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Aesthetic and functional outcome following nasal reconstruction.

Mureau MA, Moolenburgh SE, Levendag PC, Hofer SO

Department of Plastic and Reconstructive Surgery, Erasmus Medical Center Rotterdam, The Netherlands.

BACKGROUND: Few reports on outcome of aesthetic nasal reconstruction exist. Therefore, subjective and objective aesthetic and functional outcome following nasal reconstruction was assessed. METHODS: Outcome was assessed in 38 consecutive patients treated for subtotal nasal defects using standardized semistructured interviews. Standardized physical examination forms and photographs were used. RESULTS: In six patients, one aesthetic subunit was involved; in 14, two; and in 18, three or more. Defects were classified as skin only (13 percent), skin/cartilage (21 percent), and full thickness (66 percent). Some defects (32 percent) involved adjacent aesthetic units. Inner lining was reconstructed with local mucosa or turnover skin flaps. Support was provided with regional cartilage grafts and/or composite septal flaps. Skin defects were reconstructed with forehead, nasolabial, cheek advancement, Abbé, facial artery perforator, or free radial forearm flaps. Nasal reconstructions required 116 procedures. Thirty-three patients participated in the follow-up study. Mucosal crusting was noted in 36 percent, passage difficulties in 31 percent, and worse olfaction in 16 percent. Phonation was unchanged. Eighty-one percent were very satisfied with nasal function. Flap color match was moderate to good in 97 percent; hair growth occurred in 61 percent. At critical inspection, a thicker flap (58 percent), smaller ostium nasi (77 percent), thicker alar rim (86 percent), and minor alar rim retraction (46 percent) were noted. Seventy-nine percent were very satisfied with total nasal appearance. CONCLUSION: Although objective functional and aesthetic outcome following nasal reconstruction sometimes shows impairment compared with the normal situation, it gives high subjective patient satisfaction with function and aesthetics.

Published 27 September 2007 in Plast Reconstr Surg, 120(5): 1217-27; discussion 1228-30.
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