Reconstruction of Congenital Absent Columella With Bilateral Internal Nasal Vestibular Skin Flaps and Cartilage Grafts
Abstract
Background: Congenital aplasia of the nasal columella is a very rare anomaly. The deformity is characterized by the isolated absence of the columella from the nasal tip to the root of the philtrum, including the medial crura of the alar cartilages. In congenital aplasia of the nasal columella, surrounding structures such as the septum, nose, and upper lip are normal. Patient and Methods: A 26-year old female patient has been seen with complains of difficulty in breathing and aesthetically nasal tip projection insufficiency. Columella was absent at birth. She reported the presence of same pathology with her aunt in the medical history. Physical examination revealed adhesion of the nasal tip to superior philtral margin and acute depression of nasal dorsal line, extending from caudal edge of septum to nasal tip. Reconstruction was achieved by the of bilateral internal nasal vestibular skin flaps together with alar and conchal cartilage grafts. Results: Postoperative flap survival and wound healing were uneventful. Nasal tip projection obtained peroperatively was preserved without any soft tissue contraction or cartilage resorption during 6 mouth-follow-up period. Conclusions: Although there are myriad techniques available for repairing columellar defects, each of these techniques has their own advantages and disadvantages. Therefore, the treatment of columella defects should be individualized. The internal nasal vestibular flap is useful for columella reconstruction since it avoids external scarring at the flap donor site and has the advantage of good tissue match.
References
- Tang Chen YB, Chen HC, Randall P. Reconstruction of a compound facial deformity involving the columella, nasal base, and upper lip. Plast Reconstr Surg. 1991; 87(5): 950-3.
- Yanai A, Nagata S, Tanaka H. Reconstruction of the columella with bilateral nasolabial fl aps. Plast Reconstr Surg. 1986; 77(1): 129-32.
- Baker SR, Swanson NA. Oblique forehead fl ap for total reconstruction of the nasal tip and columella. Arch Otolaryngol. 1985; 111(7): 425-9.
- Lewin ML. Congenital absence of the nasal columella. Cleft Palate J. 1988; 25(1): 58-63.
- Mavili ME, Akyurek M. Congenital isolated absence of the nasal columella: reconstruction with an internal nasal vestibular skin fl ap and bilateral labial mucosa fl aps. Plast Reconstr Surg. 2000; 106(2): 393-9.
- Bilkay U, Tokat C, Ozek C, Erdem O, Cagdas A. Reconstruction of congenital absent columella. J Craniofac Surg. 2004; 15(1): 60-3.
- Castillo M. Congenital abnormalities of the nose: CT and MR fi ndings. AJR Am J Roentgenol. 1994; 162(5): 1211-7.
- Nishimura Y. Embryological study of nasal cavity development in human embryos with reference to congenital nostril atresia. Acta Anat (Basel). 1993; 147(3): 140-4.
- Bardach J, Salyer KE. Correction of Secondary Bilateral Cleft-Lip and Nasal Deformity. In Atlas of Craniofacial & Cleft Surgery, Vol 2 Cleft Lip and Palate Surgery,Lippincott-Raven, Philadelphia New York, 1999, p611-677.
- Millard DR Jr. Reconstructive rhinoplasty for the lower two-thirds of the nose. Plast Reconstr Surg. 1976; 57(6): 722-8.
- Earley MJ, Chantarasak ND. The transverse forked fl ap in columella reconstruction. Br J Plast Surg. 1989; 42(3): 270-3.
- Vecchione TR. Columella reconstruction using internal nasal vestibular fl aps. Br J Plast Surg. 1980; 33(4): 399-403.
- Blandini D, Tremolada C, Beretta M, Mascetti M. Iatrogenic nostril stenosis: aesthetic correction using a vestibular labial mucosa fl ap. Plast Reconstr Surg. 1995; 95(3): 569-71.
- da Silva G. A New Method Of Reconstructıng The Columella Wıth A Naso-Labıal Flap. Plast Reconstr Surg. 1964; 34: 63-5.
- Burget GC, Menick FJ. Nasal support and lining: the marriage of beauty and blood supply. Plast Reconstr Surg. 1989; 84(2): 189-202.
- Tanaka Y, Tajima S, Tsujiguchi K, Fukae E, Ohmiya Y. Microvascular reconstruction of nose and ear defects using composite auricular free fl aps. Ann Plast Surg. 1993; 31(4): 298-302.
- Barton FE, Byrd HS. Acquired Deformities of the Nose. In J. G. McCarthy (Ed.). Plastic Surgery, Vol. 3. Philadephia: Saunders, 1990.
Konjenital Kolumella Yokluğunun Bilateral İnternal Nazal Cilt Flepleri ve Kıkırdak Grefti ile Rekonstrüksiyonu
Abstract
Giriş ve Amaç: Nasal kolümellanın konjenital aplazisi oldukça nadir görülen bir anomalidir. Deformite, kolümellanın burun ucundan filtrum tabanına kadar, alar kartilajları da içerecek şekilde izole yokluğu ile karakterizedir. Nazal kolümellanın konjenital aplazisinde septum, burun ve üst dudak gibi çevre yapılar normaldir. Olgu ve Yöntem: 26 yaşında bayan hasta, solunum güçlüğü ve burun ucu projeksiyon yetersizliği şikayetleri ile kliniğimize başvurdu. Hikâyede kolümellanın doğumda yokluğu öğrenildi. Özgeçmişinde hastanın halasında da aynı patolojinin varlığı saptandı. Fizik muayenede burun ucunun superior filtral sınıra adhezyonu ve nazal dorsal çizgide septumun kaudal sınırından burun ucuna kadar uzanan şiddetli depresyon izlendi. Rekonstrüksiyon bilateral internal nazal vestibüler deri flepleri ve alar konkal kartilaj greftleri kullanılarak yapıldı. Postoperatif flep kaybı ve yara iyileşme problemi görülmedi. 6 aylık takipte ameliyatta sağlanan burun ucu projeksiyonu postoperatif dönemde de yumuşak doku kontraksiyonu veya kartilaj rezorpsiyonu gelişmeksizin korunduğu gözlendi. Sonuç: Kolumellar defektlerin rekonstrüksiyonunda kullanılabilecek sayısız teknik olmasına rağmen her birinin kendi avantaj ve dezavantajları vardır. Bu nedenle kolümellar defektlerin cerrahi tedavisi hastaya özel olmalıdır. Kolümella rekonstrüksiyonunda internal nasal vestibüler flep kullanımı flep donör alanında görülebilen nebbe olmaması ve iyi doku uyumu nedeniyle avantajlıdır.
References
- Tang Chen YB, Chen HC, Randall P. Reconstruction of a compound facial deformity involving the columella, nasal base, and upper lip. Plast Reconstr Surg. 1991; 87(5): 950-3.
- Yanai A, Nagata S, Tanaka H. Reconstruction of the columella with bilateral nasolabial fl aps. Plast Reconstr Surg. 1986; 77(1): 129-32.
- Baker SR, Swanson NA. Oblique forehead fl ap for total reconstruction of the nasal tip and columella. Arch Otolaryngol. 1985; 111(7): 425-9.
- Lewin ML. Congenital absence of the nasal columella. Cleft Palate J. 1988; 25(1): 58-63.
- Mavili ME, Akyurek M. Congenital isolated absence of the nasal columella: reconstruction with an internal nasal vestibular skin fl ap and bilateral labial mucosa fl aps. Plast Reconstr Surg. 2000; 106(2): 393-9.
- Bilkay U, Tokat C, Ozek C, Erdem O, Cagdas A. Reconstruction of congenital absent columella. J Craniofac Surg. 2004; 15(1): 60-3.
- Castillo M. Congenital abnormalities of the nose: CT and MR fi ndings. AJR Am J Roentgenol. 1994; 162(5): 1211-7.
- Nishimura Y. Embryological study of nasal cavity development in human embryos with reference to congenital nostril atresia. Acta Anat (Basel). 1993; 147(3): 140-4.
- Bardach J, Salyer KE. Correction of Secondary Bilateral Cleft-Lip and Nasal Deformity. In Atlas of Craniofacial & Cleft Surgery, Vol 2 Cleft Lip and Palate Surgery,Lippincott-Raven, Philadelphia New York, 1999, p611-677.
- Millard DR Jr. Reconstructive rhinoplasty for the lower two-thirds of the nose. Plast Reconstr Surg. 1976; 57(6): 722-8.
- Earley MJ, Chantarasak ND. The transverse forked fl ap in columella reconstruction. Br J Plast Surg. 1989; 42(3): 270-3.
- Vecchione TR. Columella reconstruction using internal nasal vestibular fl aps. Br J Plast Surg. 1980; 33(4): 399-403.
- Blandini D, Tremolada C, Beretta M, Mascetti M. Iatrogenic nostril stenosis: aesthetic correction using a vestibular labial mucosa fl ap. Plast Reconstr Surg. 1995; 95(3): 569-71.
- da Silva G. A New Method Of Reconstructıng The Columella Wıth A Naso-Labıal Flap. Plast Reconstr Surg. 1964; 34: 63-5.
- Burget GC, Menick FJ. Nasal support and lining: the marriage of beauty and blood supply. Plast Reconstr Surg. 1989; 84(2): 189-202.
- Tanaka Y, Tajima S, Tsujiguchi K, Fukae E, Ohmiya Y. Microvascular reconstruction of nose and ear defects using composite auricular free fl aps. Ann Plast Surg. 1993; 31(4): 298-302.
- Barton FE, Byrd HS. Acquired Deformities of the Nose. In J. G. McCarthy (Ed.). Plastic Surgery, Vol. 3. Philadephia: Saunders, 1990.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | June 1, 2011 |
| Published in Issue | Year 2011Issue: 2 |