NOSE RECONSTRUCTION SURGERY
Nose Reconstruction Surgery
Rhinoplasty, commonly known as a nose job, is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that changes the appearance of the nose.
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THE STRATEGY FOR NOSE RECONSTRUCTION
The reconstruction of nose is divided into skin only, skin plus cartilage and skin, cartilage and nasal lining. In india most the reconstruction is for trauma and some are for malignant tumors. Basal cell carcinoma is the most common type, followed by squamous cell carcinoma and melanoma. Other types of malignant tumors and benign destructive processes are rare.
Difficult problems caused by basal cell carcinoma, a type of semi-malignant tumor, are often underestimated. If such a tumor is incompletely resisted, the residual tumor is either lateral or with a deep area, much of the reconstruction problem.
Squamous cell carcinoma can arise not only from the outer skin of the nose but also from its inner surface. End nose carcinomas are more dangerous, as they are later discovered. When these lesions are diagnosed early, organ-protection surgery can be performed, followed by partial reconstruction.
NOSE RECONSTRUCTION SURGERY
Nose reconstruction surgery has a special place in nose reconstruction due to the complex three dimensional surface of the nose, varying thicknesses of the skin covering it, different types of scaffolding from hardened bone to flexible cartilage and its inner epithelial Defects are very diverse, and reconstructions, although always based on the same core principles, allow for a great deal of creativity on the part of the plastic surgeon.
SINGLE PROCEDURE NOSE RECONSTRUCTIVE
Only small nose defects are reusable by reconstruction techniques that can be performed entirely in a single sitting. Ideally, skin flaps are used, which will respect the boundaries between the different subunits of the nose the dorsum, the sidewall, and the tip of the nose, the soft triangle, the nostril, and the columella. Rotation flaps, transposition flaps, V-Y-plastics, finely pedicled sliding flaps, and bilobed flaps are known standard techniques.
Median defects involving the nasal tip and distal dorsum can be repaired with an expansion flap from the cranial portion of the dorsum.
Very small defects at the tip of the nose can be covered with a thick full-thickness graft from behind the ear.
Less than one-third of the nostril defects can be repaired with a “composite graft”, which consists of cartilage from the skin and ears, with a good chance of success.
If the defect involves more than 25% of the nasal tip or nostril, then, for esthetic reasons, it should be included as a whole subset of the nose, singly or in combination. This will no longer be possible in a single process.
For the reconstruction of the nostril half or entity this can be done with a nasolabial rotation flap in a single procedure, the procedure destroys the fur between the base of the nose and cheek, which defines the nasal border, and therefore causes cosmetic deformity. Another thing is construction with forehead flap with pedicle in the subcutaneous plane and this is a single-stage but has the disadvantage of obliterating the radix of the nose.
MULTIPLE STEP NOSE RECONSTRUCTIVE TECHNIQUES
A para median forehead flap is the method of choice for a complete reconstruction of nostril.This is a distant flap that obtains its blood supply from the medial side of the eyebrow. The vertical vascular architecture of the forehead enables the flap to be constructed with a bridge of skin from the forehead containing a defined blood vessel so that a large piece of skin can be displaced from the forehead into the nasal skin defect without any compromise of its blood supply. A second procedure is needed to divide the bridge, integrate the flap, and reconstruct the anatomy of the eyebrow. During this procedure, the donor site on the forehead is converted into a linear vertical scar.
The tip of the nose, too, is best reconstructed as an entire subunit with a forehead flap. When the columella is reconstructed, hairiness of the skin over the columella must sometimes be accepted as a temporary disadvantage, because the distance from the base of the pedicle on the eyebrow to the base of the columella where it meets the upper lip usually exceeds the height of the forehead below the hairline. Operative epilation by removal of the subcutaneous roots of the hair requires further intermittent surgical treatment. Nonsurgical alternatives such as laser epilation can be considered.
The patient’s age and personal wishes should also be considered when a reconstructive technique is chosen. In this context, the question must also be addressed whether the tissue defect must be extended to an entire esthetic subunit of the nose, which will then be totally reconstructed.
NOSE RECONSTRUCTION SURGERY COST
As with most plastic surgery, the total cost of the procedure and recovery can vary greatly depending on the region and physician. Dr. Swaroop Singh Gambhir suggests that other variables include the skill level of the surgeon, whether it is is a primary or secondarycase. Collar agrees that costs can vary widely and may include fees from surgeons, anesthesia, and hospital and ambulance surgery centers.
Nose reconstruction can range from about Rs. 40,000 to 1,50,000. However, for people with breathing problems, “surgeries of the septum, internal valve, or turbine that can be performed at the same time as aesthetic refinement may qualify for insurance coverage, but only for the functional part of the procedure.