Total Nasal Reconstruction in Albinos following Tumour Extirpation using the Paramedian Forehead Flap

Abstract

Background: The nose is one of the most prominent aesthetic structures of the face. Due to its exposure to sunlight in albinos, it is prone to malignancy. Following tumour excision, reconstruction of the various components can be challenging. The Paramedian forehead flap has been a work horse for total and near total defects. This objective of this study was to showcase reconstruction of two cases of nasal defects from tumour excision in albinos.

Methods: This is a case report of two patients treated for total nasal defects following tumour excision. Following tumour excision (using Moh’s micrographic technique). The defects created were near complete excision with the alar sub-unit spared in one patient. The defects were reconstructed with paramedian fore head pedicle flap. The reconstructions were in three stages. Firstly, was the paramedian pedicle forehead flap was designed and raised. Autologous costal cartilage was harvested and inserted for support.  A superiorly based hinged flap was raised from the residual septum. This was used as the inner lining of the right nostril. Second stage involved division of the flap and in setting. The last stage was Rhinoplasty, done to project the tip to patient’s satisfaction as well as revision of the columella, and the nasal septum.

Results: There was flattened nasal tip in one of the patients. Revision rhinoplasty was done and both patients were satisfied with the outcome.

Conclusion: The use of Paramedian fore head flap in these patients provided good tissue for nasal reconstruction. Autologous cartilaginous support and lining with proximally based hinged mucosal flap from the residual nasal septum gave a good outcome.