Defects of the nasal dorsum or sidewall can result from trauma, congenital lesions, extirpation of neoplasms, or iatrogenic injuries. Simple techniques are often used to reconstruct defects in this area with excellent outcomes. Complex defects require more sophisticated techniques including multilayer closures using pedicled flaps or free tissue transfer. This review discusses key anatomic and functional principles and techniques to assist in planning for reconstruction of nasal dorsum and sidewall defects from any cause.
Nasal dorsal and sidewall defects are often considered the least complex for nasal reconstruction. Defects in these regions may be repaired with simple techniques to produce excellent results. However, more complex defects, including full-thickness defects and those involving adjacent tissues such as the medial canthus, require thoughtful analysis and planning. Nasal defects should be analyzed with consideration of both aesthetic and functional concerns. Optimal reconstructive plans incorporate the concept of replacing like with like and strategic scar placement. Characteristics unique to the dorsum and nasal sidewall include the transitioning thickness of skin and soft tissues from the nasal dorsum to cheek, the close proximity to adjacent facial units (medial canthus, eye, cheek, and forehead) and the osseocartilaginous junction located in this region. Simple defects can be repaired with direct advancement of adjacent tissue, local flaps, or skin grafts to achieve acceptable results in this region. More complex defects may require transposition flap, interpolated flaps, or even free tissue transfer. This article addresses the multiple issues that must be considered for nasal dorsal and sidewall defect reconstruction.
Anatomy
Successful nasal reconstruction requires a thorough understanding of nasal anatomy, function, and cause of the defect being corrected. The nose functions to allow airflow and provide humidification and filtration of inspired air. The nose is a prominent facial feature and is integral to facial cosmesis, as it provides balance to the face because of its central location in both horizontal and vertical dimensions. The nose is divided into 3 layers, the mucosal lining, the osseocartilaginous framework, and the skin and soft-tissue coverage. Its surface is characterized by concave and convex curves and is divided into nasal subunits. The boundaries of the nose are the glabella superiorly, the nasofacial sulcus laterally as it transitions to the cheek, and the nasal vestibule and columella inferiorly. The nose is divided into 9 subunits: 3 unilateral structures (the dorsum, tip, columella) and 6 bilateral structures (the sidewalls, ala, and soft-tissue triangles) ( Fig. 1 ).
