Nasal Reconstruction for Nasal Deformity or Defects: Based on Aesthetical Nasal Subunits

ABSTRACT

The nose, salient part in the face, is more vulnerable to injury and its minor defect or deformity is highly perceptible. It is thus essential to establish the certain rules for reconstruction. Gonzalles Ulloa mentioned 5 aesthetic nasal subunits, which are nasal dorsum, nasal tip, lateral portion, alar portion and soft triangle. However, the authors insist on the importance of the columella and nasal floor as well as other nasal subunits, considering the nasal reconstruction in structural and functional aspects. Authors' study was based on the aesthetical nasal subunits considering the in-depth knowledge of anatomical and functional aspects of each unit as an individual. Reconstruction of the proximal 2/3 portion of the nose having thin, soft and mobile skin over the osteochondral framework with sparse distribution of the sebaceous glands can be done with skin graft, nasolabial flap, and median forehead flap and lateral wall defect can be repaired by nasolabial flap or glabellar flap. Reconstruction of the distal 1/3 portion of the nose is rather difficult due to its thick, sebaceous skin that is characterized by firm and dense cartilaginous attachment, which makes it more harder to handle especially when it comes to the alar portion. Therefore, composite graft for the small defect and nasolabial flap or median forehead flap for on the larger defect can be used. However, when defect is located on the nasal tip, it results in tremendous spoiling of the whole facial harmony even with a tiny defect so that replantation, composite graft or median forehead flap has been used for the reconstruction. Reconstruction of the columellar defect is considered more complicated and V - Y advancement flap, bilateral nasolabial flap, and composite graft have been utilized.Nasal deformity or defect was reconstructed based on 7 aesthetical nasal subunits; by further dividing the nasal units, in terms of adding 2 more subunits, columella and nasal base, aesthetically and functionally acceptable and advantageous results were deduced with less contractures and scars. Current trends of nasal reconstruction are based on the concepts of aesthetic nasal subnunits or units in which modification was added in some extent. The most important factors that contribute to the later results are evaluation of the depth and color of the deformed or defected area according to the aesthetic nasal subunits whether it is congenital or acquired. Various reconstruction methods of the nose can be utilized based on the size, depth and location of the defects where it can be reconstructed as a unit. Columella and nasal base were newly added in concepts of subdivision from the previously established nasal subunits to produce more detailed, precise and favorable result. Also, nasal reconstruction should be carefully carried out considering the importance of the psychological, social and functional influences of the nasal deformity.