Subj: Re: reconstructon of nasal defect
Good AM/PM!
Dear sir'
We have 16 y.o male who developed full-thickness loss of the nasal dome due to infection. This happened when he was still 1 y.o. Now it is already healed but left a cicatricial contrature aside from the absence of the nasal dome. What surgical techinque can you recomend for him? Thank you very much. I'll highly appreciate your idea.
RG,M.D.
Dr. Bermant responds:
This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.
There are many types of surgical defects and many more ways to rebuild them. I would have to examine the nose and feel what is left to render an effective opinion. Many nasal tips can be rebuilt with forehead tissue.
In general I like to offer an initial reconstruction to facilitate breathing through the nose and minimize the worse part of the deformity. Other kids can be devastating to a child's development. This first stage is usually before the age of socialization. If the type reconstruction is such that it will grow with the patient, we would be lucky. Most reconstruction if it grows asymmetrically such that some correction is usually necessary once the nose reaches its full size.
If reconstructive options are limited then a prosthesis can ease the deformity until reconstruction can be done.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Subj: Re: Nose Reconstruction
Dear Sir
My father in law has recently had his nose removed in the academic hostpital in Leiden, Holland. Before the operation, they did not even tell him they were going to take all of his nose away. The he thought he could get a "new" nose after an operation but the had t o find out that the doctors want to replace his nose with an artificial nose. A nose he has to take off before he goes to sleep. Probably it will be attached to his glasses, or else with some kind of glue. We are not happy with this. But the doctors here tell us that there is no other possibility and that this "removable nose" is all he can get. Dissatisfied as I was with that answer, i started searching the Internet for better possibilities. And got to your site. Can you help?
Regards
R M
The Netherlands
Dr. Bermant responds:
This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.
Sometimes an artificial nose is the best method for a particular patient. Nasal reconstruction has been done for many years and for the right patient can produce an acceptable nose. Some reconstructed noses can look very good, check out the patient with the forehead flap reconstruction from my website. The same technique can be used for a larger defect. Some nasal defects also include parts of the orbit, eyelids and cheek that require larger reconstructions or are beyond reasonable tissue techniques.
Factors that make nasal reconstruction difficult or impossible include:
- poor medical condition
- residual tumor (disease that could not be removed)
- poor scars
- poor donor sites (where the flap would come from)
- poor cooperation
There are many competent surgeons who could reconstruct a nose. The best way to find out if a patient is a reasonable candidate is for an examination and evaluation. Ask your doctors why the prosthetic nose is the only option in their opinion. There may be a very good reason they said no.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
