Nasal reconstruction surgery after continuous positive airway pressure delivered by prongs: A case report. (October 2021)

• Record Type: Journal Article
• Authors: Windura, Carolus Aldo; Josh, Fonny; Soekamto, Tomie H.; Lumalessil, Dhevie Gianfranco
• Is Part Of: Annals of medicine and surgery. Volume 70(2021)
• Publication Date: 2021-10
• Subjects: Case report -- Nasal deformity -- Nasal reconstruction -- nCPAP; nCPAP nasal prongs continuous positive airway pressure -- NICU neonatal intensive care unit -- FTSG full thickness skin grafts; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2021.102881
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction and importance: Deformities resulting from nasal continuous positive airway pressure delivered using prongs can cause functional and aesthetic issues for patients. Resultant severe tissue damage to the nasal structures often requires surgical intervention and techniques continue to evolve. Case presentation: This case report describes a 6-year-old male presenting with a full-thickness columella defect; contracture causing deformities involving the nasal tip, ala nasi, and left nasal cavity wall; missing left lateral-medial cruris cartilage; and partially missing right medial cruris cartilage. The abnormalities initially appeared when the patient was 7 days old after receiving treatment by nasal continuous positive airway pressure for 7 days. A one-stage procedure was performed as follows: left ala nasi reconstruction with skin excision followed by an ear cartilage graft; a nasal cartilage shield graft to form the nasal tip; reconstruction of the columella with a cartilage graft combined with bilateral soft tissue flaps taken from the nasal floor and mucosa vestibulum; and a full-thickness skin graft to cover the secondary defect resulting from the flaps. At 1-month post-surgery, satisfactory results were reported. Clinical discussion and conclusion: Our approach combining two flaps taken from the nasal floor and the inner layer of the ala nasi, a cartilage graft from the ear, and a full-thickness skin graft delivered a one-stage surgical technique that yielded satisfactory results without deformities of the donor site. However, the surgical technique should be individualized to patients. This case report adds to the literature and offers surgeons an alternative approach for managing nasal deformities. Highlights: The limited availability of small size nCPAP in inland hospitals have caused the increased number of nasal deformity. Combination of nasal floor flaps, shield and ear cartilage graft yielded satisfactory result for nasal reconstruction. The rarity of the case, and the combination of each techniques used, made the case interesting. This technique does not rule out the possibility of secondary corrections and should be tailored individually for each case.