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Farahani PK. Application of Tissue Engineering and Biomaterials in Nose Surgery. JPRAS Open 2024; 40:262-272. [PMID: 38708386 PMCID: PMC11067003 DOI: 10.1016/j.jpra.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/05/2023] [Indexed: 05/07/2024] Open
Abstract
Surgery of the nose involves a series of operations that are directed at restoring the nasal anatomy and physiology. The extent or degree of reconstruction needed is dependent on the appearance-based requirement of the patients and the procedure exploited for the correction such that nasal airflow is preserved. Standard surgical approach includes the use of autologous tissue or implantation alloplastic bio or synthetic/fabricated construct materials to correct the defects. Over the years, tissue engineering has been proven to be a promising technique for reconstructing tissue and organ defects, including the nose. Recently, there has been keen interest in fabricating new tissues and organ scaffolds using 3D printing technology with good control over the micro-architecture and excellent interior architecture suitable for cell seeding. Unviability of the tissue and harvest-associated complications have increased the need for the investigation of tissue engineering based methods for nasal reconstruction using biomaterials, stem cells, and growth factors combined with 3D bioprinting. However, there are only a handful of studies vis-à-vis the application of cartilage tissue engineering, stem cells, and growth factors for the purpose. This review provides highlights about the available studies based on the application of stem cells, biomaterials, and growth factors for nasal reconstruction surgery, as there is limited recent information on the use of these entities in nasal surgeries.
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Schopper HK, Gadkaree SK, Lighthall JG. Approach to Major Nasal Reconstruction: Benefits of Staged Surgery and Use of Technology. Facial Plast Surg Clin North Am 2024; 32:199-210. [PMID: 38575278 DOI: 10.1016/j.fsc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
This article reviews special considerations in complex nasal defects including treatment of adjacent subunit defects, timing of repair with radiation, reconstruction in patients with prior repairs or recurrent disease, and the role of prosthetics. The role of technological advances including virtual surgical planning, 3 dimensional printing, biocompatible materials, and tissue engineering is discussed.
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Affiliation(s)
- Heather K Schopper
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Penn State College of Medicine, 500 University Drive H-091, Hershey, PA 17033, USA.
| | - Shekhar K Gadkaree
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Miami Miller School of Medicine, 1120 Northwest 14th St, Miami, FL 33136, USA
| | - Jessyka G Lighthall
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Penn State College of Medicine, 500 University Drive H-091, Hershey, PA 17033, USA
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Howard BE, Patel S, Shockley WW, Clark JM. Total Nasal Reconstruction: Advances in Free Tissue Transfer for Internal Lining and Structural Support. Facial Plast Surg Clin North Am 2024; 32:247-259. [PMID: 38575283 DOI: 10.1016/j.fsc.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Total nasal reconstruction is a complex challenge due to the need to establish new internal lining, internal structural support, and external skin covering that is both functional and esthetic. The medial femoral condyle corticoperiosteal free flap represents an innovative option for restoration internal structure and internal nasal lining. When used in conjunction with a paramedian forehead flap, acceptable results in both function and esthetics can be achieved.
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Affiliation(s)
- Brittany E Howard
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | - Samip Patel
- Division of Head and Neck Surgery, Mayo Clinic Florida, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
| | - William W Shockley
- Division of Facial Plastic and Reconstructive Surgery, University of North Carolina, 170 Manning Drive Campus Box# 7070, Chapel Hill, NC 27599, USA
| | - Joseph Madison Clark
- Division of Facial Plastic and Reconstructive Surgery, University of North Carolina, 170 Manning Drive Campus Box# 7070, Chapel Hill, NC 27599, USA
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Shah KM, Tate JA, Srivastava D, Nijhawan RI. Nasal Lining Repair: A Comprehensive Literature Review. Dermatol Surg 2024; 50:241-246. [PMID: 38170669 DOI: 10.1097/dss.0000000000004063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Currently, there are limited reviews in the dermatology literature on how to approach reconstruction of nasal lining in full-thickness nasal defects resulting from Mohs micrographic surgery. Given variable training and experience, dermatologic surgeons may seek additional references to help reconstruct certain advanced defects. We sought to synthesize literature from dermatologic surgery, plastic surgery, and otolaryngology to review repair options and considerations for repair of nasal lining defects. OBJECTIVE To present a comprehensive literature review of repair options for nasal lining reconstruction and discuss advantages, disadvantages, specific anatomic considerations, and techniques to execute such options. MATERIALS AND METHODS Articles from several different reconstructive specialties including dermatologic/Mohs surgery, otolaryngology, and plastic and reconstructive surgery were reviewed. Instructive images were compiled to illustrate several techniques, with additional medical illustration recreations included to help showcase important reconstructive approaches. RESULTS A comprehensive descriptive review of nasal lining repair options for the reconstructive surgeon. CONCLUSION Advanced tumors can result in full-thickness nasal defects, and this review describes various reconstructive options for reconstruction based on the extent of the defect.
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Affiliation(s)
- Kishan M Shah
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jesalyn A Tate
- Department of Dermatology, The University of Kansas Medical Center, Kansas City, Kansas
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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Migliorelli A, Sgarzani R, Cammaroto G, De Vito A, Gessaroli M, Manuelli M, Ciorba A, Bianchini C, Pelucchi S, Meccariello G. Reconstructive Options after Oncological Rhinectomy: State of the Art. Healthcare (Basel) 2023; 11:1785. [PMID: 37372903 DOI: 10.3390/healthcare11121785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The nose is a central component of the face, and it is fundamental to an individual's recognition and attractiveness. The aim of this study is to present a review of the last twenty years literature on reconstructive techniques after oncological rhinectomy. METHODS Literature searches were conducted in the databases PubMed, Scopus, Medline and Google Scholar. "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA)" for scoping review was followed. RESULTS Seventeen articles regarding total rhinectomy reconstruction were finally identified in the English literature, with a total of 447 cases. The prostheses were the reconstructive choice in 213 (47.7%) patients, followed by local flaps in 172 (38.5%) and free flaps in 62 (13.8%). The forehead flap (FF) and the radial forearm free flap (RFFF) are the most frequently used flaps. CONCLUSIONS This study shows that both prosthetic and surgical reconstruction are very suitable solutions in terms of surgical and aesthetic outcomes for the patient.
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Affiliation(s)
- Andrea Migliorelli
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44100 Ferrara, Italy
| | - Rossella Sgarzani
- DIMES Department, Bologna University, 40100 Bologna, Italy
- Plastic Surgery, M. Bufalini Hospital, AUSL Romagna, 47521 Cesena, Italy
| | - Giovanni Cammaroto
- ENT Department, Morgagni Pierantoni Hospital, AUSL Romagna, 47121 Forliì, Italy
| | - Andrea De Vito
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Manlio Gessaroli
- Maxillo-Facial Unit, M. Bufalini Hospital, AUSL Romagna, 47521 Cesena, Italy
| | - Marianna Manuelli
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44100 Ferrara, Italy
| | - Andrea Ciorba
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44100 Ferrara, Italy
| | - Chiara Bianchini
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44100 Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44100 Ferrara, Italy
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Schneider TA, Gryn O, Lutz M. A Case of Squamous Cell Carcinoma of the Nasal Cavity Treated With Total Rhinectomy. Cureus 2022; 14:e23576. [PMID: 35494922 PMCID: PMC9045844 DOI: 10.7759/cureus.23576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Squamous cell carcinoma of the nasal cavity is a relatively rare cancer. Five-year recurrence-free survival rates have a large range, which may be due to the small patient population available to study. Recurrence rates vary based on the treatment regimen and aggressiveness of the surgical approach. Total rhinectomy is not often performed due to its invasive nature and extensiveness of reconstruction required afterward. This report will cover a patient who presented with squamous cell carcinoma of the left nasal vestibule and was treated with total rhinectomy and radiation therapy.
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Windura CA, Josh F, Soekamto TH, Lumalessil DG. Nasal reconstruction surgery after continuous positive airway pressure delivered by prongs: A case report. Ann Med Surg (Lond) 2021; 70:102881. [PMID: 34691424 PMCID: PMC8519769 DOI: 10.1016/j.amsu.2021.102881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Deformities resulting from nasal continuous positive airway pressure delivered using prongs can cause functional and aesthetic issues for patients. Resultant severe tissue damage to the nasal structures often requires surgical intervention and techniques continue to evolve. Case presentation This case report describes a 6-year-old male presenting with a full-thickness columella defect; contracture causing deformities involving the nasal tip, ala nasi, and left nasal cavity wall; missing left lateral-medial cruris cartilage; and partially missing right medial cruris cartilage. The abnormalities initially appeared when the patient was 7 days old after receiving treatment by nasal continuous positive airway pressure for 7 days. A one-stage procedure was performed as follows: left ala nasi reconstruction with skin excision followed by an ear cartilage graft; a nasal cartilage shield graft to form the nasal tip; reconstruction of the columella with a cartilage graft combined with bilateral soft tissue flaps taken from the nasal floor and mucosa vestibulum; and a full-thickness skin graft to cover the secondary defect resulting from the flaps. At 1-month post-surgery, satisfactory results were reported. Clinical discussion and conclusion Our approach combining two flaps taken from the nasal floor and the inner layer of the ala nasi, a cartilage graft from the ear, and a full-thickness skin graft delivered a one-stage surgical technique that yielded satisfactory results without deformities of the donor site. However, the surgical technique should be individualized to patients. This case report adds to the literature and offers surgeons an alternative approach for managing nasal deformities. The limited availability of small size nCPAP in inland hospitals have caused the increased number of nasal deformity. Combination of nasal floor flaps, shield and ear cartilage graft yielded satisfactory result for nasal reconstruction. The rarity of the case, and the combination of each techniques used, made the case interesting. This technique does not rule out the possibility of secondary corrections and should be tailored individually for each case.
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Affiliation(s)
- Carolus Aldo Windura
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Fonny Josh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Tomie H Soekamto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Dhevie Gianfranco Lumalessil
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Brajesh V, Aggarwal A, Singh S, Vora V, Rana K. Single Stage Nasal Reconstruction in a Near Total Nasal Defect. Indian J Plast Surg 2020; 53:431-434. [PMID: 33402779 PMCID: PMC7775216 DOI: 10.1055/s-0040-1721858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Reconstruction of nasal defect is difficult and challenging. A full-thickness defect of nose requires reconstruction of thin inner lining, middle skeletal (bony/cartilaginous) support, and outer skin layer cover. Large full-thickness defects of nose require complex multistage reconstruction to achieve good functional and aesthetic result. We present here a case of 12-year-old boy, a known case of xeroderma pigmentosa, who underwent wide local excision for squamous cell carcinoma of the nose, leaving a near total defect of the external nose. The reconstruction was done with a suprafascial, thin radial artery forearm free-flap for the external cover as well as the inner lining along with the septal cartilage graft for skeletal support in a single stage.
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Affiliation(s)
- Vimalendu Brajesh
- Department of Plastic, Aesthetic and Reconstructive Surgery Medanta the Medicity, Gurgaon, Haryana, India
| | - Aditya Aggarwal
- Department of Plastic, Aesthetic and Reconstructive Surgery Medanta the Medicity, Gurgaon, Haryana, India
| | - Sukhdeep Singh
- Department of Plastic, Aesthetic and Reconstructive Surgery Medanta the Medicity, Gurgaon, Haryana, India
| | - Vishal Vora
- Department of Plastic, Aesthetic and Reconstructive Surgery Medanta the Medicity, Gurgaon, Haryana, India
| | - Kanika Rana
- Department of Head and Neck Surgery Medanta the Medicity, Gurgaon, Haryana, India
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Bagher Z, Asgari N, Bozorgmehr P, Kamrava SK, Alizadeh R, Seifalian A. Will Tissue-Engineering Strategies Bring New Hope for the Reconstruction of Nasal Septal Cartilage? Curr Stem Cell Res Ther 2020; 15:144-154. [PMID: 31830895 DOI: 10.2174/1574888x14666191212160757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 01/01/2023]
Abstract
The nasal septal cartilage plays an important role in the growth of midface and as a vertical strut preventing the collapse of the nasal bones. The repair of nasal cartilage defects remains a major challenge in reconstructive surgery. The tissue engineering strategy in the development of tissue has opened a new perspective to generate functional tissue for transplantation. Given the poor regenerative properties of cartilage and a limited amount of autologous cartilage availability, intense interest has evoked for tissue engineering approaches for cartilage development to provide better outcomes for patients who require nasal septal reconstruction. Despite numerous attempts to substitute the shapely hyaline cartilage in the nasal cartilages, many significant challenges remained unanswered. The aim of this research was to carry out a critical review of the literature on research work carried out on the development of septal cartilage using a tissue engineering approach, concerning different cell sources, scaffolds and growth factors, as well as its clinical pathway and trials have already been carried out.
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Affiliation(s)
- Zohreh Bagher
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Negin Asgari
- Department of Biomedical Engineering, Faculty of Chemical Engineering, Tarbiat Modares University, Tehran, Iran
| | - Parisa Bozorgmehr
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Seyed Kamran Kamrava
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Rafieh Alizadeh
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alexander Seifalian
- Nanotechnology and Regenerative Medicine Commercialisation Centre (NanoRegMed Ltd) The London BioScience Innovation Centre, London, United Kingdom
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10
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Total nasal reconstruction: a review of the past and present, with a peak into the future. Curr Opin Otolaryngol Head Neck Surg 2020; 27:420-425. [PMID: 31461733 DOI: 10.1097/moo.0000000000000573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The goal of this article is to review the complex topic of total nasal reconstruction and present a wide range of options for completing this difficult surgical procedure. RECENT FINDINGS Nasal reconstruction has a long history dating back thousands of years. Some historical techniques still exist today, including the paramedian forehead flap. The introduction of free tissue transfer and other pedicled flaps has provided multiple options for the reconstructive surgeon. The future of nasal reconstruction will include facial transplantation and likely bioengineered tissues. SUMMARY The principles of nasal reconstruction have gone unchanged for decades; however, the techniques to meet the principles have. The current reconstructive methods of grafts, free flaps, and pedicled flaps used to replace lining, structure, and skin will likely be used for several years to come. However, the use of facial transplantation has proved effective and bioengineered tissues present an exciting future for organ replacement.
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Ruiz-Cantu L, Gleadall A, Faris C, Segal J, Shakesheff K, Yang J. Multi-material 3D bioprinting of porous constructs for cartilage regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 109:110578. [PMID: 32228894 DOI: 10.1016/j.msec.2019.110578] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 11/21/2019] [Accepted: 12/19/2019] [Indexed: 12/25/2022]
Abstract
The current gold standard for nasal reconstruction after rhinectomy or severe trauma includes transposition of autologous cartilage grafts in conjunction with coverage using an autologous skin flap. Harvesting autologous cartilage requires a major additional procedure that may create donor site morbidity. Major nasal reconstruction also requires sculpting autologous cartilages to form a cartilage framework, which is complex, highly skill-demanding and very time consuming. These limitations have prompted facial reconstructive surgeons to explore different techniques such as tissue engineered cartilage. This work explores the use of multi-material 3D bioprinting with chondrocyte-laden gelatin methacrylate (GelMA) and polycaprolactone (PCL) to fabricate constructs that can potentially be used for nasal reconstruction. In this study, we have investigated the effect of 3D manufacturing parameters including temperature, needle gauge, UV exposure time, and cell carrier formulation (GelMA) on the viability and functionality of chondrocytes in bioprinted constructs. Furthermore, we printed chondrocyte-laden GelMA and PCL into composite constructs to combine biological and mechanical properties. It was found that 20% w/v GelMA was the best concentration for the 3D bioprinting of the chondrocytes without comprising the scaffold's porous structure and cell functionality. In addition, the 3D bioprinted constructs showed neocartilage formation and similar mechanical properties to nasal alar cartilage after a 50-day culture period. Neocartilage formation was also observed in the composite constructs evidenced by the presence of glycosaminoglycans and collagen type II. This study shows the feasibility of manufacturing neocartilage using chondrocytes/GelMA/PCL 3D bioprinted porous constructs which could be applied as a method for fabricating implants for nose reconstruction.
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Affiliation(s)
- Laura Ruiz-Cantu
- Centre for Additive Manufacturing, Faculty of Engineering, University of Nottingham, University Park, Nottingham NG7 2RD, UK; Regenerative Medicine and Cellular Therapies Division, Faculty of Science, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Andrew Gleadall
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, University of Loughborough, Loughborough LE113TU, UK
| | - Callum Faris
- Department of Otorhinolaryngology and Facial Plastic Reconstructive Surgery, Poole Hospital, Poole BH15 2JB, UK
| | - Joel Segal
- Advanced Manufacturing Technology Research Group, Faculty of Engineering, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Kevin Shakesheff
- Regenerative Medicine and Cellular Therapies Division, Faculty of Science, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Jing Yang
- Regenerative Medicine and Cellular Therapies Division, Faculty of Science, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
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Ramji M, Kim GY, Pozdnyakov A, McRae MH. Microvascular lining options for subtotal and total nasal reconstruction: A scoping review. Microsurgery 2019; 39:563-570. [PMID: 30706532 DOI: 10.1002/micr.30432] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/21/2018] [Accepted: 01/11/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Restoration of nasal lining is essential in reconstruction of subtotal/total nasal defects. When local flaps are inadequate, a microvascular flap should be used. The purpose of this scoping review is to map the literature and identify the described flap options for subtotal/total nasal reconstruction. Further to that, we will summarize the stated advantages and disadvantages, evaluate functional and esthetic outcomes, and appraise the current body of literature. METHODS An electronic literature search was completed. Studies required adult patients with subtotal/total nasal defects and lining reconstruction with microvascular free flap. Two independent reviewers completed screening and data extraction. Flap characteristics, advantages, disadvantages, functional and esthetic outcomes were reviewed. Two independent reviewers evaluated study quality. RESULTS Of 305 initial articles, 22 studies were included (13 case reports, 9 case series) accounting for 65 flaps. Microvascular flaps varied by composition and anatomical location. For functional outcome, 13 studies used clinical exam by surgeon, 5 reported patient being satisfied, 3 studies used endoscopy, and 1 study used nasometry. Assessing esthetic outcome, 13 studies used clinical exam by surgeon, 5 studies reported patient being satisfied, 1 study used patient-reported outcome measures, and 16 studies included photos. Study quality (modified CARE and PROCESS checklists) was deemed poor. Quality of available evidence was level IV. CONCLUSIONS Microvascular free flaps for nasal reconstruction, confer an overall satisfactory functional and esthetic outcome. All studies lack a systematic and comprehensive approach to assessing and reporting these outcomes. Future research should provide objective assessment and utilize patient reported outcome measures.
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Affiliation(s)
- Maleka Ramji
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario
| | - Grace Y Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario
| | - Alex Pozdnyakov
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario
| | - Mark H McRae
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario
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13
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Malard O, Lanhouet J, Michel G, Dreno B, Espitalier F, Rio E. Pertes de substance étendues de la pyramide nasale : rôle de l’épithèse. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.aforl.2014.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Cannady SB, Friedman O, Chalian AA, Newman JG, Cook T, Wax MK. Reconstruction of the naso-orbital-ethmoid (NOE) complex using the osteocutaneous radial forearm flap (OCRFF). Otolaryngol Head Neck Surg 2015; 152:827-31. [PMID: 25724572 DOI: 10.1177/0194599815571536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/16/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Describe the utility of osteocutaneous forearm flaps in reconstruction of naso-orbito-ethmoid (NOE) defects. STUDY DESIGN Case series with chart review. SETTING Tertiary medical centers. SUBJECTS AND METHODS The study was conducted on patients treated between the years 2000 and 2014 undergoing NOE resection with reconstruction using the radial forearm flap. Decision making, technical feasibility, need for revisions, and patient disease outcomes were included to assess the durability of reconstruction over remaining survival period. RESULTS Fifteen patients underwent NOE reconstruction in the timeframe studied. Five recent patients reported poor nasal airway but no diplopia or immediately clinically evident enopthalmus after NOE reconstruction in mean follow-up of 17.3 months. One-third of patients succumbed to disease in the study period, 3 without revision, and all but 2 surviving patients required revisions. CONCLUSION Osteocutaneous radial forearm flap (OCRFF) is a cosmetically acceptable method of reconstructing NOE defects. Though a 1-step reconstruction can be serviceable without multiple additional procedures, longer surviving patients frequently receive revision surgery as with more traditional planned staged procedures.
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Affiliation(s)
- Steven B Cannady
- Department of Otorhinolaryngolgy, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Oren Friedman
- Department of Otorhinolaryngolgy, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ara A Chalian
- Department of Otorhinolaryngolgy, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason G Newman
- Department of Otorhinolaryngolgy, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ted Cook
- Department of Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Mark K Wax
- Department of Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
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Malard O, Lanhouet J, Michel G, Dreno B, Espitalier F, Rio E. Full-thickness nasal defect: place of prosthetic reconstruction. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 132:85-9. [PMID: 25547274 DOI: 10.1016/j.anorl.2014.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 02/14/2014] [Indexed: 11/30/2022]
Abstract
Extensive rhinectomy or full-thickness defects are not uncommon, in particular in the treatment of skin cancer. The present study lays out the principles of choice and creation of prostheses for nasal reconstruction. Prosthetic nasal reconstruction in France depends on a specialist prescription drawn up under the "Ocular and Facial Prostheses" rubric of the official List of Products and Procedures. National health insurance cover is 100% on condition that the prosthesis is produced by an approved prosthetist. The present study describes production stages, forms and means of fixation, and the timeline of implantation. Nasal prosthetic repair is simple, fast and functional, allowing social rehabilitation despite full respect of carcinologic margins, and without ruling out subsequent multilayer reconstruction. Benefits and drawbacks, and the factors determining repair options according to pathologic context are discussed. Nasal prostheses are an integral option in the repair of full-thickness nasal defects and total rhinectomies. The head and neck surgeon needs expertise in indications and techniques of reconstruction, so as to prescribe nasal prostheses as the context demands.
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Affiliation(s)
- O Malard
- Service d'ORL et de chirurgie cervico-faciale, CHU de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France.
| | - J Lanhouet
- Laboratoire Lanhouet-Oculariste, 28, rue Jacques-Prévert, 44200 Nantes, France
| | - G Michel
- Service d'ORL et de chirurgie cervico-faciale, CHU de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - B Dreno
- Service de dermatologie, CHU de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - F Espitalier
- Service d'ORL et de chirurgie cervico-faciale, CHU de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093 Nantes cedex 01, France
| | - E Rio
- Institut de cancérologie de l'Ouest Nantes-Atlantique, 44805 Saint-Herblain, France
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16
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Abstract
Currently, the gold standard for reconstruction after rhinectomy or severe trauma to the nose, includes transposition of autologous mucosal flaps plus autologous cartilage grating and coverage using a skin flap. Difficulties with this approach arise where; cartilage and mucosa harvested from autologous donor sites is insufficient to achieve a passable aesthetic and functional reconstruction. Skin flaps are often bulky, poor color matches with hair follicles that reduce the aesthetic quality of the reconstruction. We suggest that tissue engineering could be a source of functional replacement tissues for nasal reconstructive surgery. However, the advancement of such an approach is dependent on the dissemination of scientific information into the clinical community, regarding the engineering of tissues such as mucosa, skin, and cartilage. This paper therefore reviews how the tissue engineering strategies available for producing clinically viable tissues could help resolve issues around reconstructing the human nose.
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17
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Perrot P, Duteille F. Assessment of subtotal nasal reconstruction in a child after 6 years of follow-up. J Pediatr Surg 2012; 47:E13-5. [PMID: 22813824 DOI: 10.1016/j.jpedsurg.2012.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 02/17/2012] [Accepted: 02/17/2012] [Indexed: 11/24/2022]
Abstract
Nasal amputation in the child is infrequent, and the procedure is not clearly defined. Early reconstruction certainly improves the child's life and social integration. The major risk is unsatisfactory growth of the reconstructed nose, which may persuade some surgeons to postpone the operation. The evaluation of this nasal reconstruction in a 5-year-old boy who had undergone subtotal amputation of the nose after 6 years of follow-up tends to confirm the therapeutic choice of early nasal reconstruction in the child. The results were considered quite satisfactory esthetically and psychologically beneficial and are concordant with those of other studies. Early management allowed us to obtain an esthetically acceptable reconstruction with respect to growth, thereby enabling the child to resume his studies rapidly and to achieve good social integration.
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Affiliation(s)
- Pierre Perrot
- Service de chirurgie plastique et reconstructrice - Centre des brûlés, Hôpital Jean Monnet, CHU de Nantes, 44093 Nantes Cedex 01, France.
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18
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Oseni A, Crowley C, Lowdell M, Birchall M, Butler PE, Seifalian AM. Advancing nasal reconstructive surgery: the application of tissue engineering technology. J Tissue Eng Regen Med 2011; 6:757-68. [PMID: 22095677 DOI: 10.1002/term.487] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 04/20/2011] [Accepted: 07/12/2011] [Indexed: 12/17/2022]
Abstract
Cartilage tissue engineering is a rapidly progressing area of regenerative medicine with advances in cell biology and scaffold engineering constantly being investigated. Many groups are now capable of making neocartilage constructs with some level of morphological, biochemical, and histological likeness to native human cartilage tissues. The application of this useful technology in articular cartilage repair is well described in the literature; however, few studies have evaluated its application in head and neck reconstruction. Although there are many studies on auricular cartilage tissue engineering, there are few studies regarding cartilage tissue engineering for complex nasal reconstruction. This study therefore highlighted the challenges involved with nasal reconstruction, with special focus on nasal cartilage tissue, and examined how advancements made in cartilage tissue engineering research could be applied to improve the clinical outcomes of total nasal reconstructive surgery.
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Affiliation(s)
- Adelola Oseni
- Centre for Nanotechnology and Regenerative Medicine, UCL Division of Surgery and Interventional Sciences, University College London, London, UK
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19
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Abstract
Reconstruction of nasal tip and columella defects is demanding area with a range of reconstructive options, varying in complexity depending on requirements from simple skin grafting to multiple stage reconstruction with regional flaps. A framework is suggested to aid the reader in choice of reconstruction by classifying the defect based on size and the requirements of one to three layer (full thickness) reconstruction.
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20
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Abstract
Microvascular reconstruction of nasal defects is a complex procedure and must consider 3 nasal components: skin, osteocartilaginous framework, and intranasal lining. These layers can be reconstructed with various flaps and grafts. The commonly used flaps are the first dorsal metacarpal flap, dorsalis pedis flap, auricular helical rim flap, and radial forearm and prelaminated flaps. These flaps can be composed of skin and cartilage or skin and bone. The decision is based on the patient's needs taking into consideration the extent of the defect and presence or absence of nasal septum and columella.
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Affiliation(s)
- Marcelo B Antunes
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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21
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Reconstruction of extensive nasal defects with staged bilateral paramedian forehead flaps. Ann Plast Surg 2010; 65:188-92. [PMID: 20606589 DOI: 10.1097/sap.0b013e3181c71429] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reconstruction of near-total and total nasal defects is technically challenging, particularly in patients with an extensive smoking history. One of the keys to a successful esthetic and functional reconstruction is the use of intranasal lining that is reliable and not susceptible to necrosis. Unlike mucosal flaps and skin turn-in flaps with a random blood supply, paramedian forehead flaps have an axial blood supply and are less likely to be adversely affected by a patient's smoking history. In this report, we describe the use of staged bilateral paramedian forehead flaps as an alternative technique for patients with isolated near-total or total nasal defects where local tissue is of insufficient quality or quantity for intranasal flap design. The use of staged bilateral forehead flaps can result in acceptable functional and esthetic outcomes in patients with extensive nasal defects.
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Abstract
PURPOSE OF REVIEW To review recent research and advances in nasal reconstruction over the last 12 months. RECENT FINDINGS Although the major principles of replacing surgically ablated tissues with like tissue and respecting the nasal aesthetic subunits have not changed, recent advances in nasal reconstruction have focused on producing superior aesthetic and functional results, while minimizing deformity and morbidity. Future directions may also include the application of allotransplantation and tissue engineering. SUMMARY A large variety of sophisticated techniques continue to emerge with the goal of producing increasingly natural results for patients undergoing nasal reconstruction.
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