Workup
Laboratory Studies
Standard preoperative testing still is required for patient safety during anesthesia for nasal reconstruction.
Should any continuing process be suspected, institute preoperative workup and therapy prior to placing implants or performing reconstruction, whether this involves serial débridements, treatment of an infectious process, ongoing medical therapies, or other therapies.
Next:
Imaging Studies
Imaging studies are directly correlated to the reconstructive needs. The greater the degree of trauma or defect, the greater the possibility that imaging studies will be beneficial. This may give a better indication of available bone stock if metallic mesh, K-wires, or screws are to be used.
Standardized photographs can also be very beneficial in overall patient management.
Previous
Media Gallery
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Reproduction of plate from Susruta showing style of nasal reconstruction. Note that support for the nasal bridge is absent. The intrinsic rigidity of the dermis was relied upon for structural support. (Susruta, An English Translation of the Susrita Samhita, based on original Sanskrit text. Edited and published by Kaniraj Kunjabal Blushagratna. Calcutta: Bose, 1916).
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Reproduction of plate from Tagliocozzi as depicted by Gnudi and Webster. Skin of the inner upper arm has minimal intrinsic rigidity and always requires internal structural support.
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Reproduction of plate from Carpue manuscript. Note refinements in flap design.
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Rib cartilage graft and Proplast bridge graft. A 46-year-old woman with a congenital deficiency of the nasal bridge underwent a series of reconstruction attempts using septal and conchal cartilage grafts. Front view.
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Rib cartilage graft and Proplast bridge graft. A 46-year-old woman with a congenital deficiency of the nasal bridge underwent a series of reconstruction attempts using septal and conchal cartilage grafts. Right side view.
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Rib cartilage graft and Proplast bridge graft. A 46-year-old woman with a congenital deficiency of the nasal bridge underwent a series of reconstruction attempts using septal and conchal cartilage grafts. Harvesting of the rib graft.
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Rib cartilage graft and Proplast bridge graft. A 46-year-old woman with a congenital deficiency of the nasal bridge underwent a series of reconstruction attempts using septal and conchal cartilage grafts. Postoperative right side view.
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Rib cartilage graft and Proplast bridge graft. A 46-year-old woman with a congenital deficiency of the nasal bridge underwent a series of reconstruction attempts using septal and conchal cartilage grafts. Removal of deformed rib cartilage 6 years after reconstruction.
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Rib cartilage graft and Proplast bridge graft. A 46-year-old woman with a congenital deficiency of the nasal bridge underwent a series of reconstruction attempts using septal and conchal cartilage grafts. Tailored carved Proplast bridge graft to replace deformed rib cartilage.
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Rib cartilage graft and Proplast bridge graft. A 46-year-old woman with a congenital deficiency of the nasal bridge underwent a series of reconstruction attempts using septal and conchal cartilage grafts. Postoperative right side view 4 years after Proplast bridge graft.
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Calvarial bone graft and auricular conchal cartilage. A 61-year-old man required a subtotal nasal reconstruction of a septal squamous cell carcinoma and left cervical radical lymphadenectomy. Reconstruction began with a forehead flap of tissue expanded skin. Right lateral view.
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Calvarial bone graft and auricular conchal cartilage. A 61-year-old man required a subtotal nasal reconstruction of a septal squamous cell carcinoma and left cervical radical lymphadenectomy. Reconstruction began with a forehead flap of tissue expanded skin. Calvarial bone graft harvest site.
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Calvarial bone graft and auricular conchal cartilage. A 61-year-old man required a subtotal nasal reconstruction of a septal squamous cell carcinoma and left cervical radical lymphadenectomy. Reconstruction began with a forehead flap of tissue expanded skin. Sculpted calvarial bone graft.
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Calvarial bone graft and auricular conchal cartilage. A 61-year-old man required a subtotal nasal reconstruction of a septal squamous cell carcinoma and left cervical radical lymphadenectomy. Reconstruction began with a forehead flap of tissue expanded skin. Calvarial bone graft in place and anchored to glabellar area of frontal bone.
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Calvarial bone graft and auricular conchal cartilage. Harvest of auricular conchal cartilage graft from anterior approach. A 61-year-old man required a subtotal nasal reconstruction of a septal squamous cell carcinoma and left cervical radical lymphadenectomy. Reconstruction began with a forehead flap of tissue expanded skin.
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Calvarial bone graft and auricular conchal cartilage. A 61-year-old man required a subtotal nasal reconstruction of a septal squamous cell carcinoma and left cervical radical lymphadenectomy. Reconstruction began with a forehead flap of tissue expanded skin. Sculpted conchal cartilage graft on nasal tip.
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Calvarial bone graft and auricular conchal cartilage. Postoperative frontal view at 1 year. A 61-year-old man required a subtotal nasal reconstruction of a septal squamous cell carcinoma and left cervical radical lymphadenectomy. Reconstruction began with a forehead flap of tissue expanded skin.
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Silastic graft and rib bone graft. Preoperative frontal view. A 37-year-old woman presented 10 years following reconstruction of an unreduced naso-orbitoethmoid fracture with silastic H-shaped graft.
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Silastic graft and rib bone graft. Preoperative oblique view demonstrating the distortion of the silastic graft secondary to scar tissue. A 37-year-old woman presented 10 years following reconstruction of an unreduced naso-orbitoethmoid fracture with silastic H-shaped graft.
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Silastic graft and rib bone graft. Harvest of the rib bone graft. A 37-year-old woman presented 10 years following reconstruction of an unreduced naso-orbitoethmoid fracture with silastic H-shaped graft.
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Silastic graft and rib bone graft. A 37-year-old woman presented 10 years following reconstruction of an unreduced naso-orbitoethmoid fracture with silastic H-shaped graft. Fabrication of the osseous H-shaped graft. Removed silastic graft serves as a pattern.
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Silastic graft and rib bone graft. A 37-year-old woman presented 10 years following reconstruction of an unreduced naso-orbito-ethmoid fracture with silastic H-shaped graft. Postoperative frontal view at 10.5 years postreconstruction.
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Silastic graft and rib bone graft. A 37-year-old woman presented 10 years following reconstruction of an unreduced naso-orbitoethmoid fracture with silastic H-shaped graft. Postoperative side view at 10.5 years postreconstruction.
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Fascial grafts. A 55-year-old woman sought improvement of radix and upper nasal bridge following an aesthetic rhinoplasty. Preoperative side view. Note the shallow glabella.
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Fascial grafts. A 55-year-old woman sought improvement of radix and upper nasal bridge following an aesthetic rhinoplasty. Temporal fascial graft prior to placement.
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Fascial grafts. A 55-year-old woman sought improvement of radix and upper nasal bridge following an aesthetic rhinoplasty. Right temporal donor site closure.
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Fascial grafts. A 55-year-old woman sought improvement of radix and upper nasal bridge following an aesthetic rhinoplasty. Postoperative side view at 3 months.
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Proplast nasal grafts. A 20-year-old man with a posttraumatic nasal deformity with septal collapse. Preoperative side view.
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Proplast nasal grafts. A 20-year-old man with a posttraumatic nasal deformity with septal collapse. Carved Proplast graft prior to insertion.
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Proplast nasal grafts. A 20-year-old man with a posttraumatic nasal deformity with septal collapse. Postoperative side view.
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Proplast nasal grafts. A 20-year-old man with a posttraumatic nasal deformity with septal collapse. Carved Proplast graft to place on alveolar ridge to augment the columellar base.
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Proplast nasal grafts. A 20-year-old man with a posttraumatic nasal deformity with septal collapse. Proplast alveolar graft in place.
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