Reconstruction of the distal anatomical parts of the nose — analysis of cosmetic results

Objective . To analyze cosmetic results in reconstruction of defects in the distal anatomical parts of the nose. Materials and methods . The results of 103 reconstructions in patients with acquired defects of the external nose with loss of distal anatomical parts were studied. The evaluation of cosmetic results was performed using a 5-point scale of the NAFEQ (Nasal Appearance and Function Evaluation Questionnaire). Complication rate and assessments in groups with median and lateral localization of the defect (33 and 70 patients, respectively) depending on the method of reconstruction were compared. Results . Complication rate in the reconstruction of median defects (4 cases, 12.1%) and lateral defects (2 cases, 2.9%) did not have a statistically significant difference (Fisher’s exact two-tailed test, p=0.066). With median defects, a decrease in assessment of cosmetic results was more often noted in indications of “nasal tip”, “nasal alar”, and “nasal back”; with lateral defects – “nostril size”, “nasal alar”, “nasal back”. The estimates of the tip and back of the nose were statistically significantly higher after the reconstruction of lateral defects than median ones, p=0.004 and p<0.001, respectively. There was no statistically significant difference between the groups in the estimates of the nasal alar and the nostril size. The indicator “total appearance of the nose” did not have a statistically significant difference in the groups, p=0.129. The results for the indicators “nostrilя size”, “color of the outer nose”, “total appearance of the nose” were statistically significantly higher when using a puzzle flap compared with alternative methods. The estimates of the “nasal tip” index were statistically significantly higher following reconstruction with a frontal flap compared with nasal flaps. Conclusion . The complication rate in the reconstruction of the distal subunits of the nose was 5.8% and had no difference in the median and lateral localizations of the defect. Cosmetic results differed when assessed by individual measures. The assessment of the total appearance of the nose had no significant difference in the median and lateral localizations of the defect. The use of a puzzle flap and a forehead flap presented better results for the particular subunits.