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Facial Plast Surg 2023; 39(02): 180-184
DOI: 10.1055/a-1939-4132
Original Research

Applying Occam's Razor and Descending the Reconstructive Ladder: The Modified Cheek Advancement Flap for Reconstruction of Nasal Defects

Jaclyn Rosenthal Himeles 
1   The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
,
Maressa C. Criscito
1   The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
,
Rebecca Kellner
2   Icahn School of Medicine at Mount Sinai, New York, New York
,
Nayoung Lee
1   The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
,
Mary L. Stevenson
1   The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
,
Anthony P. Sclafani 
3   Department of Otolaryngology-Head and Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York
,
John A. Carucci
1   The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
› Author Affiliations Funding None.
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Abstract

Nasal reconstruction has important functional and cosmetic considerations, as proper repair of nasal defects is necessary to maintain function of the nasal airway and to recreate the normal appearance of this central facial structure. Cheek advancement flaps provide matched, mobile, and highly vascularized tissue for the reconstruction of nasal defects, allowing for the concealment of incisions within natural creases in a one-stage approach. However, cheek advancement flaps are often underutilized for nasal reconstruction because of their difficulty in restoring nasal contour. We describe reconstruction of 19 nasal dorsal and sidewall defects 0.8 to 3 cm in size. We incorporated a periosteal anchoring suture to maintain/restore nasal contour and additionally removed a half standing cone inferior to the defect to prevent encroachment of the nasal ala or alar crease. All patients were evaluated at least 3 months postoperatively. In all patients, we were able to restore concavity of the nasofacial sulcus, preserve the biconvex nasal tips, prevent alar flaring and retraction, and conserve the alar groove. All patients had excellent functional and cosmetic outcomes. We believe this modified cheek advancement flap provides functionally and aesthetically superior results and can be considered as a first-line approach for repair of nasal dorsal and sidewall defects in subselected patients.

Keywords

Mohs micrographic surgery - nasal reconstruction - advancement flap


Publication History

Accepted Manuscript online:
08 September 2022

Article published online:
31 October 2022

© 2022. Thieme. All rights reserved.

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