Three Dimensional Nasal Reconstruction for Bilateral Nasal Aplasia: Case report

Background: Congenital absence of the nose is extremely rare and it causes a great psychosocial trauma to the patient and family. Reconstruction of congenital absence of the nose represents a challenge to the surgeon. Simultaneous restoration of the skin, nasal structure (bone/cartilage), nasal mucosa should be considered when planning for restoring a normal function nose.

Method/ Case Report: A 13 month old, african american male child, product of a full term pregnancy, was found to have a septo-optic dysplasia with bilateral nasal aplasia, microcephalus, hypogonadism and soft palate cleft. Computed tomography and magnetic resonance showed complete occlusion of anterior nasopharyn with open posterior nasopharynx with no evidence of other cranial defects.

Operative technique: Nasal reconstruction was planned with a prefabricated forehead flap as described in 1995 by Mutaf et al¹. Initial procedure consisted of exploration and creation of a nasal airway that was stented with a 3.5 endotracheal tube. At approximate 1 year of age, patient underwent repair of cleft in the soft palate using a Furlow Z-plasty repair and dilation of nasal airway with 4.5 endotracheal tube. In preparation for a total nasal reconstruction, a costal cartilage graft was placed into a delayed forehead flap for maturation. A few months later, patient underwent a forehead flap creating a larger nasal airway capable of supporting two 5.5 endotracheal tubes as nasal stents.

Results: Primary closure of the donor site was possible. The skin and cartilage grafts did not present with infection or lost of graft complications. During a 6 month follow up there was no nasal distortion or decrease in nasal function.

Conclusion: The use of forehead flap for nasal reconstruction is widely known. The use of a prefabricated flap offers significant advantages: the length and width of the flap is enough to reconstruct the entire nose as one unit, primary closure of the donor site, adequate contrast between the nose skin and surroundings, symmetry of color and texture, prefabrication of the nasal framework confers adaptation of the cartilage graft to the new mucosa and skin coverage, nasal mucosa is ready before transferring the skin flap.

In our patient the application of a prefabricated forehead flap for nasal reconstruction allowed an adequate lining coverage, cartilage support and external nasal reconstruction in the same reconstructive step. We believe that prefabricated flap for nasal reconstruction can be a useful tool in nasal reconstruction allowing us to build what is necessary for a nasal reconstruction.

1. Mutaf M, Ustuner ET, Celebioglu S, Kocer U, Sensoz O. Tissue expansion – assisted prefabrication of the forehead flap for nasal reconstruction. Ann Plast Surg 1995; 34:478-84.

Pre-operative

MRI Brain

Technique Description

Post-operative