Reconstruction of all layers, including the cartilaginous skeleton, the lining and the frontal flap, should generally be counted on three surgeries four to five weeks apart. If microsurgical plasty with a free flap is additionally required for the reconstruction of the inner lining of the nose, it should be done two months before the actual reconstruction of the nose. Thus, from the beginning to the end of the rhinoplasty surgery and the removal of the stitches, it will generally take at least 12-15 weeks, of which only a few days will need to be spent in the hospital. Less extensive interventions to create an optimal contour of the reconstructed nose can be performed additionally immediately after the reconstruction of the nose.
Working patients can issue a sick leave for this entire period and, moreover, until full recovery.
Nasal Epithesis (Nose Prosthesis) – An Alternative To Nose Reconstruction Using Your Own Tissue
Replacement of the entire nose, half of the nose, or the wing of the nose with epitheses is a possible alternative to nose reconstruction using one’s own tissue. However, more often than not, this is only a temporary solution if additional radiation therapy or chemotherapy is required immediately after surgery to remove the tumor, or if there is doubt that the surgery was sufficient and the entire tumor was removed.
The epitheses of the nose are made of medical grade silicone. In this case, material of varying degrees of hardness can be purposefully used in order to provide a plasticity similar to the skin in the area of the adjacent tissue. The color and shape of the epithesis of the nose are adjusted to the existing anatomical features and are practically invisible in the patient’s everyday life.
A nasal epithesis is only suitable as a long-term solution if the patient can get used to it or if surgical repair of the nose for certain individual reasons is not considered. The epitheses of the nose at the site of the defect, as a rule, are quite stable and well adhered, or, alternatively, they can be fixed with metal implants that are fixed in the bone.
In general, epitheses should not be worn for 24 hours in a row, as the adjacent tissue in the area of direct contact takes several hours to recover. In addition, epitheses need to be changed from time to time, as they are subject to natural wear and tear.
Postoperative Follow-Up And Reconstruction Schedule
The timetable for complex nose reconstruction after malignant tumor removal differs from case to case. Since nasal reconstruction complicates regular follow-up after tumor removal, if in doubt, the patient should be encouraged to reconstruct later.
With carcinomas, it is recommended to wait one year, with very slowly growing, but the same destructive basaliomas – two years. At this time, a nasal epithesis (nose prosthesis) is suitable as a replacement for a nasal defect. The patient can, with less psychological pressure, calmly explore the options, difficulties and limits of reconstruction possibilities.
Due to the limited reserves of its own tissue, even more extensive nose reconstructions require precise planning. Unfortunately, it is always necessary to count on the possibility of relapse in tumor diseases. Therefore, at higher risk, a postoperative follow-up phase is recommended before reconstruction. Early collaboration of otorhinolaryngologists and dermatologists with reconstructive plastic surgeons achieves the best results here.