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Surgical Technique |

Initial Management of Total Nasal Septectomy Defects Using Resorbable Plating

Charles C. Della Santina, MD, PhD; Patrick J. Byrne, MD
Arch Facial Plast Surg. 2006;8(2):128-138. doi:10.1001/archfaci.8.2.128.
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Temporary reconstruction of the nasal skeleton using resorbable plating offers several advantages in management of carefully selected patients undergoing septectomy. These include protection against early soft tissue contracture, lack of interference with postoperative radiation and surveillance imaging, ease of use, and reversibility. This strategy can yield a good functional result and acceptable cosmesis during radiotherapy and a period of surveillance prior to definitive reconstruction. Herein, we describe the use of resorbable plating material for temporary nasal support in staged reconstruction of complex nasal skeletal defects. We managed near-total defects of the nasal cartilaginous and bony skeleton after cancer resection by staged reconstruction, initially using resorbable plating material to provide temporary structural support for nasal soft tissue during a 1-year period of postresection surveillance. The resorbable reconstruction provided adequate support to maintain nasal patency and external contour for a year or more, allowing early return to normal activities. Partial extrusion occurred in a patient who continued heavy smoking.

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Figure 1.

Nasal septectomy in patient 1. A, The septectomy specimen includes the attached upper lateral cartilages. B, Resulting defect before reconstruction; note the lack of nasal support.

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Figure 2.

Placement of internal nasal splint made of resorbable plating. Figure 2 was modified from an original drawing by Brian Dunham, MD, and used with his permission.

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Figure 3.

Axial computed tomographic image of a nose with temporizing resorbable plate reconstruction in place 10 months after surgery. Arrow shows the location of the plating material, just visible as a thin gray line beneath the nasal dorsum skin. There is no shadow or distortion around the implant.

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Figure 4.

Patient 1. Preoperative oblique (A) and lateral (B) facial views. C and D, Same views 4 months postoperatively (2 months after completion of radiation therapy). E and F, Fourteen months postoperatively (1 year after radiation therapy), just prior to beginning definitive reconstruction.

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Figure 5.

Patient 1. A, Appearance of the nose after placement of rib grafts with pericranial flap to stabilize foundation. B, Appearance with moulage in place. C and D, Appearance 12 months following total nasal subunit reconstruction with nasal turn-in flaps for vestibular lining, cartilage grafting, and forehead flap. Further refinement is planned.

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Figure 6.

Axial computed tomographic image (A) and magnetic resonance image (B) of patient 2 after septectomy with subtotal rhinectomy and temporizing reconstruction. Resorbable plating material (arrows) replaces the right bony nasal sidewall, medial maxilla, and orbit, supporting right midfacial soft tissues, which in turn support a nasal tip prosthesis.

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Figure 7.

Patient 2. Frontal (A) and right oblique (B) views 14 months after temporizing reconstruction, with right midface and nasal tip prosthesis supported by resorbable plating.

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Figure 8.

Patient 3. A, Intraoperative view demonstrating the defect involving the entire septum, midline upper lateral cartilages, and palate. B, Complete nasal collapse following total septectomy and removal of midline upper lateral cartilages.

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Figure 9.

Moulage used for intraoperative shaping (left) and the resorbable plating material (right) shown after molding but prior to final trimming and insertion.

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Figure 10.

Views of patient 3. A, frontal preoperative; B, frontal 4-month postoperative; C, oblique preoperative; and D, 4-month postoperative. The 4-month postoperative time was also 2 months after completion of radiation therapy.

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Figure 11.

Endoscopic examination of the nasal cavity of patient 3 demonstrating near-complete mucosalization of the cavity, including the resorbable implant.

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