The reconstructive surgery of the nose includes all those plastic surgeries – such as, for example, the same rhinoplasty – aimed to correct congenital malformations and outcomes of trauma or tumors of the nasal pyramid.
Reconstructive nose surgery allows to improve and / or eliminate congenital malformations affecting the nasal pyramid. Often, however, these types of malformations are associated with congenital alterations of the palate, oral cavity, frontal, maxillary and mandibular bones, and require, in addition to reconstructive plastic surgery, also maxillofacial surgery. The malformations that most frequently involve the nasal pyramid are: cleft lip, cleft palate and cleft lip and palate, Crouzon syndrome, Pfeiffer syndrome, Apert syndrome, Treacher Collins syndrome and Romberg syndrome.
Traumas can be divided into: wounds, loss of substance of the nasal pyramid, fracture of the nasal bones, fracture of the nasal septum, combined and / or multiple fractures that affect, in addition to the nose and septum, also the frontal, maxillary and paranasal sinuses . The traumas of the nasal skeleton can be lateral (consequent to forces acting in lateral-lateral direction) or frontal (due to forces acting in antero-posterior direction).
WOUNDS AND LOSSES OF SUBSTANCE OF THE NASAL PYRAMID
Wounds affecting the soft tissues of the nose must be immediately sutured by a specialist in plastic nose surgery, to obtain the best possible aesthetic result. In the event of substance loss, one or more reconstructive surgery must be performed using different techniques ranging from simple tissue grafting to the use of simple or compound flaps.
NASAL BONE FRACTURE
The nasal pyramid is made up of a partially bony and partly cartilaginous scaffold. The bony part is made up of the two bones of the nose which join up at the top with the nasal process of the frontal bone, and laterally with the ascending portion of the maxillary bones. Major trauma to the nasal skeleton can lead to fracture of the nasal bones. Fractures can affect one or both nasal bones and be with or without displacement. Symptomatology consists of bleeding (epistaxis), spontaneous or palpated pain, deformation of the nasal pyramid and swelling. A simple radiological examination (x-ray for nasal bones) is able to detect the presence of fractures. The fracture should be reduced within 8-10 days of trauma. Fracture reduction can occur on an outpatient basis,
FRACTURE OF THE NASAL SEPTUM
The nasal septum forms the central and supporting part of the nasal pyramid. It is formed, posteriorly, by a bony part and, anteriorly, by a cartilaginous part. The bony part is constituted by the perpendicular lamina of the ethmoid and by the plow, by the maxillary bone and the palatine bone. In most cases, this type of trauma is associated with fracture of the nasal bones. The symptomatology of nasal septum fracture is epistaxis and an acquired breathing difficulty.
Nasal pyramid tumors can be benign or malignant. Benign tumors (nevi, cysts, papillomas, fibroids, keratoses, actinic keratoses, etc.) generally require minor plastic surgery which cause small scars that are often not very visible.
The most frequent malignancies are basal cell carcinomas (also called basal cell carcinomas), squamous cell carcinomas (squamous cell carcinomas) and melanoma. When new and atypical formations appear on the skin of the nose, it is recommended to immediately contact a specialist to prevent the spread of the tumor from entailing the need for even very complex reconstructive surgical operations such as the rotation of flaps of autologous tissue to be performed in one or more operating sessions, or the use of microsurgical techniques.