Total Nasal Reconstruction Using Distraction Osteogenesis

Total nasal reconstruction is fraught with numerous challenges because of the multi-laminar nature of the nose. Structural support facilitates recreation of the aesthetic nasal subunits,(1) patent nasal valves, and an unobstructed airway. Inadequate soft tissues, however, can often make the placement of structural grafts difficult.(2,3) Columellar reconstruction is often challenging and typically relies on the most distal portion of the forehead flap for coverage. Septal pivot flaps can also be used but are often limited in reach and reliability.(4) In the following example, distraction osteogenesis was used to reconstruct the structural elements of the nasal base and columella in a patient requiring total nasal reconstruction.