Can the nose be reconstructed?
Nasal reconstruction procedures are common and well established. They may be necessary for congenital defects or after severe facial injury, or people may seek the surgery for cosmetic reasons.
The nose is one of the most important aspects of facial aesthetics. Fortunately for people with severe injuries, congenital deformities or concerns about their appearance, nose reconstruction surgery techniques are common and well-established. The reconstruction of a defect in the nose is more difficult than other parts of the face, however, because of the three-dimensional structure of the nose.
Understanding the anatomy
The nose is made up of three layers:
- Skin
- Bone and cartilage framework
- Mucosal lining
Nasal bones and cartilage create the shape of the nose, with the tip entirely defined by the cartilage.
When is nasal reconstruction done?
The typical indications for nasal reconstruction include the following:
- Defect or loss of function of the nose following trauma or surgical removal of tumors
- Aesthetic concerns
When is nasal reconstruction not done?
Absolute contraindications include:
- Poor general health
- Serious systemic diseases
- Residual disease or poorly defined reconstruction site.
Relative contraindications should be managed prior to surgery and include the following:
- Bleeding disorders
- Blood supply problems at the operative site
- Malnutrition
- Systemic diseases that delay wound healing, like uncontrolled diabetes
- Previous surgical procedure to the nose
- Radiation therapy
- Issues such as prior existing asymmetry, functional deficiencies and the possibility of skin mismatch need to be discussed with the patient before surgery.
How is nasal reconstruction performed?
- Nasal reconstruction is usually done with the patient under general anesthesia.
- In case of trauma or defect after surgical removal of a tumor, the wound is thoroughly examined.
- The location, size and extent of the defect is carefully studied.
- Small wounds may heal without any surgical intervention. Larger wounds require an extensive, detailed multi-staged plan.
- The quality and viability of the surrounding skin is assessed for tissue death, presence of scars from prior surgeries or radiation therapy.
- Identification of adjacent tissue to create a flap to fill the defect is done. This flap is used to repair the defect.
- A flap with similar texture, color and sebaceous gland density improves the aesthetic appearance. These factors dictate the type of flap or graft needed for reconstruction.
- There are various surgical approaches in nasal reconstruction which depend on the extent of defect and the surgeon’s discretion.
- Functional loss, such as reduced airway causing nasal obstruction, is also corrected during the reconstruction surgery. This should be identified and addressed prior to graft or flap placement.
What are the complications of nasal reconstruction?
Some potential complications are:
- Pain, swelling and bruising
- Infection
- Bleeding
- Hematoma (blood clot)
- Seroma (collection of fluid)
- Flap necrosis (tissue death)
- Asymmetry of the nose