1. -Barry T. Malin Nasal Reconstruction Concepts & Techniques

4. 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.

8. 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)

22. Technique Selection: Surface Repair Source: Leach (2003) Composite Graft Soft Triangle PMFF FTSG 2° Intention Columella Cheek Advancement FTSG, Rhomboid, Rotation, Cheek Adv 1° Closure Sidewall PMFF FTSG, Rhomboid, Rotation 1° Closure Dorsum Nasolabial 2° Intention Ala PMFF Bilobed, Rotation 2° Intention Lobule > 1.5 cm Exposed Bone / Cart < 1.5 cm < 1 cm < .5 cm Defect Size Site

23. Source: Baker & Nacify (2002)

28. Bipedicle Vestibular Flap

30. Intranasal Mucosal Flap Options Source: Tollefson (2005) Intranasal dissection Turbinate size Airway obstruction When septal mucosa absent Avoids septal perforation Caudal, middle vault Inferior Turbinate Difficult dissection Septal perforation Bilateral lining Tip, columella, middle vault Composite Septal Pivotal Septal perforation Can be composite Middle vault Hinged Septal Mucosal (Contralateral) May obstruct airway Bilateral flaps possible Ala, tip, lower vault Ipsilateral Septal Mucosa Risk of alar retraction Ease of dissection Alar margin Bipedicled vestibular Disadvantage Advantage Defect Location Type