Case presentation
A 71-year-old male, with a history of 2 month painful erythematous
lesion in the nasal base and columella, referring to our otolaryngology
clinic with the primary impression of nasal abscess. On examination,
there was a destructive lesion involving nasal columella, septum with
erythematous margins extended to upper lip. Nasal squamous cell
carcinoma was confirmed through a biopsy of the nasal lesions. (Figure
1) The patient underwent resection of the lesion until all margins were
free of tumor based on the histopathologic examination. A large defect
created that involved nasal base, columella, septum, upper two thirds of
upper lip, and philtrum. (Figure 2)Then, patient underwent nasal
reconstruction in two stages. In the first stage, bilateral malar
transposition flaps were planned and elevated to cover both the missed
skin of nose and upper lip. For more support and contour the nasal tip
and columella were shaped by an auricular cartilage graft. On both
sides, The incision involved the inferior orbital rims then the flaps
were elevated over the facial musculature from medial to lateral.
Moreover, further undermined was done laterally to facilitate
advancement. After transposition of both flaps, they were divided to two
portions to cover the columella and nasal tip in superior and the upper
lip in inferior. The superior division of flap made the columella
lateral surface in one side and medial surface in the other side, while,
columella was more supported in middle layer by cartilage graft. The
donor sites were closed directly. (Figure 3) In the second stage, six
weeks later, pedicle release and nasal base restoration was performed.
In the second surgery, pedicle was released on both sides ,then it was
rotated to restore nasal base. After that, the remaining tissue from the
pedicle was excised. (Figure 4, 5)
Also,at the supra tip, a small site of tissue necrosis was detected that
was excised with fusiform incision. Since the histopathology analysis
confirmed there was no tumor recurrence on biopsied tissue, it was
closed primary while supporting with an on lay cartilage graft. All
steps were performed under general anesthesia.