Nasal Reconstruction
Introduction
Clefts
of the Lip and Palate
Ear
Reconstruction
Craniosynostosis
Orbital Reconstruction
Treacher Collins Syndrome
Nasal Reconstruction
Orthognathic Surgery Trauma
Reconstruction
Hemifacial
Microsomia
Summary
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A properly
proportioned, well placed nose can have a dramatic impact on one's
facial appearance. Nasal surgery involves a wide spectrum of procedures
ranging from cosmetic rhinoplasty to total nasal reconstruction. Basic
rhinoplasty surgery involves the correction or reshaping of existing
nasal structures, whereas more extensive cases will require that the
craniofacial surgeon actually construct a part of the nose that may be
missing or badly misshapened due to disease or trauma. Meticulous
attention to detail when repairing or reconstructing the nasal lining,
skeletal support, or skin covering is essential to obtain a structure
that is fully functional as well as pleasing to the eye.
When large defects of the nose are
present from tumor resection or trauma, flap tissue provides the best
aesthetic coverage. The most common flap used for major nasal
reconstruction is the forehead flap. This reliable flap can supply a
large area of skin with good color match making it suitable for partial
or total nasal reconstruction.
Reconstruction of the nasal skeletal
framework is frequently necessary in patients with congenital or
traumatic deformities. This support is best obtained using bone or
cartilage. Outer table calvarial bone grafts harvested from the parietal
area of the skull make excellent cantilever bone struts for support of
the nasal dorsum. These grafts can be rigidly fixed with lag screws to
provide good stability and dorsal contour. Additional techniques are
available to provide nasal support such as the L-shaped
grafts and columella struts. The tip of the nose is best supported with
cartilage grafts. Careful attention to detail and planning is necessary
in these procedures to create a structure that is both functional and
aesthetically pleasing.
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Nasal
Reconstruction |
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| Sixteen
year old girl with deformity of the nose. |
Result
after reconstruction of nose with bone graft. |
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| Technique
of using a cantilever bone graft for reconstruction of the nose.
Calvarial bone is most commonly used and is rigidly fixed with
countersunk lag screws. |
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| Resection
of basal cell carcinoma with full thickness defect on left side
of nose. Forehead flap outlined. |
Forehead
flap rotated to close defect on left side of nose. Tip of flap
lined with skin graft. |
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| Postoperative
result after division and insetting of forehead flap. |
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| Fifteen
year old girl with severe nasomaxillary hypoplasia. |
Postoperative
result after nasomaxillary osteotomy with nasal lengthening and
calvarial bone grafts. |
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Preoperative |
Postoperative |
The Tennessee Craniofacial
Center, part of the Erlanger Health System, is located in Chattanooga,
Tennessee. The Center, led Larry A. Sargent, M.D., specializes in the
evaluation and treatment of patients of all ages with craniofacial deformities.
Location:
975 East Third Street. Chattanooga, Tennessee 37403
Phone: 423-778-9192 or 800-418-3223 Fax: 423-778-8172
Internet: www.craniofacialcenter.com Copyright ©1997, 2000, Erlanger
Health Systems
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