Reconstruction of the nasal alar may be challenging due to the complex nature of multiple cosmetic units and functional considerations, including maintenance of valvular competency. Reconstructive options include various flaps or graft repairs, depending on the subunit involvement and the size of the defect. Linear closures may be suitable for small defects, while bilobed flaps, melolabial flaps, and forehead flaps may be considered for moderate to large defects involving partial and full-thickness defects of the ala.
Congenital Abnormalities* ; Forehead ; Transplants

Eighty-three cases with severe blepharoptosis were treated by the superiorly based muscle flaps around eye including orbicularis oculi muscle, frontalis muscle, levator muscle. The selection of the muscle flaps were done in accordance with the levator function of patients. The orbicularis oculi muscle flap technique in 32 patients who have 2-5 mm levator function, 21 cases of the interdigitated orbicularis oculi-frontalis muscle flap for 1-3 mm levator function, frontalis muscle flap technique for less than 2 mm levator function, 22 cases of levator muscle resection for 2-8 mm levator function, 7 cases of levator plication for 5-9 mm levator function. The majority of patients recorded as satisfactory results. There has been no complete failure but there were 14 cases of undercorrection, 4 cases of overcorrection, 2 cases of exposure keratitis, 3 cases of corneal erosion, 2 cases of sensory loss, hematoma loss of wrinkle and a few cases of eyelid deformity such as notching, entropion, fading or unnatural fold. The orbicularis oculi muscle technique or the interdigitated orbicularis oculi-frontalis muscle flap technique offers several advantages over conventional frontalis muscle flap technique such as being a simple with a good operative field, single incision or supratarsal fold, no depression on the forehead, no risk of neurovascular injury and relatively easy technique with less complication. The levator resection or levator plication could offer good results by careful selection of patients. In conclusion, we would like to say that the interdigitated frontalis orbicularis oculi muscle flap technique is best in cases with less than 2 mm levator function, orbicularis oculi muscle flap technique in 2-4 mm levator function, levator resection in 4-8 mm levator function, levator plication in more that 8 mm levator function.
Blepharoptosis* ; Congenital Abnormalities ; Depression ; Entropion ; Eyelids ; Forehead ; Hematoma ; Humans ; Keratitis

Binder syndrome is a rare maxillofacial abnormality. Yet, once presented, it often needs to be addressed surgically. To suit this purpose, various surgical techniques have been developed. This paper is a case report of a staged nasal reconstruction in a Binder syndrome patient using rib bone and cartilage graft and forehead flap. At the same time, preoperative and postoperative anthropomorphometric measurements were compared to assess the efficiency of the proposed surgical technique.
Cartilage* ; Forehead* ; Humans ; Maxillofacial Abnormalities ; Nose ; Ribs* ; Transplants*

Cochlear Implantation ; Cochlear Implants ; Forehead/abnormalities* ; Humans ; Mutation ; Osteochondrodysplasias/genetics*

The nose, salient part in the face, is more vulnerable to injury and its minor defect or deformity is highly perceptible. It is thus essential to establish the certain rules for reconstruction. Gonzalles Ulloa mentioned 5 aesthetic nasal subunits, which are nasal dorsum, nasal tip, lateral portion, alar portion and soft triangle. However, the authors insist on the importance of the columella and nasal floor as well as other nasal subunits, considering the nasal reconstruction in structural and functional aspects. Authors' study was based on the aesthetical nasal subunits considering the in-depth knowledge of anatomical and functional aspects of each unit as an individual. Reconstruction of the proximal 2/3 portion of the nose having thin, soft and mobile skin over the osteochondral framework with sparse distribution of the sebaceous glands can be done with skin graft, nasolabial flap, and median forehead flap and lateral wall defect can be repaired by nasolabial flap or glabellar flap. Reconstruction of the distal 1/3 portion of the nose is rather difficult due to its thick, sebaceous skin that is characterized by firm and dense cartilaginous attachment, which makes it more harder to handle especially when it comes to the alar portion. Therefore, composite graft for the small defect and nasolabial flap or median forehead flap for on the larger defect can be used. However, when defect is located on the nasal tip, it results in tremendous spoiling of the whole facial harmony even with a tiny defect so that replantation, composite graft or median forehead flap has been used for the reconstruction. Reconstruction of the columellar defect is considered more complicated and V - Y advancement flap, bilateral nasolabial flap, and composite graft have been utilized.Nasal deformity or defect was reconstructed based on 7 aesthetical nasal subunits; by further dividing the nasal units, in terms of adding 2 more subunits, columella and nasal base, aesthetically and functionally acceptable and advantageous results were deduced with less contractures and scars. Current trends of nasal reconstruction are based on the concepts of aesthetic nasal subnunits or units in which modification was added in some extent. The most important factors that contribute to the later results are evaluation of the depth and color of the deformed or defected area according to the aesthetic nasal subunits whether it is congenital or acquired. Various reconstruction methods of the nose can be utilized based on the size, depth and location of the defects where it can be reconstructed as a unit. Columella and nasal base were newly added in concepts of subdivision from the previously established nasal subunits to produce more detailed, precise and favorable result. Also, nasal reconstruction should be carefully carried out considering the importance of the psychological, social and functional influences of the nasal deformity.
Cicatrix ; Congenital Abnormalities* ; Contracture ; Forehead ; Nose ; Replantation ; Sebaceous Glands ; Skin ; Transplants

BACKGROUND: The skin over the nose is not relatively less mobile for primary closure of nasal defects. In addition to skin grafts and secondary intention healing, there are various local flap techniques available for the reconstruction of nasal defects. OBJECTIVE: The aim of this study was to assess the effectiveness and the cosmetic consequences of various local flap techniques in reconstructing nasal defects. METHODS: Between December 2002 and April 2004, 18 patients were treated with a local flap technique for the reconstruction of a nasal skin defect following Mohs micrographic surgery. The post-operative result of each case was rated with serial clinical photographs and medical records by two independent physicians. RESULTS: The nasal skin defects were reconstructed with various local flaps, such as the nasolabial interpolation flap, bilobed flap, glabellar flap, median forehead flap, and subcutaneous island pedicle flap. The cosmetic and functional results of the nasal reconstructions were judged to be generally satisfactory, excluding a trapdoor deformity in one patient, and eyebrow distortion and cancer recurrence in another patient. The cosmetic results of the cases reconstructed with a subcutaneous island pedicle flap were favorable in color and texture of the flaps, and incision scar formation, compared to the other techniques used. CONCLUSION: There are various local flap techniques which can be used in the reconstruction of nasal defects, and each of them has its own merits and drawbacks. The reconstructive plan should be customized to the patient considering not only the size, depth and location of the defect but also the medical history of the patient, the patients expectations, and the surgeons experience. Reconstruction with a subcutaneous island pedicle flap has been found to be one of the most effective methods, and allows the surgeon to spend a relatively short time in reconstructing defects of the upper and lower part of the nose. Furthermore, it has many advantages over the skin graft and other local flap techniques, especially with the aesthetic result.
Cicatrix ; Congenital Abnormalities ; Eyebrows ; Forehead ; Humans ; Intention ; Medical Records ; Mohs Surgery ; Nose ; Recurrence ; Skin ; Transplants

Reconstruction of total nasal defect is limited in methods, but in cases of partial nasal defect, various methods can be adapted according to the size, shape and location. The authors tried to summarize the relationship between the etiology, location, size of partial nasal defect and reconstructive methods. The authors experienced 27 patients of partial nasal defect for the recent 3 years, male patients were 13 and female patients were 14 among them. The age of the patients ranged from 27 to 78. Malignant skin tumor was the most common among the causes of the defect: 16 cases of basal cell carcinoma, 4 cases of squamous cell carcinoma. The locations of the defect can be summarized as 8 cases of nasal alar area, 8 cases of nasal tip area, 6 cases of nasal side wall and 5 cases of nasal dorsum. As reconstructive methods, the authors used median forehead flap in 7 cases, dorsal nasal flap in 6 cases, full thickness skin graft in 5 cases, bilobed local flap in 3 cases, nasolabial flap in 3 cases, and other local flap in 3 cases. Skin graft is an easy method for the shallow defect, but its major disadvantage is color mismatch with adjacent skin. In cases of flap surgery, though it often causes deformity in contour, appropriate reconstruction was possible with through preoperative evaluation. According to our survey, local flap such as bilobed flap was enough for the defect of small size, and in cases moderate to large sized defect, nasolabial flap was appropriate for defect in nasal tip area, dorsal nasal flap was good for the defect in nasal dorsum and median forehead flap was useful for the defect in nasal side wall. The authors presents our comparative results of the 27 cases of partial nasal defect for the recent 3 years with the hope of being contributed in choosing the reconsfructive methods in the future.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Congenital Abnormalities ; Female ; Forehead ; Hope ; Humans ; Male ; Nose* ; Skin ; Transplants

BACKGROUND: Burow's graft is a useful full-thickness skin graft that employs the adjacent lax skin as a donor site and this is especially suitable for the facial region. When reconstructing a facial cutaneous surgical defect, we have to consider the facial cosmetic unit together with various other factors. OBJECTIVE: The aim of this study was to assess the feasibility of using a Burow's graft by dermatologists and the cosmetic outcomes of Burow's graft for reconstructing facial defects, based on different facial cosmetic units. METHODS: From August 2005 to February 2007, 26 patients were treated with the Burow's graft technique for the reconstruction of facial cutaneous defects following Mohs micrographic surgery. According to the facial cosmetic unit, we divided the face into the forehead, periorbital area, nose, cheek and chin, and we redistributed the cases by the cosmetic units. The post-operative result of each case was rated with using serial clinical photographs that were taken at 1, 6 and 12 months, and the patient's charts were reviewed by two independent physicians. RESULTS: The cosmetic results of facial reconstructions by using Burow's graft were satisfactory, regardless of the cosmetic unit. 21 cases out of the 26 cases (81%) showed good to excellent results after 6 months. The early cosmetic consequence of the periorbital region was better than those of the other facial cosmetic units. No side effects were reported other than a trapdoor deformity in three cases. CONCLUSION: Burow's graft can be a good choice for reconstruction of facial cutaneous defects after skin cancer surgery in all the facial cosmetic units.
Cheek ; Chin ; Congenital Abnormalities ; Cosmetics ; Forehead ; Humans ; Mohs Surgery ; Nose ; Skin ; Skin Neoplasms ; Tissue Donors ; Transplants

BACKGROUND: Burow's graft is a useful full-thickness skin graft that employs the adjacent lax skin as a donor site and this is especially suitable for the facial region. When reconstructing a facial cutaneous surgical defect, we have to consider the facial cosmetic unit together with various other factors. OBJECTIVE: The aim of this study was to assess the feasibility of using a Burow's graft by dermatologists and the cosmetic outcomes of Burow's graft for reconstructing facial defects, based on different facial cosmetic units. METHODS: From August 2005 to February 2007, 26 patients were treated with the Burow's graft technique for the reconstruction of facial cutaneous defects following Mohs micrographic surgery. According to the facial cosmetic unit, we divided the face into the forehead, periorbital area, nose, cheek and chin, and we redistributed the cases by the cosmetic units. The post-operative result of each case was rated with using serial clinical photographs that were taken at 1, 6 and 12 months, and the patient's charts were reviewed by two independent physicians. RESULTS: The cosmetic results of facial reconstructions by using Burow's graft were satisfactory, regardless of the cosmetic unit. 21 cases out of the 26 cases (81%) showed good to excellent results after 6 months. The early cosmetic consequence of the periorbital region was better than those of the other facial cosmetic units. No side effects were reported other than a trapdoor deformity in three cases. CONCLUSION: Burow's graft can be a good choice for reconstruction of facial cutaneous defects after skin cancer surgery in all the facial cosmetic units.
Cheek ; Chin ; Congenital Abnormalities ; Cosmetics ; Forehead ; Humans ; Mohs Surgery ; Nose ; Skin ; Skin Neoplasms ; Tissue Donors ; Transplants

PURPOSE: The purpose of this study is to develop hydroxyapatite cement simplified procedures for reconstruction of craniofacial deformities. Due to its expense and characteristics of quick hardening time, it may be inappropriate for forehead reconstruction or augmentation. Therefore we hear by introduce a more precise, easy and cheap method. The authors report forehead reconstruction with hydroxyapatite cement for a patient who suffered from craniofacial deformity. METHODS: Case report and literature review. RESULTS: A 35 year old man came to us with forehead and temporal area depression. He had a history of brain operations due to traumatic epidural hematoma. A physical exam showed an evidence of right side forehead weakness sign. Authors made RP model of his skull and applied check framework with Kirschner's wires for measuring accurate volume and contour on the depressed right side forehead area on the RP model. After complete exposure of defect area by bicoronary insicion, absorbable plate which applied on skull area was removed. Using three Kirschner's wires, authors made check framework on the right forehead lively and fixed with 2-hole miniplates on the boundary of the defect. After checking asymmetry, hydroxyapatite was applied on check shape framework just above Kirschner's wire. After removing Kirschner's wire, we corrected minimal unbalance and contour with bur. CONCLUSION: Check framework with Kirschner's wire was very convenient and cost saving methods for forehead reconstruction with hydroxyapatite cement.
Brain ; Congenital Abnormalities ; Cost Savings ; Depression ; Durapatite ; Forehead ; Hematoma ; Humans ; Hydroxyapatites ; Porphyrins ; Skull