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Columellar reconstruction: a refinement of technique.

Rotem Tzur1, Alexander Bogdanov Berezovsky1, Yuval Krieger1

  • 1Division of Plastic and Reconstructive Surgery, Soroka University Medical Center, Ben- Gurion University of the Negev, Beer-Sheva, Israel.

Archives of Craniofacial Surgery
|July 13, 2018
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Summary

Reconstructing the columella, the facial structure between nostrils, presents challenges. A novel technique using perialar/nasocheek flaps and cartilage grafts offers a successful single-stage solution for complex defects, yielding excellent aesthetic outcomes.

Keywords:
Columella reconstructionColumella resectionNose reconstruction

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Area of Science:

  • Plastic Surgery
  • Facial Reconstruction
  • Oncologic Surgery

Background:

  • The columella, a key nasal subunit, is crucial for nasal tip support and aesthetics.
  • Columellar defects, often resulting from oncologic resection, are complex to reconstruct due to anatomical challenges.
  • Limited vascularity and adjacent tissue availability complicate reconstruction efforts.

Purpose of the Study:

  • To present a novel surgical technique for reconstructing columellar, septal, and upper lip defects.
  • To evaluate the aesthetic and functional outcomes of this single-stage reconstruction method.

Main Methods:

  • Utilized a modified Webster perialar/nasocheek advancement for lip reconstruction.
  • Employed discarded perialar/nasocheek tissue as inferiorly based skin flaps for columellar and septal reconstruction.
  • Incorporated a rib cartilage graft as a columellar strut for structural support.

Main Results:

  • Achieved successful reconstruction of columellar, membranous septum, and upper lip defects in one stage.
  • Demonstrated good nasal contour and projection at 1-year follow-up.
  • Observed subtle scarring of the columella, indicating favorable aesthetic results.

Conclusions:

  • This technique offers a versatile and effective approach for single-stage reconstruction of extensive central facial defects involving the columella.
  • The method provides satisfactory aesthetic outcomes with minimal patient morbidity.
  • The use of perialar/nasocheek flaps and cartilage grafts represents a valuable addition to reconstructive surgery armamentarium.