Nasal Obstruction after Mohs Surgery: Prevention and Correction

2020 ◽  
Vol 36 (01) ◽  
pp. 084-090
Author(s):  
Shannon F. Rudy ◽  
Jeffrey S. Moyer
Keyword(s):  
Risk Factors ◽  
Nasal Obstruction ◽  
Nasal Reconstruction ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Plastic And Reconstructive Surgery ◽  
Nasal Anatomy ◽  
Facial Plastic ◽  
The Aesthetic ◽  
Nasal Function

AbstractAs 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.

scholarly journals Mohs Micrographic Surgery Peripheral Margin Control Prior to En Bloc Tumor Resection: A Report of Three Cases

2018 ◽  
Vol 2 (1) ◽  
pp. 49-53
Author(s):  
Daniel Bernstein ◽  
Sara Giddings ◽  
Hooman Khorasani
Keyword(s):  
Plastic Surgery ◽  
Tumor Resection ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
En Bloc ◽  
Facial Plastic Surgery ◽  
Facial Plastic ◽  
Tumor Extirpation ◽  
The Right ◽  
Margin Control

Background: Mohs micrographic surgery (MMS) is an important part of non-melanoma skin cancer (NMSC) management but may even be useful for tumors that cannot be cleared in an office setting.  There are sparse reports of MMS for peripheral margin control in the dermatology literature but various techniques have been reported.Case 1: 58-year-old male with morpheaform basal cell carcinoma of the left midface treated with MMS peripheral margin control followed by facial plastic surgery central tumor extirpation and defect repair.Case 2: 56-year-old female with recurrent morpheaform BCC of the scalp treated with MMS peripheral margin control followed by facial plastic surgery central tumor extirpation and defect repair.Case 3: 73-year-old male with multiply recurrent SCC of the right lower extremity treated with MMS peripheral margin control followed by above the knee amputation.Conclusions:  MMS peripheral margin control followed by central tumor extirpation and defect reconstruction at a later date in the operating room is an option for deeply invasive, large and aggressive NMSC.  Benefits include decreased time under general anesthesia and superior rates of tumor clearance.  In the interim, the peripheral defect between the central tumor and healthy outer tissue can be sutured closed to decrease patient morbidity.

Nasal Anatomy and Function

2017 ◽  
Vol 33 (01) ◽  
pp. 003-008 ◽  
Author(s):  
Ruchin Patel
Keyword(s):  
Complex Structure ◽  
Respiratory Physiology ◽  
Nasal Reconstruction ◽  
Facial Aesthetics ◽  
Basic Understanding ◽  
Nasal Anatomy ◽  
And Function ◽  
Nasal Function ◽  
Nasal Defects

AbstractThe nose is a complex structure important in facial aesthetics and in respiratory physiology. Nasal defects can pose a challenge to reconstructive surgeons who must re-create nasal symmetry while maintaining nasal function. A basic understanding of the underlying nasal anatomy is thus necessary for successful nasal reconstruction.

Narrowing the Wide Tip via Endonasal Approach

2021 ◽  
Author(s):  
Omotara Sulyman ◽  
Steven Dayan
Keyword(s):  
Healing Time ◽  
Open Rhinoplasty ◽  
Endonasal Approach ◽  
Nasal Tip ◽  
Nasal Anatomy ◽  
Facial Plastic ◽  
The Aesthetic ◽  
Contractile Forces ◽  
Tip Rhinoplasty ◽  
Gain Access

AbstractRhinoplasty is arguably the most complex and intricate surgery performed by facial plastic surgeons. Nasal tip refinement of a broad nasal tip has remained the most challenging part of rhinoplasty as sophisticated techniques are critical to achieve aesthetically pleasing and structurally sound nasal tips that can withstand the contractile forces of healing. Successful tip refinement relies on an in-depth preoperative and intraoperative understanding of the patient's nasal anatomy, well developed arsenal of techniques, the experience of the surgeon, and the aesthetic desires of the patient. Although the approach to gain access to the nasal tip so as to successfully reshape the tip has been a topic of debate over many years, the aim of this article is to outline and demonstrate how the broad nasal tip can be successfully recontoured through an endonasal approach using nondestructive techniques that have been effectively used in open rhinoplasty. We believe that there continues to be a place for endonasal tip rhinoplasty especially in this era in which patients desire less invasive procedures with shorter healing time.

scholarly journals Predictive indicators for revisional surgery in nasal reconstruction after Mohs surgery

2020 ◽  
Author(s):  
Tom W. Andrew ◽  
Jennifer J. Garioch ◽  
Penny E. Lovat ◽  
Marc D. Moncrieff
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Skin Cancer ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Revisional Surgery ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Aesthetic Result ◽  
Increased Risk

Abstract Background Reconstruction of nasal lesions is complex due to the topography, mobile free margins and borders of anatomical subunits. Reconstructive challenges can lead to multiple revisional surgeries to achieve the final aesthetic result. This study aimed to evaluate risk factors and predictors of revisional surgery in patients undergoing reconstruction after Mohs micrographic surgery for nasal tumours. Methods This was a prospective cohort study from April 2, 2008 to February 26, 2019. The study population included all consecutive patients who underwent Mohs micrographic surgery for nasal skin cancer. Resection and reconstruction of nasal skin cancer was performed by the Mohs team. Results A total of 988 cases met our study inclusion criteria with 64 (6.5%) cases requiring unplanned surgical revision. Revision rates were highest in the ala (9.0%, p < 0.05) and complex anatomical subunits (16.7%, p < 0.0001). In contrast, revision rates for dorsum lesions were lowest (1.8%, p < 0.001). In terms of reconstructive modalities, local flaps resulted in significantly higher rates of revision when compared to grafts (relative risk, 2.37; 95% CI, 1.15–5.0; p < 0.01). In terms of histological diagnosis, squamous cell carcinoma had significantly higher revision rates when compared to basal cell carcinoma (p < 0.05). Conclusions To our knowledge, this is the first study to report the risk factors and predictors of revision surgery in patients undergoing MMS for nasal tumours. This study highlights that the reconstructive modality utilised affects the functional and cosmetic outcome of MMS. We note that ala complex subunit lesions, squamous cell carcinoma and flap reconstruction were associated with an increased risk of revision after Mohs reconstruction of nasal lesions. Level of evidence: Level III, risk/prognostic; therapeutic study. Trial registration number (Ref: PLA-19-20_A03) 04/02/2020.

Rationale and Argument for Subunit Mohs Excision in Nasal Reconstruction

2016 ◽  
Vol 20 (4) ◽  
pp. 343-345
Author(s):  
Zachary R. Jergensen ◽  
Ronnie A. Pezeshk ◽  
James F. Thornton
Keyword(s):  
Functional Results ◽  
Nasal Reconstruction ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Nasal Ala ◽  
Aesthetic Results ◽  
Nasal Defects

Background: Optimal aesthetic results are achieved when nasal defects after Mohs micrographic surgery (MMS) are reconstructed as entire nasal subunits. Objective: To illustrate the importance of reconstructing the nose in entire subunits and explore the possibilities of expanding the principles of subunit reconstruction to the concept of subunit Mohs excision. Methods: An 83-year-old man presented for MMS to excise 3 lesions on the nasal ala. The surgeons elected to excise and reconstruct the entire subunit. Results: Excellent aesthetic and functional results were obtained. Conclusion: When a defect greater than 50% of a nasal subunit is encountered during MMS, immediate marginal control excision of the entire subunit can be performed with subsequent reconstruction. This technique ultimately has the potential to deliver a more aesthetically pleasing outcome and should be, at the very least, considered by all Mohs surgeons.

scholarly journals Risk Factors and Rate of Recurrence after Mohs Surgery in Basal Cell and Squamous Cell Carcinomas: A Nationwide Prospective Cohort (REGESMOSH, Spanish Registry of Mohs Surgery)

2021 ◽  
Author(s):  
Alejandra Tomás-Velázquez ◽  
Onofre Sanmartin-Jiménez ◽  
JR Garcés ◽  
MA Rodríguez-Prieto ◽  
V Ruiz-Salas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Basal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Basal Cell ◽  
Squamous Cell Carcinomas ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery

Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of prospective cohorts. This study presents the “real-life” results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patient-years for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for basal cell carcinoma (95% confidence interval 1.1–1.5) and 4.5 for squamous cell carcinoma (95% confidence interval 3.3–6.1), being constant over time (0–5 years). In conclusion, follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to squamous cell carcinoma (especially in immunosuppressed patients), elderly patients, non-primary tumours, and those procedures requiring more stages, or unfinished surgeries.

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