The nose has a complex three-dimensional shape, which is unique to each of us, and is in a key aesthetic area of the face. This means that any defect, or missing part of the nose, will be unique in its shape and size. Because if its shape and location, any differences between the two sides are obvious so nasal reconstruction not only has to recreate the structure and function of the nose but also has to create a shape that matches the other side. Nasal reconstruction was first described in India as far back as 600BC.
It is useful to think of the nose in 3 layers: the central layer is a strong scaffold of bone, cartilage and connective tissue that gives the nose strength and most of its shape. On the surface, there is skin and, on the inside, there is a thin but important lining layer. Depending on the extent of the defect, it may be necessary to reconstruct all three of these layers.
Often, when considering reconstruction of the nose, surgeons will consider reconstructing entire subunits. These are subdivisions of the nose and their importance is that scars within these subunits are more noticeable than scars lying in between them. It may give a better final result from the reconstruction to make a defect larger before reconstructing it, but where any scarring will lie between these subunits.
There are many ways to reconstruct a nose, but nasal reconstruction is particularly difficult in children. The reconstructed nose must grow and change in shape as the child’s face changes otherwise a reconstruction that gives a good result to start with can become unsatisfactory later on. This means that considering the timing and age of the child at the time of reconstruction is important. It is also important to consider that children tend not to have as much loose skin over the bridge of their noses or on their cheeks as adults, so certain techniques used in adults are less successful at giving good reconstructive results in children.
Different types of nasal reconstruction depend very much on the defect: whether it is necessary just to reconstruct the skin over the nose, or whether the structural framework needs to be reconstructed together with the skin and the lining. The size of the defect also is an important consideration in choosing which type of reconstruction will be effective, as it whether the defect is at the nostril, as this requires additional support in order to prevent the nostril collapsing when breathing in.
How a nasal defect affects a child depends on the size and position of the defect as well as the age of the child when it occurred, and the age at which it is reconstructed. A good reconstruction at the appropriate age with Clinical Psychology support throughout the reconstruction process can help to minimize the psychosocial complications faced by the child.