: changes in anatomy and physiology in normal subjects. Rhinology 2000;38:7–12Google ScholarPubMed
13Wustrow, TP, Kastenbauer, E. Surgery of the internal nasal valve. Facial Plastic Surgery 1995;11:213–27CrossRefGoogle ScholarPubMed
14Kern, EB. Surgical approaches to abnormalities of the nasal valve. Rhinology 1978;16:165–89Google ScholarPubMed
15Sulsenti, G, Palma, P. The nasal valve area: structure, function, clinical aspects and treatment. Sulsenti's technique for correction of valve deformities [in Italian]. Acta Otorhinolaryngol Ital 1989;9 (suppl 22):1–25Google ScholarPubMed
16Thomas, JR. Skin grafts. In: Thomas, JR, Roller, J, eds. Cutaneous Facial Surgery. New York: Thieme Medical Publishers, 1992;73–90Google Scholar
17Arden, RL, Nawroz-Danish, M, Yoo, GH, Meleca, RJ, Burio, DL. Nasal alar reconstruction: a critical analysis using melolabial island and paramedian forehead flaps. Laryngoscope 1999;109:376–82CrossRefGoogle ScholarPubMed
18Chait, LA, Fayman, MS. Reconstruction of the alar groove. Br J Plast Surg 1989;42:281–4CrossRefGoogle ScholarPubMed
19Walton, RL, Burget, GC, Beahm, EK. Microsurgical reconstruction of the nasal lining. Plast Reconstr Surg 2005;115:1813–29CrossRefGoogle ScholarPubMed
20Moore, EJ, Strome, SA, Kasperbauer, JL, Sherris, DA, Manning, LA. Vascularised radial forearm free tissue transfer for lining in nasal reconstruction. Laryngoscope 2003;113:2078–85CrossRefGoogle ScholarPubMed
21Day, TA, Stucker, FJ. Regional and distant flap in nasal reconstruction. Facial Plastic Surgery 1994;10:349–57CrossRefGoogle ScholarPubMed
22Shumrick, KA, Smith, TL. The anatomic basis for the design of forehead flaps in nasal reconstruction. Arch Otolaryngol Head Neck Surg 1992;118:373–9CrossRefGoogle ScholarPubMed
23Menick, FJ. Aesthetic refinements in use of forehead for nasal reconstruction: the paramedian forehead flap. Clin Plast Surg 1990;17:607–22CrossRefGoogle ScholarPubMed
24Raghavan, U, Jones, NS. Use of auricular composite graft in nasal reconstruction. J Laryngol Otol 2001;115:885–93CrossRefGoogle ScholarPubMed
25Burget, GC, Menick, FJ. The resurrection of skin graft for lining. In: Burget, GC, Menick, FJ, eds. Aesthetic Reconstruction of The Nose. St Louis: Mosby, 1994;525–75Google Scholar
26Konig, F. The covering of defects of the nose [in German]. Klin Wochensch 1902;7:37–42Google Scholar
27Gillies, H. New free graft applied to reconstruction of the nostril. Br J Surg 1943;30:305–9CrossRefGoogle Scholar
28Limberg, AA. Rhinoplasty with free transplantation from auricle [in Russian]. Sovetskoe Khirurgii 1935;9:70–75Google Scholar
29Brown, JB, Cannon, B, Lischer, CE, Davis, WB, Moore, A, Murray, J. Further reports on use of composite free grafts of skin and cartilage from ear. Plast Reconstr Surg 1946;1:130–7CrossRefGoogle ScholarPubMed
30Dupertuis, SM. Free ear lobe grafts of skin and fat. Their value in reconstruction about the nostril. Plast Reconstr 1946;1:135–45CrossRefGoogle Scholar
31Szlasak, J. Repair of nasal defects with free auricular grafts. Br J Plast Surg 1948;1:176–80Google Scholar
32Walter, C. Survey of the use of composite grafts in the head and neck region. Otolaryngol Clin North Am 1972;5:571–97CrossRefGoogle ScholarPubMed
33Park, SS. Reconstruction of nasal defects larger than 1.5 centimeters in diameter. Laryngoscope 2000;110:1241–50CrossRefGoogle ScholarPubMed
34Walton, RL, Burget, GC, Beahm, EK. Microsurgical reconstruction of the nasal lining. Plast Reconstr Surg 2005;115:1813–29CrossRefGoogle ScholarPubMed
35Brackley, P, Jones, NS. The use of a periosteal/forehead flap with sandwiched conchal cartilage graft – a novel approach for nasal reconstruction in the absence of a nasal septum. Plast Reconstr Surg 2002;110:831–5CrossRefGoogle Scholar
36Tardy, ME Jr. Alternatives in nasal reconstruction. “Five flaps and a graft”. Laryngoscope 1976;86:1824–7CrossRefGoogle Scholar
37Danahey, DG, Hilger, PA. Reconstruction of large nasal defects. Otolaryngol Clin North Am 2001;34:695–711CrossRefGoogle ScholarPubMed
38Raghavan, U, Jones, NS. The complications of giant titanium implants in nasal reconstruction. J Plast Reconstr Aesthet Surg 2006;59:74–9CrossRefGoogle ScholarPubMed
39Raghavan, U, Jones, NS, Romo, T 3rd. Immediate autogenous cartilage grafts in rhinoplasty after alloplastic implant rejection. Arch Facial Plast Surg 2004;6:192–6CrossRefGoogle ScholarPubMed
40Baker, S. Reconstruction of the ala, cheek, and upper lip. In: Baker, S, Naficy, S, eds. Principles of Nasal Reconstruction. St Louis: Mosby, 2002;284–8Google Scholar