Reconstructive rhinoplasty

ABSTRACT

To assess the results of reconstructive rhinoplasty. Observational study. Department of plastic surgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad from January 2002 to December 2003. All the patients with acquired nasal defect due to trauma, accident, assault, infection or tumour excision were included. Patients having cleft lip nasal deformity were excluded from the study. The different surgical options used for reconstruction included skin grafts, composite grafts, median/paramedian forehead flap, nasolabial flap, scalping forehead flap and arm flap. All the operations were performed under general anaesthesia except with small defects using grafts/local flaps. The skeletal support was achieved by using a composite graft, conchal cartilage graft, or bone graft from the rib/iliac crest. The flaps were monitored closely for first 48 hours. Stitches were removed from 6-9 days. Flap division and insetting was done after 2-3 weeks. Follow up of the patients was done monthly for first 3 months and six month interval onwards. The aesthetic result was assessed objectively as well as subjectively. Twenty one patients were admitted for treatment of acquired nasal defects. Male to female ratio was 11.1. The mean age in males was 40.3 years, and in females 35.9 years. The most common cause was assault [47.6%] followed by accident [23.8%]. The different options used for reconstruction included skin grafts, median/paramedian forehead flaps, scalping forehead flap, arm flap. Only one flap was lost. There was no case of postoperative infection. In 2 cases, flap debulking was performed to improve the nasal contour. Reconstruction of nasal defect is a challenging task. Median or paramedian forehead flap is the most suitable option. The emphasis should be paid to the reconstructive as well as aesthetic component of the reconstruction rhinoplasty