Combined Techniques for Bilateral Maxillary and Nasal Reconstruction After Ablative Surgery for Adenoid Cystic Carcinoma

Indolent tumor growth up to large tumor masses and broad infiltration of surrounding tissue are the most typical characteristics of malignant tumors of the nasal cavity and paranasal sinuses. If surgery is a therapeutic option, extended resections and complex reconstruction modalities have to be taken into account. We present a combination of different reconstruction techniques to restore midface integrity after bilateral maxillectomy, including parts of the nasal skeleton, for adenoid cystic carcinoma. After obtaining tumor-free margins, reconstruction was performed using a microvascular double-flap technique to achieve a neo-maxilla and soft tissue lining of the oral cavity, dental implantology with prosthetic restoration and the insertion of a patient-specific implant for nasal re-shaping and stability. In cases of extended maxillary resection, a combination of different techniques can achieve sufficient functional and aesthetic rehabilitation, and restore quality of life. Further studies are warranted to evaluate the long-term stability of such complex reconstructions. However, local tumor control remains the highest priority and will be essential for years.

A Case Report on Lateral Proboscis: A Rare Congenital Anomaly

Lateral proboscis is a rare congenital condition characterized by a cylindrical protuberance on the nasofrontal region accompanied by abnormal nasal development on the affected side. We aimed to describe the management of the lateral proboscis in staged repair. A 7-year-old girl came with a tube-like projection on the left medial canthal region and nasal agenesis on the ipsilateral side. She was diagnosed with lateral proboscis, left microphthalmia, lower eye lid coloboma, and asymmetry in the orbital region. The patient has undergone 3 major surgeries at our institution. The first surgery involved the deconstruction of the tube to form the left nasal body and nostril. The second operation involved trimming of the new nose form and the excision of the bony protrusion directly beneath the base of the pedicle through bifrontal craniotomy. The remaining bone defect was closed using a pericranial flap. The orbital floor was reconstructed using titanium mesh. The third operation involved nasal reconstruction using a costal cartilage graft to create a dorsal nasal and alar framework. The patient healed with no complications, had become less reserved and her grades improved significantly after the operation. Further appointments are being scheduled to evaluate growth distortion and the resulting facial asymmetry. Surgical correction will be planned thereafter to further reconstruct the facial features. Evaluation of patient is necessary to explore possible clinical outcomes and corresponding treatment options. Multidisciplinary management is highly recommended, involving plastic surgeons, neurosurgeons, ophthalmologists, pediatricians, and pediatric psychiatrists in order to improve patient's quality of life.