Nasal reconstruction

Reconstruction of nasal skin is one of the earliest recorded procedures of what is now referred to as the discipline of reconstructive plastic surgery. In the ancient Hindu Sanskrit text, ‘Sushruta Samhita’ (600–700 bc) the forehead rhinoplasty is described and later the Italian surgeon Tagliacozzi (1597) performed nasal reconstruction with skin pedicled from the upper arm. These early procedures treated the defects left by the ancient punishment of nasal amputation. Sir Harold Gillies and colleagues reinvigorated the art of plastic surgery after the First World War and provided the sound principles of reconstruction that are followed to this day. In more modern times, the refinement of this surgical technique has advanced considerably due to the work and publications of Dr Gary Burget and Dr Frederick Menick. They have greatly flattened the learning curve and finesse of the paramedian forehead flap and associated procedures.

The Paramedian Forehead Flap: A Retrospective Clinical Model for Understanding the Connection Between Supraorbital and Supratrochlear Nerve Pathology and Headaches

Background: In the later stages of a paramedian forehead flap (PMFF) surgery, the supratrochlear (STN) and branches of the supraorbital nerve (SON) are transected during flap inset above the supraorbital rim. This can lead to either a nerve release if the compression point was previously distal to the transection point or a new nerve compression through neuroma or scar tissue formation. We inferred that PMFF could be a model for understanding the correlation between STN/SON pathology and migraines headaches (MH). We hypothesized that patients undergoing PMFF would experience either a change in severity or an onset of a new headache (HA) or MH. Methods: One hundred ninety-nine patients who underwent a PMFF at a tertiary medical centre were identified and contacted by phone. Patients were asked about the presence of MH or HA before and after the procedure. If a patient reported a perioperative history of MH/HA, their pre- and postoperative MH/HA characteristics were recorded. Results: Of the 199 patients contacted, 74 reported no perioperative HA/MH history and 14 reported a perioperative history of HA/MH. Of these 14 patients, 5 had stable HA/MH pre- and post-surgery, and 9 reported a change in HA/MH post-surgery. In this subset of 9 patients, 3 reported change in HA/MH quality post-surgery, 1 reported HA/MH resolution post-surgery, and 5 reported new onset HA/MH post-surgery. Conclusion: Sixty-four percent of patients with perioperative HA/MH experienced a change in headache quality following surgery. These results suggest a potential connection between SON and STN pathology and HA/MH pathophysiology; further work is warranted.