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Surgical Technique
May 2005

Defects of the Nasal Internal LiningEtiology and Repair

Author Affiliations

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Fletcher, Shonka, and Park) and Dermatology (Dr Russell) and Division of Facial Plastic and Reconstructive Surgery (Dr Park), University of Virginia Medical Center, Charlottesville.

Correspondence: Stephen S. Park, MD, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–@Head and Neck Surgery, University of Virginia Medical Center, PO Box 800713, Charlottesville, VA 22908 (ssp8a@virginia.edu).

Arch Facial Plast Surg. 2005;7(3):189-194. doi:10.1001/archfaci.7.3.189

Objectives  To analyze risk factors leading to full-thickness (FT) defects, to review methods of repair, and to present guidelines for management of aggressive basal cell carcinomas (BCCs) of the nose.

Design  Retrospective medical chart review of patients who underwent nasal reconstruction by the Department of Otolaryngology–Head and Neck Surgery between 1996 and 2003.

Results  Two hundred ten patients underwent nasal reconstruction; 183 had complete medical records and were included in this study. There were 53 patients with FT nasal defects, 38 (71.7%) of which were due to BCC. Among all patients presenting with an aggressive histologic subtype of BCC, 30.1% (22/73) developed FT defects. In contrast, 14.5% (16/100) with a nonaggressive subtype had FT involvement (P<.05).

Conclusions  Internal lining defects are more likely to occur from aggressive histologic subtypes of BCC (infiltrative, morpheaform, and micronodular) than nonaggressive subtypes (P<.05). For BCCs 1 to 2 cm2 located on the nasal ala, histologic subtype is a significant risk factor for resulting in a FT defect, which should influence the method of excision (direct vs Mohs micrographic surgery) and the anticipated reconstruction. Large lesions (>2 cm2) involving the ala have a high rate of internal lining involvement independent of pathologic subtype.