External Nose Reconstruction After Oncological Resection.


HLOŽKOVÁ Tereza STUPKA Igor GÁL Břetislav

Rok publikování 2019
Druh Další prezentace na konferencích
Fakulta / Pracoviště MU

Lékařská fakulta

Popis Introduction: Spinocellular carcinoma of the skin is invasive tumor destroying surrounding tissues (cartilage, bone) and evolving lymphatic metastases. The treatment of choice is radical surgery eventuelly with radiotherapy. Postoperative radiotherapy is indicated in case of positive margin or perineural and perivascular invasion. Further indications of the above is the bone, cartilage and deep muscle involvement and lymphatic metastasis. External nose is a basic physiognomic element of the human face. If a tumor resection is necessary, the flap reconstruction follows. For the choice of flap is important to think of cosmetic and functional aspect. The flap choice is determinated by extent and place of the tumor, spreading to individual layers of the nose – nasal mucosa, skeleton and skin coverage. Objective: The aim was to evaluate the oncological, functional and esthetic state of two patients who underwent resection of external nose for a malignant tumor with a different flap reconstrucion. Methods: Both patients underwent clinical and rinoendoscopic examination and histologic verification. Moderately differentiated squamous cell carcinoma of external nose was confirmed in both cases. CT scan with contrast determinated the extent to surrounding tissues and size of lymphonodes. Oncostaging excluded distant metastases. The first patient underwent a subtotal nasal ablation for tumor of the left nasal wing and nasal tip. Postoperative defect was covered by a rotational frontal (Indian) skin flap. Alar cartilages were reconstructed from the pinna and inner nasal mucosa covered by Tirsch flap from left tight, similarly like a donor side. Elective neck disection (I-III.) was performed on the left side. Peroperative lymphonode´s biopsy on the other side was negative. Histology confirmed moderately differentiated squamous cell carcinoma without cartilage invasion. The neck dissection specimen was clear from metastases. Postoperative radiotherapy was not indicated by Multidisciplinary Oncology Team. The second patient underwent resection of nasal septum, columella and part of upper lip, which was affected by tumor. Reconstruction by rotational lateral (nasolabial) cheek flap was provided. Donor side was directly sutured without using Tirsch flap. The surgical procedure included an ipsilateral elective neck dissection (I-III). It was clear from metastases. Adjuvant radiotherapy was indicated due to nasal septum cartilage invasion. Results and conclusion: The patients are regularly followed up by ENT with no evidence of the disease. Functional and cosmetic results are satisfactory. Rotational frontal (Indian) skin flap and lateral cheek (nasolabial) flap seem to be favorable choice for reconstruction of external nose after oncological ablation.

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