Facial Plast Surg 2020; 36(01): 084-090
DOI: 10.1055/s-0040-1701481
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nasal Obstruction after Mohs Surgery: Prevention and Correction

Shannon F. Rudy
1   Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
,
Jeffrey S. Moyer
1   Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
› Author Affiliations
Further Information

Publication History

Publication Date:
19 March 2020 (online)

Abstract

As rates of Mohs micrographic surgery (MMS) have risen over recent decades in the setting of increased incidence of nonmelanoma skin cancer, so too has the need for post-Mohs reconstruction. The nose is one of the most common sites of post-MMS nasal reconstruction and presents unique challenges that often require expertise in facial plastic and reconstructive surgery. In addition to the aesthetic importance of the nose, preserving nasal function and preventing nasal obstruction are paramount to successful nasal reconstruction. This article will provide a brief review of nasal anatomy, with a focus on particular anatomic risk factors for post-MMS reconstruction nasal obstruction, strategies to prevent nasal obstruction, as well as techniques to correct the problem when it arises.

 
  • References

  • 1 American Cancer Society: Detailed Guide: Skin Cancer: Basal and Squamous Cell. Available at: http://www.cancer.org/Cancer/SkinCancer-BasalandSquamousCell/DetailedGuide/index . Accessed October 2, 2019
  • 2 Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (Keratinocyte Carcinomas) in the U.S. population, 2012. JAMA Dermatol 2015; 151 (10) 1081-1086
  • 3 Kim DP, Kus KJB, Ruiz E. Basal cell carcinoma review. Hematol Oncol Clin North Am 2019; 33 (01) 13-24
  • 4 Casey AS, Kennedy CE, Goldman GD. Mohs micrographic surgery: how ACMS fellowship directors practice. Dermatol Surg 2009; 35 (05) 747-756
  • 5 Berens AM, Akkina SR, Patel SA. Complications in facial Mohs defect reconstruction. Curr Opin Otolaryngol Head Neck Surg 2017; 25 (04) 258-264
  • 6 Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg 1985; 76 (02) 239-247
  • 7 Joseph AW, Truesdale C, Baker SR. Reconstruction of the Nose. Facial Plast Surg Clin North Am 2019; 27 (01) 43-54
  • 8 Apaydin F. Nasal valve surgery. Facial Plast Surg 2011; 27 (02) 179-191
  • 9 Kern EB. Surgical approaches to abnormalities of the nasal valve. Rhinology 1978; 16 (03) 165-189
  • 10 Barrett DM, Casanueva FJ, Cook TA. Management of the nasal valve. Facial Plast Surg Clin North Am 2016; 24 (03) 219-234
  • 11 Baker S. Local Flaps in Facial Reconstruction. Philadelphia, PA: Elsevier Inc.; 2014
  • 12 Robinson JK, Burget GC. Nasal valve malfunction resulting from resection of cancer. Arch Otolaryngol Head Neck Surg 1990; 116 (12) 1419-1424
  • 13 Reynolds MB, Gourdin FW. Nasal valve dysfunction after Mohs surgery for skin cancer of the nose. Dermatol Surg 1998; 24 (09) 1011-1017
  • 14 Woodard CR, Park SS. Reconstruction of nasal defects 1.5 cm or smaller. Arch Facial Plast Surg 2011; 13 (02) 97-102
  • 15 Yong JS, Christophel JJ, Park SS. Repair of intermediate-size nasal defects: a working algorithm. JAMA Otolaryngol Head Neck Surg 2014; 140 (11) 1027-1033
  • 16 Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol 1989; 125 (07) 957-959
  • 17 Yoon T, Benito-Ruiz J, García-Díez E, Serra-Renom JM. Our algorithm for nasal reconstruction. J Plast Reconstr Aesthet Surg 2006; 59 (03) 239-247
  • 18 Park SS. Reconstruction of nasal defects larger than 1.5 centimeters in diameter. Laryngoscope 2000; 110 (08) 1241-1250
  • 19 Little SC, Hughley BB, Park SS. Complications with forehead flaps in nasal reconstruction. Laryngoscope 2009; 119 (06) 1093-1099
  • 20 Zenga J, Chi JJ. Reconstruction of the intranasal lining. Facial Plast Surg 2017; 33 (01) 67-73
  • 21 Cordova A, Di Lorenzo S, Moschella F. “Composite graft”: a simple option for nasal lining. Int J Dermatol 2007; 46 (04) 417-421
  • 22 Teltzrow T, Arens A, Schwipper V. One-stage reconstruction of nasal defects: evaluation of the use of modified auricular composite grafts. Facial Plast Surg 2011; 27 (03) 243-248
  • 23 Menick FJ. The evolution of lining in nasal reconstruction. Clin Plast Surg 2009; 36 (03) 421-441
  • 24 Aksoy F, Veyseller B, Yildirim YS, Acar H, Demirhan H, Ozturan O. Role of nasal muscles in nasal valve collapse. Otolaryngol Head Neck Surg 2010; 142 (03) 365-369
  • 25 Lindsay RW, Bhama P, Hohman M, Hadlock TA. Prospective evaluation of quality-of-life improvement after correction of the alar base in the flaccidly paralyzed face. JAMA Facial Plast Surg 2015; 17 (02) 108-112
  • 26 Facial Nerve Rehabilitation- ClinicalKey. Available at: https://www-clinicalkey-com.proxy.lib.umich.edu/#!/content/playContent/1-s2.0-S1064740616300657?returnurl=null&referrer=null . Accessed November 17, 2019
  • 27 Shindo M. Management of facial nerve paralysis. Otolaryngol Clin North Am 1999; 32 (05) 945-964
  • 28 Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the nasal obstruction symptom evaluation (NOSE) scale1, *1. Otolaryngol Head Neck Surg 2004; 130 (02) 157-163
  • 29 Fung E, Hong P, Moore C, Taylor SM. The effectiveness of modified Cottle maneuver in predicting outcomes in functional rhinoplasty. Plast Surg Int 2014; 2014: 618313
  • 30 Miladi A, McGowan IV JW, Donnelly HB. Two suturing techniques for the prevention and treatment of nasal valve collapse after Mohs micrographic surgery. Dermatol Surg 2017; 43 (03) 407-414
  • 31 Wang JH, Finn D, Cummins DL. Suspension suture technique to prevent nasal valve collapse after Mohs micrographic surgery. Dermatol Surg 2014; 40 (03) 345-347
  • 32 Orseth ML, Nijhawan RI. Managing nasal valve compromise with suspension sutures. Dermatol Surg 2018; 44 (06) 878-881
  • 33 Ezzat WH, Liu SW. Comparative study of functional nasal reconstruction using structural reinforcement. JAMA Facial Plast Surg 2017; 19 (04) 318-322
  • 34 Gruber RP, Park E, Newman J, Berkowitz L, Oneal R. The spreader flap in primary rhinoplasty. Plast Reconstr Surg 2007; 119 (06) 1903-1910
  • 35 Oneal RM, Berkowitz RL. Upper lateral cartilage spreader flaps in rhinoplasty. Aesthet Surg J 1998; 18 (05) 370-371
  • 36 Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997; 99 (04) 943-952 , discussion 953–955
  • 37 Millman B. Alar batten grafting for management of the collapsed nasal valve. Laryngoscope 2002; 112 (03) 574-579