xRead - Facial Reconstruction Following Mohs Micrographic Surgery

Reconstruction of the Nose

Andrew W. Joseph, MD, MPH *, Carl Truesdale, MD , Shan R. Baker, MD

KEYWORDS Nasal reconstruction Facial plastic surgery Head and neck reconstruction Skin cancer Mohs excision KEY POINTS Reconstruction of cutaneous nasal defects has evolved significantly over the past 50 years. Modern reconstructive techniques often allow for inconspicuous scars and overall nondeforming surgical results. Cutaneous nasal defect reconstruction should be considered within the context of nasal aesthetic subunits. Nasal lining, structural framework, and cutaneous covering should be independently considered; reconstruction should address all 3 components when they are involved.

INTRODUCTION

of the nose. The authors attempt to identify com mon pitfalls and offer practical suggestions that they have found helpful in their clinical experience.

The nose occupies a central portion of the face and plays a functional role in breathing and sense of smell. Furthermore, due to its central location in the face, the aesthetics of a person’s nose can profoundly impact the way he or she is perceived by the outside world. Recent research has shown that patients who exhibit a cutaneous deformity in the central portion of their face are much more likely to be perceived as less attrac tive by lay observers compared with those with facial deformity located elsewhere. 1–4 This finding is important because patients who are perceived negatively as a result of nasal defor mity can have increased difficulty interacting with others in social situations or in the workplace. 3 Nasal reconstruction has a history dating back thousands of years to first descriptions by physi cians in India. 5 Since then, many refinements have been made to these early techniques. There are numerous textbooks dedicated to the topic, and the authors direct the interested reader to several of these excellent texts. 6–8 The current focus is to highlight some of the more common techniques used to reconstruct cutaneous defects

SURGICAL ANATOMY OF THE NOSE

Surgeons who perform nasal reconstruction should be intimately familiar with the surgical anatomy of the nose. The nose has a rigid bony and cartilaginous structural support system, which is lined on the inner surface by an epithelial layer, and covered on the outer surface by soft tissue. The latter are commonly referred to as the skin and soft tissue envelope (SSTE). The SSTE itself, from superficial to deep, is made up of the skin and 4 additional layers: superficial subcutaneous layer (fatty panniculus), the nasal superficial musculoaponeurotic system (SMAS), a deep fatty layer, and the perichondrium (or periostium), which overlies the structural framework. 9

Skin

There are substantial variations in skin thickness and sebaceous glands density among the various subunits of the nose (see overview of the subunits

Disclosure Statement: None. Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA * Corresponding author. E-mail address: josephan@umich.edu

Facial Plast Surg Clin N Am 27 (2019) 43–54 https://doi.org/10.1016/j.fsc.2018.08.006 1064-7406/19/ 2018 Elsevier Inc. All rights reserved.

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