Reconstruction of the Isolated Columellar Defect: A Novel Two-Stage Technique and Review of the Literature

Publication date: Available online 10 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Brian S. Pan, Anthony T. Vu, Scott J. Rapp, Nick J. Saenger
The importance of the nasal complex cannot be overstated from a functional, social and psychological perspective. The goal of reconstruction is to restore the trilaminar composition of the nose. This is accomplished by recreating the nasal lining, providing a cartilaginous framework to simultaneously support a patent airway, and project the defining features to the overlying soft tissue. The techniques for nasal reconstruction have evolved from simply providing closure and coverage of a defect to adeptly concealing incisions within favorable anatomic topography. Gonzalez-Ulloa et al. initially presented this concept in their treatise on regional facial aesthetic units; however, Burget and Menick applied this principle to nasal analysis, characterizing the topographic subunits of the nose.^1,2Although the columella is one of the smallest subunits of the nose, loss of this structure has important aesthetic and structural implications. The medial footplates of the columella in combination with the caudal septum contribute to the projection of the nasal tip. From a profile view, the columella comprises an important aesthetic line necessary for analyzing the nasolabial angle. Despite an enhanced appreciation of this structure and multiple reconstructive techniques for restoring other nasal structures, the ideal operation for an isolated defect of the columella remains elusive. Skin and composite grafts can heal unpredictably due to a limited bed on which to graft. Local and regional flaps either supply minimal, unsupported tissue or may result in an unacceptable donor site defect for the patient. The ideal reconstruction would match the pigmentation, texture of the surrounding nasal skin and provide a convex contour with underlying structural support. In addition, the donor site would not create a secondary deformity by disrupting normal anatomy. In this article, we present a novel two-stage technique for reconstruction of the columella and review the current literature.



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