Reconstruction of nasal deformity

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Reconstruction of nasal deformity

• Dr Adnan Abou-hassoun
• (MD.FRCS.DLO)
• Consultant ENT

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• Rare case of congenital nasal deformity of 22
  yrs old patient with incomplete nasal development
  (absent incomplete fuse of medial nasal
  placodes part of the (frontonasal processes).
• Three stages reconstruction Surgery
  (functioning cosmetic purposes).

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What are they looking at ? crown or nose !!

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Facts

• Nose is the most prominent structure of the face.
• For breathing (cleaning, moistening, worming air
  to the lung).
• For smelling.
• It is like Tent
• framework consist of bone cartilage.
• skin tents above.

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Facial development

• Five facial prominences bordering the stomodeum.
• Frontonasal prominence ..prolonged and bifurcate
  to Lateral Medial nasal placodes (create the
  nostrils) L.N.PM.N.P later fuse with
• Maxillary and Mandible prominences (First
  branchial arch) form the caudal and lateral
  border of the stomodeum.
• Facial development occur 4-8 weeks and face
  clearly seen by 10 weeks age.

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Facial developmentFace of human embryo (30 -32
days age) .
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Anatomy

• Nasal pyramid consist of
• Upper bony part
• Nasal bone
• Frontal process of Maxilla
• Vomer.
• Lower cartilaginous part
• Upper lateral cartilage
• Lower alar cartilage
• Septum cartilage
• Skin cover all the framework

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Nasal Deformity

• Congenital
• Complete absent of nose.
• incomplete development
• Acquired
• Trauma
• Iatrogenic (post nasal surgery).
• infection
• nasal polyps
• Tumor.

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Congenital Nasal Deformity

• Congenital
• complete absent
• incomplete development

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Acquired nasal deformity

• Acquired
• Trauma
• Iatrogenic (Post nasal surgery/ septoplasty)
• infection
• nasal polyps
• tumors (SCC, BCC,)

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Nasal Reconstruction

• Reconstruction techniques are designed to
  accomplish the following
• Minimize cosmetic deformity.
• Restore the 3-dimention shape of the nose.
• Maintain structural strength of the nose .
• Maintain airway patency.
• Satisfactory result requires success in both
  cosmetic and functional aspect of reconstruction.

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Nasal Reconstruction

• Rhinoplasty (Simple reconstruction)
• (pure cosmetic target).
• Advanced (Multiple-stage) reconstruction
• ( functioning cosmetic target )

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Reconstruction

• Surgical reconstruction of
• Skin/mucosa.
• Cartilage
• Bone
• All (partial facial implant) Free flaps
  microvascular surgery .
• Nasal Prostheses

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Nasal Prostheses

• Method of choice in nasal rehabilitation in which
  bone and soft tissue largely resected (i.e. total
  rhinectomy).
• Patient with poor health surgical condition.
• Patient request.
• Prostheses retained by spectacles.

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Skin Repair

• Crafts
• Split skin craft
• full thickness craft
• Flaps
• local advanced
• Rotation flaps
• Regional flaps (forehead flap)
• Distal flap (forearm flap).
• Free flap.

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Framework Repair

• Cartilage from
• pinna
• costal cartilage
• Bone from
• superior iliac crest
• Fibula

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Advanced / Multiple-Stage reconstruction
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Example of 3 stages (Reconstruction nasal
surgery)
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Surgery Plane

• Collumela Creation
• (skin bone craft strut support) !! Tent
  built
• Nasal (dorsum tip) support pinna cartilagenouse
  craft.
• Cosmetic stage
• rim reduction

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1.Create Collumella(skin bone craft /support
)?tent built
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2.Nasal tipdorsum craft(cartilagenous craft
from pinna)
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3.Cosmetic stage(nasal base / rim reduction)
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Complications

• Failed reconstrucion
• infection
• necrosis( insufficient blood supply of the
  flaps)
• tumor recurrence .
• Patient high risk factors (smoking, alcohol,
  diabetes, drugs,.).
• Deformity.

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Post nasal reconstruction surgery

• Psychological rehabilitation is essential
• (after most cosmetic surgery)
• New nosenew face.. new personality.

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Rhinoplasty (Simple Reconstruction)
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Thank You