Reconstructing the lining in full-thickness nasal defects: techniques, challenges, and innovations

Abstract

Full-thickness nasal defects pose significant reconstructive challenges due to the complex anatomical and functional requirements of nasal lining reconstruction. The lining is crucial for maintaining nasal patency, humidification, and overall structural integrity. This review explores the existing literature on nasal lining reconstruction, highlighting common etiologies, reconstructive principles, techniques, outcomes, and complications associated with various approaches. Techniques discussed range from simple local mucosal flaps suitable for small defects to more complex regional flaps, such as septal mucosal flaps and inferior turbinate flaps, ideal for moderate defects. Additionally, advanced approaches, including microvascular free tissue transfer - such as the radial forearm free flap - are evaluated for their effectiveness in larger or composite defects. Emerging strategies involving tissue engineering, biomaterials, and prefabricated composite grafts are explored as potential advancements that could mitigate current limitations. Critical appraisal of the advantages, complications, and limitations of each method highlights the importance of tailored reconstruction based on defect size, location, and patient-specific factors such as prior radiation therapy or surgical history. This review underscores the necessity for meticulous surgical planning, adherence to reconstructive principles, and consideration of innovative technologies to improve patient satisfaction and functional outcomes. By summarizing current evidence and identifying critical gaps, this paper aims to guide future research toward refining nasal lining reconstruction practices.

Keywords

Nasal reconstruction / nasal lining / full-thickness nasal defect / mucosal flaps / septal flap / hinge flap / composite nasal defects / folded forehead flap

References

[1] Zenga J.Reconstruction of the Intranasal Lining.Facial Plast Surg.2017;33:67-73

[2] Menick FJ.The evolution of lining in nasal reconstruction.Clin Plast Surg.2009;36:421-41

[3] Murakami CS,Ierokomos AP.Nasal reconstruction using the inferior turbinate mucosal flap.Arch Facial Plast Surg1999;1:97-100

[4] Menick FJ.Nasal reconstruction.Plast Reconstr Surg.2010;125:138e-50

[5] Walton RL,Beahm EK.Microsurgical reconstruction of the nasal lining.Plast Reconstr Surg.2005;115:1813-29

[6] Menick FJ.Nasal reconstruction: forehead flap.Plast Reconstr Surg.2004;113:100e-11

[7] Tollefson TT.Complex nasal defects: structure and internal lining.Facial Plast Surg Clin North Am.2005;13:333-43

[8] Sozansky J.The physiological mechanism for sensing nasal airflow: a literature review.Int Forum Allergy Rhinol.2014;4:834-8

[9] Cannady SB,Wax MK.The total nasal defect and reconstruction.Facial Plast Surg Clin North Am.2009;17:189-201

[10] Havlik RJ.Principles of nasal reconstruction.Ann Plast Surg.2003;51:333

[11] Burget GC.The subunit principle in nasal reconstruction.Plast Reconstr Surg.1985;76:239-47

[12] Haack S,Gubisch W.Lining in nasal reconstruction.Facial Plast Surg.2014;30:287-99

[13] Goreshi R.Tissue conserving technique for reconstruction of nasal lining defects.Dermatol Surg.2016;42:124-6

[14] Iacobucci JJ.Bolster dressing to support a full-thickness skin graft.Ann Plast Surg.1987;18:550-1

[15] Hatoko M,Kuwahara M,Imai K.An evaluation of hard palate mucosa graft as a lining material in alar reconstruction: a 7-year experience applied to the full-thickness alar defect.Plast Reconstr Surg.2000;105:1940-7

[16] Teltzrow T,Schwipper V.One-stage reconstruction of nasal defects: evaluation of the use of modified auricular composite grafts.Facial Plast Surg.2011;27:243-8

[17] Keck T,Kühnemann S.Healing of composite chondrocutaneous auricular grafts covered by skin flaps in nasal reconstructive surgery.Laryngoscope.2003;113:248-53

[18] Bashir MM,Abbas M.Outcome of modified turn in flaps for the lining with primary cartilage support in nasal reconstruction.J Craniofac Surg.2013;24:454-7

[19] Hessam S,Georgas D,Bechara FG.Scar hinge flap for inner lining reconstruction of full-thickness defects on the ala of the nose.Rhinology.2015;53:167-70

[20] Lee KK,Swanson NA.Hinged turnover flap: a one-stage reconstruction of a full-thickness nasal ala defect.Dermatol Surg.2004;30:479-81

[21] Ulug BT.Nasal reconstruction based on subunit principle combined with turn-over island nasal skin flap for nasal lining restoration.Ann Plast Surg.2008;61:521-6

[22] Menick FJ. Nasal reconstruction: art and practice. Elsevier Health Sciences; 2008. Available from: https://www.amazon.com/Nasal-Reconstruction-Practice-Frederick-Menick-ebook/dp/B005IX89DE. [Last accessed on 18 Mar 2026].

[23] Baker S. Local flaps in facial reconstruction. Elsevier/Saunders; 2014. Available from: https://www.sciencedirect.com/book/edited-volume/9780323036849/local-flaps-in-facial-reconstruction. [Last accessed on 18 Mar 2026].

[24] Sertel S.Pericranial flap for inner lining in nasal reconstruction.Ann Plast Surg.2016;77:425-32

[25] Farias N.Full thickness nasal reconstruction with paired pericranial and paramedian forehead flaps.J Craniofac Surg.2024;Epub ahead of print:

[26] Yoshioka N.Anteriorly based pericranial flap: an anatomic study of feeding arteries.Skull Base Surg.1991;1:161-4 PMCID:PMC1656298

[27] Bastaninejad S,Saeedi N.Endoscopic pericranial flap design for the restoration of nasal mid-vault lining defects.Int J Oral Maxillofac Surg2018;47:865-8

[28] Waters CM,Thorp BD,Clark JM.Repair of septal perforation with endoscopic-assisted pericranial flap harvest and open rhinoplasty approach.Facial Plast Surg Aesthet Med.2020;22:225-6

[29] Howard BE,Shockley WW.Total nasal reconstruction: advances in free tissue transfer for internal lining and structural support.Facial Plast Surg Clin North Am.2024;32:247-59

[30] Rahpeyma A.Facial artery musculomucosal (FAMM) flap for nasal lining in reconstruction of large full thickness lateral nasal defects.Ann Med Surg.2015;4:351-4 PMCID:PMC4600940

[31] Durgun M,Selçuk CT,Seven E.Repair of full-thickness nasal alar defects using nasolabial perforator flaps.Ann Plast Surg.2015;75:414-7

[32] Iwao F.Alar reconstruction with subcutaneous pedicled nasolabial flap: difficulties, considerations, and conclusions for this procedure.Dermatol Surg.2005;31:1351-4

[33] Yellin SA.Melolabial flaps for nasal reconstruction.Facial Plast Surg Clin North Am2011;19:123-9

[34] Burget GC.Optimal use of microvascular free flaps, cartilage grafts, and a paramedian forehead flap for aesthetic reconstruction of the nose and adjacent facial units.Plast Reconstr Surg.2007;120:1171-207

[35] Antunes MB.Microvascular reconstruction of nasal defects.Facial Plast Surg Clin North Am.2011;19:157-62

[36] Seth R,Scharpf J,Fritz MA.Free anterolateral thigh fascia lata flap for complex nasal lining defects.JAMA Facial Plast Surg.2013;15:21-8

[37] Weber SM.Options for internal lining in nasal reconstruction.Facial Plast Surg Clin North Am.2011;19:163-73

[38] Menick FJ.Practical details of nasal reconstruction.Plast Reconstr Surg2013;131:613e-30

[39] Rosenthal EL,McGrew B,Peters GE.Use of negative pressure dressings in head and neck reconstruction.Head Neck J Sci Spec Head Neck2005;27:970-5

[40] Ziegler JP.Prelaminated paramedian forehead flap for subtotal nasal reconstruction using three-dimensional printing.BMJ Case Rep.2021;14:e238146 PMCID:PMC7839864

[41] Denour E,Crozier J.The use of three-dimensional photography and printing in the fabrication of a nasal prosthesis.J Craniofac Surg2020;31:e488-91

[42] Scheller E,Kohn D.Tissue engineering: state of the art in oral rehabilitation.J Oral Rehabil2009;36:368-9 PMCID:PMC2744808

[43] Xie Q,Huang Y.Characterization of human ethmoid sinus mucosa derived mesenchymal stem cells (hESMSCs) and the application of hESMSCs cell sheets in bone regeneration.Biomaterials2015;66:67-82

[44] Fairbairn NG,Redmond RW.The clinical applications of human amnion in plastic surgery.J Plast Reconstr Aesthet Surg.2014;67:662-75

[45] Chaudhari AA,Baganizi DR.Future prospects for scaffolding methods and biomaterials in skin tissue engineering: a review.Int J Mol Sci.2016;17:1974 PMCID:PMC5187774