Open rhinoplasty concepts in facilitating tip reconstruction

Overview

The nose is a common site for skin cancer, and most defects after removal are wide but shallow. Covering a wide defect needs a large flap, which leaves noticeable scars at both the donor and the recipient site. The authors point out that skin cancer patients are usually older, with typical aged nose features, and that reducing the framework can reduce the amount of skin needed.

Sections of note

• Concept and technique article. No patient numbers, outcomes, follow-up or complication rates are reported.
• The nose accounts for roughly 26 percent of facial basal cell carcinomas and roughly 13 percent of the squamous cell cancers described in the abstract as spinal cell carcinomas.
• Melanoma, mostly lentigo maligna melanoma, is also frequently located on the nasal pyramid.
• Defects vary in size and depth and some involve all three layers of the nose, but most stay superficial and rarely invade the underlying framework.
• Aged noses are described as commonly showing a plunging tip, increased length and a prominent hump.
• Reducing and reshaping the framework downsizes the defect, so less skin is needed for coverage.
• The open rhinoplasty approach makes these manoeuvres easier, and they are largely the same as in cosmetic work.

What it means for a patient

• Reconstruction after nose skin cancer can include reshaping the nose itself, not only covering the wound.
• Doing so can mean a smaller flap and less scarring than covering the defect at its original size.
• No results are reported here, so there is no measured comparison against covering the defect without framework reduction.
• The concept applies mainly to older patients whose noses have lengthened and dropped with age.

Why this paper matters

It links cosmetic rhinoplasty technique to cancer reconstruction, two fields usually kept separate. Unanswered is how often defect downsizing is achievable, how much it reduces flap size in practice, and whether the reshaped nose satisfies patients.

Terms

• Basal cell carcinoma: the most common and least aggressive form of skin cancer.
• Lentigo maligna melanoma: a slow growing melanoma arising in sun damaged skin.
• Flap: skin moved from a nearby area, with its blood supply, to cover a wound.
• Nasal framework: the bone and cartilage giving the nose its shape.
• Plunging tip: a nasal tip that has dropped downward, typical with age.