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-- Irishmen who cannot pay taxes suffer nasal amputation.
-- Sixtus Quintus of Rome mandates amputation of noses of thieves.
-- Naskatapoor = city without noses.
-- Tipu Sultan pays rewards for amputated noses of citizens who worked for the British.
Mera noc kart gaya = “You have cut off my nose”
Historical Perspectives 1500 BC: -- Lady Surpunakha’s nose reconstructed by Indian court physicians. 700 BC: -- Sushruta Samhita describes cheek flap for nasal reconstruction. 14th century: -- Branca family develops Italian Method. 1794: -- Gentleman’s Magazine in London describes Indian Method. -- Fosters interest in nasal reconstruction in Europe.
-- Face composed of aesthetic subunits based on surface features and histologic variation.
Millard (mid 1980s):
-- Advocates against “simply filling holes” in facial reconstruction.
-- Argues for replacement of entire subunits and strategic scar placement.
Burget & Menick (late 1980s):
-- Elaborate subunit principle in the context of nasal reconstruction.
Processes in Visual Perception “ Our eyes see the unexpected and disregard what is or simulates normal”
Visual search = active process in which eye is directed to areas of interest.
Visual information sorted between target signals (registered) and background signals (discarded).
Eye is directed to fixation points (angles and junctions of aesthetic units) of face -- facilitating recognition and discrimination of key features.
Processes in Visual Perception “ Our eyes normally pass over the smooth flat expanses of the face, lighting on the ridges and valleys that create facial contour and landmarks” “ We see color, texture and contour changes or the absence of a feature unit that surprises the eye and causes it to stop in its normal unconscious scanning on the unexpected” Source: Menick (1987)
The Subunit Principle: Controversies “ Scars placed within subunits can be well camouflaged in nasal reconstruction …We suggest that the excision of healthy tissue is unnecessary if one can obtain a satisfactory scar within the borders of a subunit.” Source: Rohrich et al (2004)
Rohrich et al presented a series of 1334 nasal reconstruction cases in which a policy of maximal conservation of native tissue was used.
Advocated reconstruction of the defect, not the subunit and concluded that complementary ablative procedures allowed for good cosmetic outcomes without use of the subunit principle.
“ Ideal” intranasal lining repair restores a thin , vascular and supple nasal lining.
Goals of reconstruction of intranasal lining:
Promote airway patency
Support structural cartilage grafts
Preserve mucosal function (if possible)
Options for donor tissue include skin grafts, septal mucoperichondrial flaps, turbinate flaps, turn-over flaps (PMFF, glabellar), intra-oral mucosal flaps and free flaps.
Intranasal Lining Repair Although hidden, lining is the most important part of a reconstruction. The unlined nose crumbles under the powerful forces of scar contracture and the reconstruction melts into an amorphous blob. Source: Taghinia & Pribaz (2008)