Aesthetic and Functional Evaluation of Total Nasal Reconstructions

  • Luigi Angelo Vaira
  • Olindo Massarelli
  • Giovanna Deiana
  • Silvio Mario Meloni
  • Giovanni Dell’aversana Orabona
  • Pasquale Piombino
  • Giacomo De Riu
Original Article


The loss of a portion or the totality of the nose has great relevance on the perception of the beauty of a face and can result in a catastrophic quality of life impairment. Several surgical techniques are currently available for the reconstruction of the nasal pyramid. However, there are very few nasal reconstruction quality evaluation protocols that allow the surgeon to choose objectively the best technique for each kind of defects. Six total nasal reconstruction performed in University of Sassari Maxillofacial Unit were evaluated with a protocol that investigate objectively and subjectively the surgical aesthetic and functional outcome. Sensitivity recovery on the reconstructive flaps was also assessed. Patients reported a satisfactory nasal reconstruction both functionally and aesthetically. Sensitivity recovery on the forehead flap was always present even after pedicle resection or in case of traumatic section of the infraorbital nerve. The use of a three layer reconstruction has proved a viable technique both aesthetically and functionally. In particular the use of the forehead flap to reconstruct the outer layer of the nose allows to carry a tissue with very similar characteristics to the original with a recovery of the sensitivity almost complete.


Nasal reconstruction Nasal reconstruction evaluation Forehead flap Aesthetic nasal evaluation Functional nasal evaluation 


Compliance with Ethical Standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study is approved by University of Sassari Ethical committee.

Informed consent

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.


  1. 1.
    Gillies H, Millard DR (1957) The principles and art of plastic surgery. Little, Brown, BostonGoogle Scholar
  2. 2.
    Whitaker IS, Karoo RO, Spyrou G, Fenton OM (2007) The birth of plastic surgery: the story of nasal reconstruction from the Edwin Smith Papyrus to the twenty-first century. Plast Reconstr Surg 120:327–336CrossRefPubMedGoogle Scholar
  3. 3.
    Moolenburgh SE, Mureau MAM, Duivenvoorden HJ, Hofer SOP (2009) Validation of a questionnaire assessing patient’s aesthetic and functional outcome after nasal reconstruction: the patient NAFEQ-score. Plast Reconstr Surg 62:656–662Google Scholar
  4. 4.
    Mureau MAM, Moolenburgh SE, Levendag PC, Hofer SOP (2007) Aesthetic and functional outcome following nasal reconstruction. Plast Reconstr Surg 120:1217–1227CrossRefPubMedGoogle Scholar
  5. 5.
    Burget GC (1985) Aesthetic restoration of the nose. Clin Plast Surg 12:463–480PubMedGoogle Scholar
  6. 6.
    Burget GC, Menick FJ (1985) The subunit principle in nasal reconstruction. Plast Reconstr Surg 76:239–247CrossRefPubMedGoogle Scholar
  7. 7.
    Burget GC, Menick FJ (1986) Nasal reconstruction: seeking a fourth dimension. Plast Reconstr Surg 78:145–157CrossRefPubMedGoogle Scholar
  8. 8.
    Strasser EJ (1999) An objective grading system for the evaluation of cosmetic surgical results. Plast Reconstr Surg 104:2282–2285CrossRefPubMedGoogle Scholar
  9. 9.
    Alsarraf R (2002) Outcomes instruments in facial plastic surgery. Facial Plast Surg 18:77–86CrossRefPubMedGoogle Scholar
  10. 10.
    Singh DJ, Barlett SP (2003) Aesthetic considerations in nasal reconstruction and the role of modified nasal subunits. Plast Reconstr Surg 111:639–648CrossRefPubMedGoogle Scholar
  11. 11.
    Driscoll BP, Baker SR (2001) Reconstruction of nasal alar defects. Arch Facial Plast Surg 3:91–99CrossRefPubMedGoogle Scholar
  12. 12.
    Arden RL, Nawroz-Danish M, Yoo GH, Meleca RJ, Burgio DL (1999) Nasal alar reconstruction: a critical analysis using melolabial island and paramedian forehead flaps. Laryngoscope 109:376–382CrossRefPubMedGoogle Scholar
  13. 13.
    Uchinuma E, Matsui K, Shimakura Y, Murashita K, Shioya N (1997) Evaluation of median forehead flap and the nasolabial flap in nasal reconstruction. Aesthetic Plast Surg 21:86–89CrossRefPubMedGoogle Scholar
  14. 14.
    Kheradmand AA, Garajei A, Motamedi MH (2011) Nasal reconstruction: experience using tissue expansion and forehead flap. J Oral Maxillofac Surg 69:1478–1484CrossRefPubMedGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  • Luigi Angelo Vaira
    • 1
    • 3
  • Olindo Massarelli
    • 1
  • Giovanna Deiana
    • 1
  • Silvio Mario Meloni
    • 2
  • Giovanni Dell’aversana Orabona
    • 3
  • Pasquale Piombino
    • 4
  • Giacomo De Riu
    • 1
  1. 1.Operative Unit of Maxillo-Facial SurgeryUniversity of Sassari HospitalSassariItaly
  2. 2.Dental SchoolUniversity of Sassari HospitalSassariItaly
  3. 3.Operative Unit of Maxillo-Facial SurgeryUniversity of Naples “Federico II” HospitalNaplesItaly
  4. 4.ENT Operative UnitSecond University of Naples HospitalNaplesItaly

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