Reconstruction of the columella in a pediatric patient

Nasal columella reconstruction - A comprehensive review of the current techniques

The nasal columella is often described as being one of the most difficult nasal subunits to reconstruct. There are a wide range of indications for columella reconstruction, with defects resulting from ischaemic injuries, trauma, tumour resection, vascular malformations and congenital agenesis/dysgenesis of nasal anatomy. There is a variety of columella reconstruction techniques reported in the literature, giving reconstructive surgeons options when approaching different columella defects. Each technique has surgical pearls and pitfalls as well as advantages and disadvantages. This review aims to give reconstructive surgeons a comprehensive review of currently used columella reconstruction techniques.

Reconstruction of the Isolated Columellar Defect: A Novel 2-Stage Technique and Review of the Literature

The importance of the nasal complex cannot be overstated from a functional, social, and psychological perspective. The goal of reconstruction is to restore the trilaminar composition of the nose. This is accomplished by recreating the nasal lining and providing a cartilaginous framework to simultaneously support a patent airway and project the defining features to the overlying soft tissue. The columella is one of the smallest subunits of the nose, but the loss of this structure has important esthetic and structural implications. The ideal operation for an isolated defect of the columella remains elusive. The ideal reconstruction would match the pigmentation and texture of the surrounding nasal skin and provide a convex contour with underlying structural support. In addition, the donor site would not create a secondary deformity by disrupting normal anatomy. This report describes a novel 2-stage technique for reconstruction of the columella and reviews the current literature.

Sublabial approach for columellar reconstruction in corrective rhinoplasty

Columellar reconstruction is a challenging endeavour, both functionally and aesthetically. The aim of this study is to present a novel technique for columellar reconstruction via the sublabial approach. Thirty-two patients (21 men, 11 women, mean age 33.8) with columellar collapse underwent columellar reconstruction via the sublabial approach. Following an upper gingivo-buccal sulcus incision, a tunnel was created through which a cartilage graft, preferably septal, was introduced and fixed. An additional crescent-shaped graft was introduced to secure the fixed graft into position. Average operating time was 35 min for septal grafts, and 55 min for conchal grafts. The mean duration of follow up was 21 months. Postoperative complications included graft absorption in two cases (6.25%), graft extrusions in two cases (6.25%), and postoperative infection in one case (3.12%). These complications were encountered at the beginning of our learning curve. Following technical modifications, these complications were virtually eliminated. Precise control on recipient pocket dimensions, proper graft fixation and avoidance of graft visibility are strongly recommended. In conclusion, columellar reconstruction via the sublabial approach is an anatomic, minimally invasive, time-saving procedure. The operative technique is easy to perform and can be rapidly mastered. It provides structural support, shape, height, and projection to the tip lobule, and the resultant scar is cosmetically superior. It is particularly advantageous in cases of previous septal operations and septal perforation.

The nasal crease sign in segmental facial hemangioma--an early sign of cartilage destruction

Although the majority of hemangiomas of infancy do not require treatment, a subset of patients have complications such as ulceration, functional impairment or severe disfigurement that necessitate intervention. It is often difficult to predict which hemangiomas will lead to permanent disfigurement and medical complications. We present three patients with segmental facial hemangiomas involving the nose which resulted in nasal cartilage destruction. All three patients had a linear gray atrophic crease in the inferior columella visualized on clinical examination prior to the onset of nasal collapse. We propose that this ''nasal crease sign'' in infants with segmental facial hemangioma involving the nose and philtrum may be a premonitory clinical finding of impending nasal cartilage destruction. Dermatologists should be aware of this clinical sign which may help identify patients at high risk of nasal destruction. Unfortunately, aggressive medical intervention may not always prevent devastating disfigurement.

A modification of the transverse forked flap to allow three-dimensional columella reconstruction

The original transverse forked flap is effective in reconstructing the anterior wall of columella in a single stage without leaving a noticeable secondary deformity. A modification was done to allow reconstruction of the lateral walls of columella in addition. This three-dimensional reconstruction will provide enough coverage for a cartilage graft if used. This modification was applied to three patients with columella defects. A costal cartilage graft was used in one of these patients. All flaps survived and donor site scarring was unnoticeable. Elevation of the base of the forked flap allowed using it to reconstruct the anterior wall of columella while sparing the lateral wings to reconstruct the lateral walls of columella.

Reconstruction of the columella with bilateral nostril sill flaps

The treatment of total columellar defects is very difficult, and there is not any first choice in reconstruction of these defects. Various techniques have been reported for this purpose. Each technique has its own drawbacks, and few can be performed in one stage. We report a pediatric patient with a defect involving the entire columella. Reconstruction of the defect was accomplished with laterally based bilateral nostril sill flaps. An acceptable cosmetic result was obtained. This method can be done as a single-stage operation with an excellent color and texture match. We think that this method leads to good aesthetic results, and should be considered for total columellar reconstruction.