External Nose Reconstruction After Total Extended Rhinectomy: Case Review
This case-based lecture presents a complex reconstructive pathway after total extended rhinectomy for an advanced recurrent basal cell carcinoma of the nose.
The speaker walks through the full clinical logic of the case: a 72-year-old comorbid patient with a long history of basal cell carcinoma, prior radiation treatment, repeated recurrence, full-thickness involvement of the external nose, extension to the septum, upper lip, and right cheek, and the need to prioritize oncologic radicality before functional and aesthetic reconstruction.
The video focuses on practical surgical decision-making: why R0 margins were central to the treatment plan, why previously performed radiotherapy limited further non-surgical options, how the multidisciplinary discussion shaped management, and how the patient’s preference for reconstruction with autologous tissues influenced the operative strategy.
Step by step, the lecture reviews the main stages of treatment: total extended rhinectomy, reconstruction of the nasal aperture with bilateral cheek-temporal advancement/rotation flaps, temporary skin grafting, later aperture widening and scar correction, radial forearm free flap for internal nasal lining, formation of future nostrils with silicone splints, paramedian forehead flap for external nasal coverage, division of the flap pedicle, upper lip correction, ectropion repair with lateral tarsal strip, and Z-plasty to improve nostril patency.
A particularly valuable part of the session is the honest analysis of what worked and what did not. The speaker discusses the absence of a cartilage framework, the impact of patient refusal on further aesthetic reconstruction, the need for stronger reconstructive teams and two-team approaches, the challenges of flap monitoring, and the long-term nature of such reconstructive projects.
The discussion section adds practical nuance: questions address hydrodissection during local flap elevation, methods of assessing radicality when Mohs surgery is unavailable, the rationale for choosing local cheek flaps before free flap reconstruction, and the possible role of postoperative CT assessment of the paranasal sinuses.
This is a high-yield case review for learners interested in oncologic reconstruction of the head and neck, free flap planning, staged nasal reconstruction, and the real-world compromises that shape complex surgical care.
The speaker walks through the full clinical logic of the case: a 72-year-old comorbid patient with a long history of basal cell carcinoma, prior radiation treatment, repeated recurrence, full-thickness involvement of the external nose, extension to the septum, upper lip, and right cheek, and the need to prioritize oncologic radicality before functional and aesthetic reconstruction.
The video focuses on practical surgical decision-making: why R0 margins were central to the treatment plan, why previously performed radiotherapy limited further non-surgical options, how the multidisciplinary discussion shaped management, and how the patient’s preference for reconstruction with autologous tissues influenced the operative strategy.
Step by step, the lecture reviews the main stages of treatment: total extended rhinectomy, reconstruction of the nasal aperture with bilateral cheek-temporal advancement/rotation flaps, temporary skin grafting, later aperture widening and scar correction, radial forearm free flap for internal nasal lining, formation of future nostrils with silicone splints, paramedian forehead flap for external nasal coverage, division of the flap pedicle, upper lip correction, ectropion repair with lateral tarsal strip, and Z-plasty to improve nostril patency.
A particularly valuable part of the session is the honest analysis of what worked and what did not. The speaker discusses the absence of a cartilage framework, the impact of patient refusal on further aesthetic reconstruction, the need for stronger reconstructive teams and two-team approaches, the challenges of flap monitoring, and the long-term nature of such reconstructive projects.
The discussion section adds practical nuance: questions address hydrodissection during local flap elevation, methods of assessing radicality when Mohs surgery is unavailable, the rationale for choosing local cheek flaps before free flap reconstruction, and the possible role of postoperative CT assessment of the paranasal sinuses.
This is a high-yield case review for learners interested in oncologic reconstruction of the head and neck, free flap planning, staged nasal reconstruction, and the real-world compromises that shape complex surgical care.