phenylephrine-hydrochloride and Carcinoma--Squamous-Cell

Case 1 was a 75-year-old Japanese man who presented with a poorly demarcated, dark-red nodule with a destructive defect in the center, measuring 3 cm × 2 cm on the right wing of his nose. The histological diagnosis was a common form of infundibular squamous cell carcinoma. Atypical neoplastic cells radiated from the wall of a follicular infundibulum. The majority of neoplastic cells were positive for AE1/AE3 and 34βE12. Cytokeratin 17 expression was seen in the suprabasal cells of the deeply situated neoplastic components. Case 2 was a 73-year-old Japanese man who presented with a poorly demarcated, dark-red nodule with an irregularly shaped ulcer in the center, measuring 3 cm × 2 cm on the left wing of his nose. The histological diagnosis was a crater form of infundibular squamous cell carcinoma. Atypical neoplastic cells radiated from the broad base of the central keratin-filled crater, continuous with two infundibular canals. In both cases, some of the more deeply situated aggregations were composed of neoplastic keratinocytes with eosinophilic glassy or pale cytoplasm. In addition, no atypical keratinocytes could be seen in the interfollicular epidermis. In case 1, a hematogenous metastasis to the vocal cord and the forehead occurred in addition to a lymph node metastasis. In case 2, a local recurrence occurred with an intralymphatic dissemination. We describe two cases of infundibular squamous cell carcinoma on the nose with aggressive clinical behavior, one of which was accompanied by a hematogenous metastasis while another revealed a local recurrence.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Chemoradiotherapy, Adjuvant; Granuloma, Pyogenic; Humans; Laryngeal Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Neoplasm Recurrence, Local; Nose; Plaque, Atherosclerotic; Skin Neoplasms; Vocal Cords

Decisions about medical and surgical treatment can be complex-even for health care providers, who can struggle with which treatment option to offer their patients. In the current landscape of patient-centric value-based health care, the need for appropriate medical decision making to maximize treatment outcomes is evermore important. Shared decision making is a process in which clinicians and patients make decisions together using the best available evidence while accounting for the patients' values and beliefs. A patient-centered approach has been associated with improved patient satisfaction, clinical outcomes, and patient adherence to treatment. Only by taking a collaborative care approach among patients, physicians, and caregivers can we hope to deliver the best possible care and improve our outcomes for each and every patient.

Topics: Age Factors; Aged, 80 and over; Carcinoma, Squamous Cell; Clinical Decision-Making; Decision Making; Follow-Up Studies; Humans; Male; Mohs Surgery; Nose; Patient-Centered Care; Risk Assessment; Skin Neoplasms; Surgery, Plastic; Treatment Outcome

A 90-year-old Japanese woman presented with a dome-shaped, dark-red, ulcerated nodule measuring 23 mm × 19 mm × 9 mm on the right side of the nasal root. Histologically, anastomosing cord-like arrays of atypical polygonal keratinocytes exhibiting internal pseudolumina containing detached cells and erythrocytes were observed. Although acantholytic and cohesive areas overlapped, cancer pearls were not detected. The lower epidermis partially demonstrated scattered dyskeratotic and acantholytic keratinocytes with loss of polarity, continuous with an underlying tumor mass. The tumor cells were positive for a variety of cytokeratins, p40 and vimentin. The Ki-67 proliferation index was 50-60%. Both CD31 and CD34 were expressed in reactive blood vessels of the tumor. A local excision margined by 1 mm was performed, followed by X rays and electron beam irradiation. Neither lymph node nor distant metastasis has appeared over the 14 months since the excision. We performed a review of the published work and identified 24 previously reported patients with pseudovascular squamous cell carcinoma of the skin, oral mucosa and vulva to reassess the prognosis of this tumor. In 12 of these patients (50%), sites other than the head and neck were involved. Eight (33%) tumor-associated deaths occurred. It is believed that pseudovascular squamous cell carcinoma has a tendency to develop at morbid skin and mucous membranes sites in organs other than the face and neck and to possess an aggressive clinical behavior.

Topics: Aged, 80 and over; Carcinoma, Squamous Cell; Epidermis; Female; Humans; Nose; Prognosis; Skin Neoplasms

Während einfache Defekte auch durch freie Hauttransplantate oder lokale Lappenplastiken rekonstruiert werden können, stellen komplexe dreischichtige Defekte eine Herausforderung für den rekonstruktiv tätigen Chirurgen dar. Diese bezieht sich in erster Linie auf eine suffiziente Wiederherstellung der inneren Nasenauskleidung, ohne die physiologischen Funktionen der Nasenschleimhaut zu kompromittieren. Die Autoren gehen auf verschiedene Rekonstruktionstechniken zur Wiederherstellung der inneren Nasenauskleidung ein. Eine besondere Bedeutung kommt hier dem epithelialen Kipplappen und dem kürzlich erst beschriebenen prälaminierten Stirnhautlappen bei (sub)totalen Nasendefekten zu. Beide haben sich in der Wiederherstellung der inneren Nasenauskleidung als sehr wertvolle und schleimhautschonende Alternativen zu herkömmlichen intranasalen Schleimhautlappen bewährt.

Topics: Carcinoma, Squamous Cell; Cartilage; Composite Tissue Allografts; Esthetics; Humans; Melanoma; Microsurgery; Nasal Cavity; Nasal Mucosa; Nose; Nose Neoplasms; Rhinoplasty; Surgical Flaps

The advances in endoscopy have revolutionized the management of sinonasal and skull base lesions. Many complex cancers that traditionally required open approaches are now amenable to purely endoscopic endonasal resection, providing less invasive surgery with lower morbidity but with comparable oncologic outcomes in terms of survival rates. This article discusses the current evidence for the multimodal management of sinonasal and anterior skull base cancers focusing on the different treatment protocols driven by histologic subtypes.

Topics: Adenocarcinoma; Carcinoma; Carcinoma, Adenoid Cystic; Carcinoma, Neuroendocrine; Carcinoma, Squamous Cell; Disease Management; Endoscopy; Esthesioneuroblastoma, Olfactory; Hemangiopericytoma; Humans; Maxillary Sinus Neoplasms; Nose; Professional Corporations; Skull Base; Skull Base Neoplasms; Survival Rate

Traditionally, patients with maxillofacial defects have been challenging to treat. A multitude of challenges associated with maxillofacial prosthetic treatment are not typically seen with patients who need conventional prosthodontic treatment. These types of patients generally require replacement of significant amounts of hard and soft tissues than do conventional prosthodontic patients. Most maxillofacial patients also warrant more emotional support than do conventional prosthodontic patients. Successful maxillofacial prosthetics still need to embrace the traditional goals of prosthodontic treatment: stability, support, retention, and esthetics. It is unlikely that a maxillofacial prosthesis will exactly duplicate the anatomy and function of missing or damaged structures. Although craniofacial implants (CFI's) have lower cumulative survival rates (CSR's) than intraoral endosseous implants, osseointegrated CFI's have proven to be significant adjuncts to improving retention of maxillofacial prostheses. However, CSR's of CFI's have been reported to be lower than CSR's for intraoral endosseous implants. Lately, computer-assisted design and computer-assisted machining (CAD/CAM) has been used in dentistry to facilitate fabrication of implant-supported frameworks. CAD/CAM protocols have numerous advantages over conventional casting techniques, including improved accuracy and biocompatibility, and decreased costs. The purpose of this paper is to review the literature on cumulative survival rates (CSR's) reported for CFI's and to illustrate the treatment of a maxillofacial patient using CFI's and a CAD/CAM copy-milled framework for retention and support of a nasal prosthesis.

Topics: Aged; Alloys; Carcinoma, Squamous Cell; Computer-Aided Design; Humans; Magnets; Male; Nasal Septum; Neck Dissection; Neoplasm Recurrence, Local; Nose; Nose Deformities, Acquired; Nose Neoplasms; Patient Care Planning; Prostheses and Implants; Prosthesis Design; Prosthesis Retention; Radiotherapy, Adjuvant; Survival Analysis; Titanium

Surgery on the nose is inseparable from the practice of dermatology. Extensive training and experience is required to account for the nose's unique role in determining individuality, its function as an airway, and its predilection for hosting aggressive tumors. This overview of anatomy and general surgical principles provides the novice with a foundation on which to build and the experienced practitioner a review of pertinent literature.

Topics: Biopsy; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms

This article reviews the indications and techniques for performing a bilobed flap for reconstruction of surgical wounds. Various examples of surgical defects where a bilobed flap can be used are shown. Possible complications and pitfalls are also reviewed.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Ear, External; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

The Koebner phenomenon, also known as the isomorphic response, is the development of preexisting skin disease following trauma to uninvolved skin. Various cutaneous disorders have been described to arise at surgical wounds and scars. Moreover, dermatologic procedures, such as cold-steel and laser surgery, can evoke koebnerization.. To describe a case of pemphigus foliaceus arising in postoperative wounds and to present a review of dermatologic disorders triggered by surgical procedures.. We report a case of pemphigus foliaceus initially presenting at sites of Mohs' micrographic surgery, shave biopsy, and cryotherapy and, subsequently, at a nonsurgical site. We reviewed the English literature in MEDLINE from November 1955 to April 2004 for reports of Koebner and related phenomenon following surgical procedures.. To our knowledge, this is the first reported case of pemphigus foliaceus erupting at surgical and cryotherapy wounds. The clinical appearance can mimic wound infection. In addition to inducing preexisting disease, cutaneous procedures can also trigger the onset of new disease, which can either be limited only to the surgical site or subsequently become generalized.. Postoperative Koebner or related responses should be included in the differential diagnosis of poorly healing surgical wounds. Skin biopsies for histopathology and immunologic studies may be necessary for definitive diagnosis and optimal management.

Topics: Aged; Carcinoma, Squamous Cell; Cicatrix; Diagnosis, Differential; Female; Humans; Nose; Pemphigus; Postoperative Complications; Skin Neoplasms; Surgical Wound Infection

There are several options for closure of a given surgical defect after tumor extirpation is confirmed. Flap reconstruction is one of these options.. The purpose of this article is to introduce the three basic types of flap movement: advancement, rotation, and transposition.. Five similar defects located on the nasal sidewall were repaired, each using a different flap design.. The optimal flap design for a given defect on a particular patient is based on the answers to a series of questions: Where is the available tissue reservoir? How can tissue be mobilized from the reservoir to cover the defect? How do the resulting tension vectors affect critical structures? Where are the final incision lines?. Many factors must be evaluated before determining a method of reconstruction. Flap reconstruction requires a thorough understanding of anatomy and tissue movement.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Cutaneous metastases from carcinoma are relatively uncommon in clinical practice. Metastasis to skin sites from squamous cell carcinoma of the mucosa of the head and neck are also very rare. However, skin metastases may be the first clinical evidence of the malignant disease or its loco-regional recurrence. Early recognition of skin metastasis can lead to an accurate and prompt diagnosis and timely treatment. Patients with skin metastases have very poor prognosis. We report on four such patients, one of them with multiple skin metastases from the squamous cell carcinoma in the cervical part of the esophagus above and below the level of the diaphragm. In reviewing the literature, only two cases of solitary skin metastases below the diaphragm from laryngeal squamous cell carcinomas have been reported

Topics: Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Leg; Male; Middle Aged; Nose; Skin Neoplasms; Thorax

Invasion of squamous cell carcinoma of the head and neck into cutaneous nerves is rare and can easily be missed. Perineural outgrowth into cerebral nerves may result in severe pain or neurological disturbances. In addition, these carcinomas more often recur or metastasize and therefore are associated with a poor prognosis.. We report on two patients with squamous cell carcinoma of the dorsum of the nose and lower lip exhibiting neurotropic growth.. Histology showed pleomorphic keratinocytes growing deep into the subcutaneous tissue and bone, respectively. The presence of few pleomorphic keratinocytes could be only confirmed by immunohistochemistry, though indicated by a perineural lymphocytic infiltrate. In both patients, several re-excisions were necessary to achieve cure.. In neurotropic squamous cell carcinoma a consequent radical micrographic surgery as well as neurological and radiological investigations are mandatory. We also review the literature.

Topics: Aged; Biomarkers, Tumor; Biopsy; Carcinoma, Squamous Cell; Humans; Immunoenzyme Techniques; Lip; Lip Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Nerve Fibers; Nose; Nose Neoplasms; Skin; Skin Neoplasms

Various approaches to the base of the skull for the treatment of cranial base tumours are described in detail. Advantages and disadvantages of the particular approaches are discussed. This clinical experience is based on 303 neoplasms involving the base of the skull, operated on by the authors. Retrospective survival studies are presented and a review of the literature on the subject is discussed. Utilizing microsurgical techniques the 2-, 3- and 5-year survival rates were significantly improved. The functional and aesthetic outcomes were also dramatically superior compared with standard ablative procedures. Reconstructive postoperative strategies are suggested.

Topics: Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Craniotomy; Esthetics; Facial Bones; Female; Humans; Male; Meningioma; Microsurgery; Mouth; Neoplasm Invasiveness; Nose; Osteotomy; Paranasal Sinuses; Plastic Surgery Procedures; Radiotherapy, Adjuvant; Retrospective Studies; Skull Base Neoplasms; Skull Neoplasms; Survival Rate; Treatment Outcome

Surgical treatment for aggressive intranasal squamous cell carcinoma (SCC) requires a multidisciplinary team approach to ensure optimal patient outcomes. Surgical procedures for the removal of intranasal malignancies may include rhinectomy, palatectomy, and maxillectomy. These procedures leave patients with significant facial defects that are corrected with staged surgical reconstructions or applications of facial prostheses. This article describes the etiology of intranasal SCC, discusses treatment options, and presents a case study that chronicles the events from diagnosis through rehabilitation of a patient undergoing rhinectomy, partial bilateral maxillectomy, and partial palatectomy.

Topics: Aged; Carcinoma, Squamous Cell; Combined Modality Therapy; Humans; Male; Nasal Septum; Nose; Nose Neoplasms; Perioperative Nursing; Prostheses and Implants

Advanced carcinoma of the external nose is almost always associated with prior inadequate therapy. The first principle, therefore, in managing cutaneous malignancies of the nose is to achieve adequate tumor-free removal at the initial treatment. Recurrent carcinoma of the nose may require either hemirhinectomy or total rhinectomy to achieve tumor control.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Male; Nose; Nose Neoplasms; Prostheses and Implants; Rhinoplasty; Skin Neoplasms; Treatment Outcome

Cancer of the nasal skin is usually well-circumscribed, superficial, and has an excellent prognosis. However, a small number of aggressive lesions require a partial or total rhinectomy. We retrospectively reviewed patients seen at the M.D. Anderson Cancer Center between January 1, 1970, and December 31, 1980, for nasal cancer. There were 147 patients identified as requiring full-thickness nasal resections, of whom 68 (46.3%) required a hemi- or complete rhinectomy. Lesions requiring extensive rhinectomy usually involved the ala or were recurrent multicentric, squamous cell carcinomas greater than 4 cm. These patients had significantly poorer prognoses than the group in general. Recurrence developed in 45 patients (30.6%), and two thirds of all recurrences were seen within 2 years. In this series, the histology of the malignancy and its size, in the case of large basal cell carcinomas, were both predictive of a poor prognosis. Only the primary site was significant in predicting recurrence, whereas tumor size and histology were significant predictors of the need for an extensive rhinectomy. Delayed reconstruction is recommended in patients who are in poor health and have large recurrent lesions that are multicentric or involve the ala or dorsum. The timing of reconstruction is individualized, but a 2-year wait after surgery is recommended. Prosthetic rehabilitation is a good interim measure.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Nose; Nose Neoplasms; Prognosis; Skin Neoplasms

A subgroup of midfacial basal and squamous cell carcinomas invade extensively into the surrounding soft tissues and at times into bone, cartilage, and the nearby cavities. Their management can be optimized by using the combined skills of the Mohs micrographic surgeon and the head and neck surgeon. Relevant tumor biology and anatomy of this area are presented as a background for the discussion of the mechanics involved in tumor extirpation. Reconstructive philosophies and alternatives are reviewed.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Combined Modality Therapy; Female; Humans; Male; Microsurgery; Nose; Nose Neoplasms; Skin Neoplasms; Surgery, Plastic

Inverted papillomas which arise from the lining membranes of the nose and paranasal sinuses are relatively unfamiliar lesions which have been reported in the literature under a variety of titles. The uncertainly surrounding their etiology, their relationship to nasal polyps and their malignant potential have resulted in an ill-defined clinical approach to their management. The designation Inverted Schneiderian Papilloma is suggested as an appropriate title that best conveys the qualities of inversion, location and distinctiveness of character. The characteristic microscopic feature is the increase in thickness of the covering epithelium with extensive invasion of this hyperplastic epithelium into the underlying stroma. In the absence of a better explanation of the origin, the tumor should be considered a true epithelial neoplasm. The clinical features in 24 previously unreported cases are presented. The most common presenting complaints are nasal obstruction and epistaxis. The common site of origin is the lateral nasal wall in the region of the middle meatus and ethmoid cells. In no instance was an isolated lesion of the maxillary, frontal or sphenoid sinus present. The most characteristic attributes of the tumor were its tendency to recur, its destructive capacity and its propensity to be associated with malignancy. The common radiographic abnormality on routine sinus films was unilateral opacification of the sinuses and nasal airway. Tomography is helpful in defining the extent of the lesion and in selecting an appropriate surgical approach. A philosophy of management has evolved based on the experiences gained from these 24 patients, combined with a review of the experience of others and a study of the regional anatomy. Surgical excision is the treatment of choice. A bold surgical approach has been used for tumors involving the lateral nasal wall and paranasal sinuses. A lateral rhinotomy incision is employed and when necessary, this exposure is increased by extending the incision of split the upper lip and reflect the cheek flap as is customarily done with the Weber-Ferfusson incision. Fifteen patients have been followed for more than two years and the results have been excellent with the exception of one patient who later developed an invasive squamous carcinoma. An associated malignancy was found in 12.5 percent of the cases.

Topics: Adult; Aged; Airway Obstruction; Carcinoma, Squamous Cell; Epistaxis; Female; Humans; Hypersensitivity; Male; Maxillary Sinus; Middle Aged; Nasal Polyps; Nose; Nose Neoplasms; Papilloma; Paranasal Sinus Neoplasms; Paranasal Sinuses; Recurrence; Sex Factors; Terminology as Topic; Tomography, X-Ray; Virus Diseases

Complex nasal defects in the distal regions of the nose are cosmetically difficult to repair. In 70 patients over a period of 10 years, defects of the nasal ala and the soft triangle, nasal tip, columella, and columellar-lobular junction were reconstructed with modified auricular composite grafts. A randomized group of 40 of these patients was assessed after a mean of 55.5 months to evaluate the method's functional and cosmetic long-term results. The majority of the patients (60%, N = 48) had been treated primarily for basal cell carcinoma. Of all defects, 57% ( N = 46) measured 2 to 3 cm in width and 43% ( N = 34) 1 to 2 cm. Seventy-five percent ( N = 60) of all defects were composite lesions involving skin, cartilage, and vestibular mucosa, in contrast to 25% ( N = 20) involving skin and cartilage with intact vestibular skin. Two crucial technical modifications seemed to have improved survival for larger grafts: first, the use of hinge flaps from the margins of the defect to obtain a well-vascularized recipient bed and optimization of the raw contact surface; second, postoperative gentle scarification of the graft in combination with a constantly applied heparin solution decongests venous stasis normally seen in such grafts. This maneuver establishes a stable and early blood supply enhancing graft take. With this type of treatment, 67 (84%) grafts healed well without further complications, whereas 13 (16%) grafts developed complications, resulting in partial ( N = 9) and total ( N = 4) necrosis of the transplant. Six of these patients underwent a secondary reconstruction using another auricular composite graft. Long-term results of this method have turned out to be very satisfying in terms of functional and cosmetic outcome and patient acceptance.

Topics: Adolescent; Adult; Aged; Burns; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Ear Cartilage; Esthetics; Female; Follow-Up Studies; Graft Survival; Humans; Male; Melanoma; Middle Aged; Nasal Cartilages; Nose; Nose Neoplasms; Patient Satisfaction; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Skin Transplantation; Treatment Outcome; Young Adult

Alar batten cartilage grafts can restore form and function to a compromised ala, prevent stenosis of the nasal valve, and maintain unrestricted air movement. Soft tissue reconstructive options can be combined with alar batten grafts.. Our purpose was to analyze functional and cosmetic outcomes in a series of patients undergoing alar batten cartilage grafting.. We analyzed the functional and cosmetic outcomes of 25 patients in whom reconstruction involved alar batten cartilage grafts. Assessment included defect characteristics, function and cosmesis (rated by physician and patient), and complications.. Eighty-three percent of patients had good to excellent functional and cosmetic results by patient and physician assessment. Three patients were rated as having poor cosmetic results by the physician; all 3 patients graded these results as good. One episode of graft failure occurred, and recipient and donor site complications were minor.. Alar batten cartilage grafts appear to be an excellent option for reconstruction of substantial alar defects.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cartilage; Graft Rejection; Graft Survival; Humans; Nose; Patient Satisfaction; Plastic Surgery Procedures; Skin Neoplasms

Twelve patients with advanced epithelial nonadenocarcinoma of the paranasal sinuses and nasal fossa were treated with three cycles of cisplatin (100 mg/m2, day 1) and 5-fluorouracil (1000 mg/m2/24 hours on days 1-5 by continuous infusion), followed by preoperative external radiation therapy of 48 Gy and limited surgery, clearing the paranasal sinuses and nasal fossa.. After chemotherapy, 11 of 12 patients were free of the previous symptoms of disease. Clinical response rates were different, however, with an overall response rate of approximately 70% with no complete responses. Histopathologic analysis of resected specimens showed no vital tumor in eight patients, minimal microscopic disease in three patients, and infiltrating tumor in one patient. Local control was achieved in 11 of 12 patients. Ten patients are alive with no evidence of disease (mean follow-up, 27 months). Surgical mutilation was avoided, with no functional or cosmetic loss.. The results of this small pilot study seem to indicate a high chemosensitivity of carcinomas of the paranasal sinuses and nasal fossa, which, in this study, has meant significant relief of symptoms and an unusually high rate of local control (90%) without mutilation.

Topics: Actuarial Analysis; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Fluorouracil; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Pilot Projects; Prospective Studies

Topics: Carcinoma, Squamous Cell; Humans; Nasal Cavity; Nose; Nose Neoplasms; Skin Neoplasms

Chronic inhalation of formaldehyde by F344 rats causes nasal squamous cell carcinoma (SCC). This outcome is well-characterized: including dose-response and time course data for SCC, mechanistic endpoints, and nasal dosimetry. Conolly et al. (Toxicol. Sci. 75, 432-447, 2003) used these resources to develop a biologically based dose-response (BBDR) model for SCC in F344 rats. This model, scaled up to humans, has informed dose-response conclusions reached by several international regulatory agencies. However, USEPA concluded that uncertainties precluded its use for cancer risk assessment. Here, we describe an updated BBDR model that addresses uncertainties through refined dosimetry modeling, revised analysis of labeling index data, and an extended dataset where both inhaled (exogenous) and endogenous formaldehyde (exogF, endoF) form DNA adducts. Further, since Conolly et al. (ibid) was published, it has become clear that, when controls from all F344 inhalation bioassays are considered, accounting for over 4000 rats, at most one nasal SCC occurred. This low spontaneous incidence constrains possible contribution of endoF to the formation of nasal SCC via DNA reactivity. Further, since both exogF and endoF form DNA adducts, this constraint also applies to exogF. The revised BBDR model therefore drives SCC formation through the cytotoxicity of high concentration exogF. An option for direct mutagenicity associated with DNA adducts is retained to allow estimation of an upper bound on adduct mutagenicity consistent with the lack of a spontaneous SCC incidence. These updates represent an iterative refinement of the 2003 model, incorporating new data and insights to reduce identified model uncertainties.

Topics: Animals; Carcinoma, Squamous Cell; DNA Adducts; Formaldehyde; Humans; Models, Biological; Nose; Rats; Rats, Inbred F344

Topics: Animals; Carcinoma, Squamous Cell; Dog Diseases; Dogs; Nose; Nose Neoplasms; Plastic Surgery Procedures

A 68-year-old patient was referred to the dermatology clinic with a large destructive tumour on his nose. Due to COVID-19-related fear, he had avoided his regular dermatology appointments. Histopathology revealed a poorly differentiated squamous cell carcinoma. This case demonstrates the impact of delayed healthcare due to fear of COVID-19.

Topics: Aged; Appointments and Schedules; Carcinoma, Squamous Cell; COVID-19; Humans; Male; Nose; Skin Neoplasms

Topics: Arteries; Carcinoma, Squamous Cell; Forehead; Humans; Male; Medical Illustration; Middle Aged; Nose; Nose Deformities, Acquired; Nose Neoplasms; Postoperative Complications; Rhinoplasty; Surgical Flaps

Total rhinectomy for tumors of the nasal cavity substantially alters patients' appearance and requires local reconstruction. While full nasal epitheses are well-established for this purpose, potential long-term adverse effects and impact on patients' quality of life are not fully understood.. Sixteen patients who underwent total rhinectomy with ensuing nasal reconstruction with a full nasal epithesis were included in the study. Oncologic outcomes were assessed, and adverse effects and quality of life analyses were performed based on a patient-reported outcomes tool.. In patients with squamous cell carcinomas of the nasal cavity, total rhinectomy led to excellent local tumor control. Immediate and long-term adverse effects of total rhinectomy and placement of a nasal epithesis were predominantly limited to the immediate nasal region. While patients were satisfied with their nasal appearance, they reported a worse assessment of their facial appearance and a measurable long-term effect on their psychological well-being.. Total rhinectomy and reconstruction with a full nasal epithesis is a safe and oncologically sound treatment approach. However, its effects on patients' overall appearance and psychological well-being need to be considered during treatment planning and follow-up.

Topics: Carcinoma, Squamous Cell; Female; Humans; Long Term Adverse Effects; Male; Mental Health; Middle Aged; Nose; Nose Neoplasms; Patient Reported Outcome Measures; Physical Appearance, Body; Postoperative Complications; Quality of Life; Rhinoplasty; Surgical Flaps; Treatment Outcome

To describe the surgical technique for nasal planum reconstruction with a lip-to-nose flap after curative intent surgical excision of squamous cell carcinoma (SCC) in cats and to report the surgical outcomes.. Short case series.. Seven cats with SCC of the lateral (n = 6) or dorsal (n = 1) aspect of the nasal planum.. After tumor excision, a mucocutaneous lip-to-nose flap was harvested from the upper lip and transposed to reconstruct the nasal planum. Variables recorded included surgical time, surgical complications, healing complications, flap success rate, and cosmetic and long-term functional outcomes.. Median surgical time was 67.5 minutes (range 49-80), and no intraoperative complications occurred. Postoperatively, six cats developed self-limiting edema of the muzzle, and one cat had nasal discharge for 2 days. No major complications occurred during the healing process, and all cats went on to achieve successful healing of their flap. A small area of partial-thickness necrosis developed at the cranial edge of the flap in three cats and healed spontaneously in all cases within a few days. According to owner satisfaction and periodic clinical assessment, cosmetic and long-term functional of outcomes were considered good in all cats.. The lip-to-nose flap allowed for aesthetic and functional reconstruction of the nasal planum after curative intent surgical excision of feline SCC.. The lip-to-nose flap is an option for a single-stage reconstruction of the nasal planum following partial nasal planectomy in cats.

Topics: Animals; Carcinoma, Squamous Cell; Cats; Face; Female; Humans; Lip; Male; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps; Wound Healing

Topics: Aged; Biopsy; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cryosurgery; Curettage; Female; Humans; Male; Melanoma; Mohs Surgery; Nose; Radiotherapy; Skin Neoplasms

Like all surgical procedures, dorsal nasal flaps may be followed by both early and late complications. The aim of this study was to evaluate the surgical complications and cosmetic outcome of dorsal nasal flaps over a 7-year period in an academic dermatologic surgery unit.. Data were collected retrospectively for all patients undergoing dorsal nasal flap between 1 January 2006 and 31 December 2013. Early and late complications were recorded. Patients were contacted by phone to assess long-term outcomes.. A total of 35 patients were included. Early complications included bleeding (n=2), local infection (n=2) and focal flap necrosis (n=1). Late complications comprised flap thickening (n=7), restriction of the medial canthus (n=2), opening of the labionasal angle (n=1), stitch granuloma (n=1) and telangiectasia on the flap (n=1). Regarding the aesthetic result, seven patients were very satisfied with the flap. Four patients underwent corrective surgery and one patient had laser treatment for telangiectasia on the flap.. Two thirds of patients were satisfied with the aesthetic results and one third had late complications of the flap. Consequently, patients undergoing Rieger-Marchac procedures must be informed of the potential need for further corrective measures following nasal dorsal flap repair.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Esthetics; Female; Granuloma; Humans; Keratoacanthoma; Keratosis, Actinic; Male; Middle Aged; Necrosis; Nose; Nose Neoplasms; Patient Satisfaction; Postoperative Hemorrhage; Retrospective Studies; Rhinoplasty; Surgical Flaps; Surgical Wound Infection

Topics: Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Margins of Excision; Nose; Nose Neoplasms; Skin; Skin Neoplasms; Treatment Outcome; Tumor Burden

The establishment of lung isolation is often particularly challenging for the anesthesiologist in patients with difficult airway. Usually, orotracheal intubation with double lumen tube is the commonly used technique for achieving 1 lung anesthesia. Whereas, in patients with limited mouth opening and restricted cervical mobility, this technique becomes extremely difficult and hazardous. We report a case in which bronchial blocker placement was succeeded via both nostrils in a difficult airway due to restricted mouth opening.. A 50-year-old, non-smoking female with a painless mass in the left upper lobe. She had a 10-year history of ankylosing spondylitis and squamous cell carcinoma of the floor of the mouth after 5 operations 4 years previously.. Left upper lobe adenocarcinoma, ankylosing spondylitis and oral squamous cell carcinoma.. To achieve 1 lung anesthesia, both nostrils were used for extraluminal bronchial blocker placement.. Initially, oral intubation was selected for establishing a patent airway but failed. Then switched to nasal canal for insertion, after several attempts, a conventional nasal intubation tube (internal diameter 6.0 mm) was placed via 1 nostril under topical anesthesia, with the aid of a flexible fiberoptic bronchoscope, and a bronchial blocker was advanced to the desired position via the other nostril.. In difficult airway with limited mouth opening and restricted cervical mobility, multidisciplinary experts participated discussion is a prerequisite for contemplating a scientific plan. Preoperative computed tomography scan and 3-dimensional computed tomography reconstruction would be helpful in detecting the narrowest part of airway conduit and determining a safe, reliable, and feasible airway program.

Topics: Adenocarcinoma of Lung; Airway Obstruction; Carcinoma, Squamous Cell; Female; Humans; Intubation; Lung Neoplasms; Middle Aged; Mouth; Mouth Neoplasms; Nose; One-Lung Ventilation; Spondylitis, Ankylosing

Topics: Carcinoma, Squamous Cell; Humans; Nose

Malignant keratinocyte tumors-that is, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)-are commonly found on sun-exposed body areas such as the nose. The primary aim of tumor surgery is complete excision. Due to anatomical, functional, and aesthetic issues, reconstruction of such defects remains a challenge.. We report on a series of 52 patients that were treated from 2015 to 2019 at the Goldman Clinic in Porto Alegre, Brazil. The mean age was 63 years (range 28-82 years, standard deviation 14.25 years). Thirty-nine (75%) patients were male and 13 (25%) female. The histological diagnosis was BCC in 49 patients and SCC in three.. Nasal defect closures were located on the nasal dorsum, tip, alar nose, and nasion. The nasal dorsal and alar region were the regions most commonly involved. All tumor specimens were 3D histologically investigated. A nasolabial flap was the reconstructive option in 40 subjects (76.9%). A bilobed flap was used in six patients (11.5%). Other flaps used for defect closure were a Rintala flap (n = 2), tunneled island flap (n = 1), and frontal flap (n = 1). Adverse events were rare and manageable. Three relapses were noted during follow-up.. Nasal reconstruction requires an armamentarium of surgical techniques to tailor the procedures based on tumor localization, size, and depth, and patients' needs.

Topics: Adult; Aged; Aged, 80 and over; Brazil; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Topics: Aged; Carcinoma, Squamous Cell; Esthetics; Forehead; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Rhinoplasty; Surgical Flaps; Treatment Outcome; Wound Closure Techniques

Standard treatment of squamous cell carcinoma (SCC) of the anterior nasal mucosa is surgical resection with or without postoperative radiation.. Retrospective review of patients diagnosed with SCC of the nasal cavity between January 2000 and July 2018 who refused total rhinectomy and who were treated with radiation with or without chemotherapy with curative intent.. Eleven patients were identified, 73% had stage III or stage IV disease. Four patients were treated with intensity-modulated radiotherapy and seven with intensity-modulated proton radiotherapy. Concurrent chemoradiotherapy was used in nine patients (82%). With a median follow-up of 15 months (3-124 months), two patients experienced recurrence and one developed distant metastasis and died from disease. The 2-year rhinectomy-free survival rate was 88%. Two-year overall survival and recurrence-free survival were 100% and 75%, respectively.. A radiation-based approach for SCC of the nasal cavity mucosa is a valid option for selected patients who refuse up-front surgery.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Carboplatin; Carcinoma, Squamous Cell; Chemoradiotherapy; Cisplatin; Female; Humans; Induction Chemotherapy; Male; Middle Aged; Nasal Cavity; Nose; Nose Neoplasms; Organ Sparing Treatments; Paclitaxel; Radiotherapy, Intensity-Modulated; Retrospective Studies

Microvascular reconstruction of the nose was pioneered in China in the early 1970s using the radial forearm flap. Since then, different flaps, methods, and flap designs have been used to improve outcomes. Microvascular tissue transfer has become the first step of multistage reconstruction, which includes rebuilding the nasal framework, transferring a forehead flap for external skin coverage, and sculpting the nose for improved appearance and breathing. In this article, the authors present their long-term experience in microvascular reconstruction of the nose using the infolded radial forearm flap for full-thickness nasal defects, and a single circumferential flap for inner lining only.. Fifty microvascular nasal reconstruction procedures were performed on 47 patients between 2000 and 2017 using the radial forearm flap. The reconstructions included total/subtotal nasal defects using a trapezoid-shaped forearm flap folded in one or two planes, and a rectangular flap positioned internally and circumferentially for lining only. The nasal defects were caused by cancer resection, trauma, infection, cocaine abuse, and failed attempts at nasal reconstruction.. Forty-seven flaps were transferred successfully for nasal reconstruction, with two immediate failures (4 percent) caused by flap insetting complications and one late loss. Forty-six patients completed the multistage nasal reconstruction. Follow-up was 1 to 17 years (average, 6 years).. The radial forearm flap infolding technique is the authors' method of choice for microvascular reconstruction of the nose because it allows placement of a primary dorsal cartilage graft for optimal vascularization, and uses the excess dorsal skin during forehead resurfacing to modify the lining inset and shape the nostrils.. Therapeutic, IV.

Topics: Adolescent; Adult; Aged; Carcinoma, Squamous Cell; Child; Female; Forearm; Humans; Male; Middle Aged; Nose; Nose Diseases; Nose Neoplasms; Rhinoplasty; Skin Transplantation; Surgical Flaps; Young Adult

Feline leishmaniasis (FeL) is an emerging infectious disease of cats caused by Leishmania infantum with global distribution. This study investigated the cause of chronic progressive cutaneous lesions in two cats from Central-west Brazil by using cytological, histopathologic, and immunohistochemical (IHC) analyses. Clinically, both cats had ulcerative cutaneous lesions at the nasal planum and ear resulting in a tentative diagnosis of squamous cell carcinoma (SCC). Moreover, both cats had varying degrees of onychogryphosis. However, cytology revealed chronic inflammatory reactions associated with intralesional amastigotes; histopathology confirmed chronic ulcerative dermatitis associated with intralesional and intracytoplasmic parasitic organisms consistent with amastigotes of Leishmania spp. within histiocytes. The IHC assay demonstrated that the intralesional parasitic structures identified by cytology and histopathology were immunoreactive to antigens of Leishmania spp., confirming the participation of this infectious disease agent in the development of the cutaneous lesions of these cats. The observation of onychogryphosis must be highlighted, since this lesion is frequently observed in dogs with visceral leishmaniasis but is underreported in FeL. Collectively, the pathologic and IHC findings of the chronic cutaneous disease confirmed active infections due to Leishmania spp. in these cats. Additionally, FeL with associated lesions to the ear and nasal planum must be considered as differential diagnosis for SCC in cats.

Topics: Animals; Biopsy, Fine-Needle; Brazil; Carcinoma, Squamous Cell; Cat Diseases; Cats; Cities; Diagnosis, Differential; Ear, External; Female; Forelimb; Hindlimb; Immunohistochemistry; Leishmania infantum; Leishmaniasis, Cutaneous; Nose; Skin Neoplasms

Topics: Carcinoma, Squamous Cell; Forehead; Humans; Maxillary Sinus; Nose; Rhinoplasty; Skin; Subcutaneous Fat; Surgical Flaps; Tonsillectomy

Direct silicone printing may be applied to the fabrication of maxillofacial prostheses, although its clinical feasibility is unknown. The present clinical report shows an early application of a directly printed silicone prosthesis for the rehabilitation of a nasal defect. Two extraoral scanning systems were used to capture the face and the defect. The virtual construction of the nasal prosthesis was performed with free-form software. Two prostheses were printed in silicone and post-processed by manual sealing and coloring. The clinical outcome was acceptable for an interim prosthesis; however, the marginal adaptation and color match were not satisfactory without further individualization.

Topics: Adult; Carcinoma, Squamous Cell; Coloring Agents; Computer-Aided Design; Face; Female; Humans; Imaging, Three-Dimensional; Maxillofacial Prosthesis; Nasal Cavity; Nose; Printing, Three-Dimensional; Prosthesis Design; Prosthesis Implantation; Silicones; Software; Workflow

Squamous cell carcinoma (SCC) of the head and neck can be treated with a combination of modalities. There is an esthetic and functional compromise with midfacial defects secondary to ablative surgery and adjuvant therapies for SCC. Osteoradionecrosis, tissue contracture, and trismus, are all negative side effects of treatment and can impact a patient's function and possibly their nutrition. In this report, we describe a procedure for fabrication of a prosthesis that provides cosmetic improvement and labial competence to maintain caloric intake.

Topics: Aged; Carcinoma, Squamous Cell; Face; Humans; Lip; Lip Neoplasms; Male; Nose; Nose Neoplasms; Plastic Surgery Procedures

Total nasal reconstruction is a challenging surgical procedure which usually involves a free flap, forehead flap, and cartilage grafts. In certain failure situations where patients do not accept the idea of anaplastology, possibilities become very limited. We report the case of a patient who underwent several reconstruction steps with multiple failures including free and local flaps and cartilage harvests which showed recurrent episodes of necrosis and infection leading to melting and collapse of reconstructed structures. Furthermore, the patient did not want any anaplastological rehabilitation. We proposed to the patient an innovative method that consists to print a three-dimensional custom-made porous titanium prosthesis, based on the original shape of his nose, to replace the cartilage support. This implant was first inserted in a thoracodorsal artery perforator flap for primary integration before the free transfer of the complete structure, two months later. The free transfer was successful without any complication. A stable reconstruction and satisfying result was obtained. The patient did not want additional surgical improvement 24 months post-operatively, and resumed his professional activities. The possibility of using three-dimensional custom titanium prostheses to replace the bone and cartilage support seems to be an interesting alternative for patients in the failure situation of nasal reconstruction.

Topics: Amputation, Surgical; Anastomosis, Surgical; Carcinoma, Squamous Cell; Echocardiography, Doppler, Color; Follow-Up Studies; Humans; Length of Stay; Male; Mandibular Reconstruction; Maxillary Neoplasms; Middle Aged; Nose; Perforator Flap; Prostheses and Implants; Rhinoplasty; Surgical Mesh; Thoracic Arteries; Titanium; Transplant Donor Site; Treatment Outcome

Merkel cell carcinoma (MCC) is a rare but more lethal cutaneous cancer than melanoma. However, spontaneous regression of a number of MCC has been reported, although the cause of this regression remains unclear. In most cases, MCC regresses after a surgical procedure, for example, biopsy. Herein, we report a case of Merkel cell polyomavirus-negative MCC coincident with squamous cell carcinoma (SCC) that underwent true spontaneous regression without biopsy. One month after the patient's first visit, clinical examination revealed that the tumor had not grown, but its surface showed changes in texture and color. Histopathologically, the excised specimen was indicative of MCC coincident with SCC and showed extensive necrosis in the upper portion of the tumor, numerous caspase-3-positive apoptotic cells, an accumulation of CD68-positive foam cells and vascular invasion. These findings suggested that the tumor had regressed. We hypothesize that extensive coagulative necrosis resulting from an insufficient local blood supply triggered the shedding of some products or components of MCC and SCC, which in turn induced antitumor immunity against both lesions.

Topics: Aged, 80 and over; Biopsy; Carcinoma, Merkel Cell; Carcinoma, Squamous Cell; Female; Humans; Margins of Excision; Merkel cell polyomavirus; Neoplasm Regression, Spontaneous; Neoplasms, Multiple Primary; Nose; Skin; Skin Neoplasms

Topics: Adenocarcinoma; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Carotid Artery Injuries; Carotid Artery, Common; China; Cholesterol; Granuloma, Foreign-Body; Humans; Ligation; Natural Orifice Endoscopic Surgery; Nose; Retrospective Studies; Salivary Gland Neoplasms; Salvage Therapy; Skull Base

Surgical excision of large malignant lower eyelid tumors may cause important full-thickness eyelid defects. The reconstruction of such defects must restore the physiologic function of the eyelid and also re-establish an acceptable aesthetic result.. We report the outcomes of full-thickness excision of tumors extending over half of the horizontal lid length, followed by reconstruction using a nasal chondromucosal graft (coming from the ipsilateral ala of the nose) and an upper eyelid myocutaneous flap. Histological analysis of the specimen identified the tumor type and surgical margins for each patient.. A total of 25 patients were operated using this reconstruction technique between March 2009 and June 2015: 17 basal cell carcinomas, 3 spindle cell carcinomas and 5 conjunctival melanomas (out of which 2 were associated with lentigo maligna). Mean duration of follow-up after surgery was respectively 36, 41 and 17 months for each of these 3 tumor types. We found a single local tumor recurrence and this was a basal cell carcinoma in a xeroderma pigmentosum patient. After surgery, none of the patients had lagophthalmos or ocular surface complications. Only 4 patients had a 1mm scleral show postoperatively; 3 other patients developed a small retraction of the eyelid after adjuvant radiotherapy and a 1mm scleral show occurred.. In malignant tumors, complete surgical excision with histological margins adapted to tumor type prevents local recurrence in most cases. Our repair strategy of nasal chondromucosal graft and skin-muscle flap for large inferior eyelid defects provides good functional and aesthetic results.

Topics: Adult; Aged; Aged, 80 and over; Blepharoplasty; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Eyelid Neoplasms; Female; Humans; Male; Melanoma; Middle Aged; Myocutaneous Flap; Nasal Cartilages; Nose; Plastic Surgery Procedures; Respiratory Mucosa; Retrospective Studies; Skin Neoplasms; Skin Transplantation; Treatment Outcome; Young Adult

Squamoid eccrine ductal carcinoma (SEDC) is an extremely rare cutaneous tumor of unknown etiology. We report the case of a 77-year-old man with a history of treated chronic lymphocytic leukemia along with numerous basal cell and squamous cell carcinomas who presented for evaluation of a 5-cm, stellate, sclerotic plaque on the left chest of approximately 2 years' duration and a suspicious 3-mm pink papule on the right nasal sidewall of 2 months' duration. Initial histology of both lesions revealed carcinoma with squamous and ductal differentiation that extended from the undersurface of the epidermis, favoring a diagnosis of SEDC. It was later determined that the patient had distant metastasis of SEDC. This report of an immunocompromised patient with SEDC is a rare case of distant metastasis of SEDC. A review of the literature on the diagnosis, treatment, and surveillance of SEDC also is provided.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Diagnosis, Differential; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Neoplasm Metastasis; Neoplasms, Multiple Primary; Nose; Skin Neoplasms; Sweat Gland Neoplasms; Thorax

Skin cancer removal surgery involving the tip or dorsum of the nose often results in large-sized defects with exposure of cartilage. In such cases, the paramedian forehead flap is a frequently used reconstruction technique; however, this method is complex and can result in a cosmetically unsatisfying outcome.. To describe the folded transposition flap as an aesthetically pleasing alternative to the paramedian forehead flap for large nasal defects with exposed cartilage.. The folded transposition flap is a 2-stage surgical modification of the transposition flap. In the first stage, an overlong axial cheek pedicle is used to cover the defect. In the second stage, the flap is thinned and the nasal scars are revised.. All 4 patients experienced aesthetically pleasing results.. The folded transposition flap is an alternative for reconstructing large surgical defects of the nasal tip or distal dorsum of the nose.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Dermatologic Surgical Procedures; Esthetics; Female; Forehead; Humans; Male; Middle Aged; Nasal Cartilages; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps; Wounds and Injuries; Xanthomatosis

Topics: Antineoplastic Agents; Carcinoma, Squamous Cell; Delayed Diagnosis; Ear Auricle; Fatal Outcome; Humans; Keratosis; Laryngeal Neoplasms; Male; Middle Aged; Nose; Paraneoplastic Syndromes; Radiotherapy

The typical reconstructive option for closing large-sized defects of the distal half of the nose is the paramedian forehead flap. Other alternatives are a melolabial interpolation flap and bilobed or trilobed flaps. The dorsal nasal (Rieger) flap is suitable for closing small-sized defects at this location, especially when they are medially located.. The authors describe a modified dorsal nasal flap reconstruction for large nasal defects. The novelty of this study lies in lengthening the leading edge of flap rotation, which may provide tissue either from the adjacent nasal skin, the nasofacial groove, or the cheek.. The authors performed a retrospective chart review of all patients with large defects (>20 mm) of the nose who underwent modified dorsal nasal flap repair between January 2004 and March 2015 at a single academic center.. Twenty-seven patients (16 male, 11 female; ages 44-88, mean age 62 years) had defects (the smallest 15 × 21 mm, and the largest 32 × 37 mm) on the lower portion of the nasal pyramid. Follow-up ranged from 12 months to 11 years with good or excellent results in all cases.. Elongated dorsal nasal flap is a reproducible one-stage flap for large defects of the nose, with minimal risk of aesthetic or functional complications.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Esthetics; Female; Follow-Up Studies; Humans; Hutchinson's Melanotic Freckle; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Retrospective Studies; Surgical Flaps

The risk of cancer is significantly increased in patients undergoing renal transplant surgery than in the general population. In particular, skin cancer is the most commonly occurring cancer in these patients.A 34-year-old man underwent living renal transplantation for focal segmental glomerulosclerosis. After 18 months, he developed a lesion on the nasal dorsum, approximately 1 cm in size, and the lesion rapidly expanded to cover the entire dorsum.Owing to its rapid expansion, the lesion was suspected to be a malignant tumor and wide excision was planned.We removed the lesion with a 6-mm margin. Squamous cell carcinoma was diagnosed through intraoperative rapid pathological examination. The nasal bone and septum were invaded by the tumor and, as a result, the entire external nose was removed. The patient's nose was subsequently reconstructed using a free forearm flap for lining, iliac bone graft for the nasal frame, and a scalping forehead flap for skin coverage.Selective target radiotherapy was administered at the closest margin around the lesion, and the dosage of immunosuppressants was reduced.At >2 years postoperatively, the patient showed good cosmetic results with no relapse or metastasis of the tumor.We report the unusual case of a young man who developed a rapidly progressing squamous cell carcinoma on his nasal dorsum after 18 months of immunosuppression. Squamous cell carcinoma in organ transplant recipients may be more aggressive and may progress differently than in regular patients. Therefore, special attention is required for patients who take immunosuppressive drugs after renal transplant surgery.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Disease Progression; Free Tissue Flaps; Graft Rejection; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Nose; Nose Neoplasms; Time Factors; Young Adult

Topics: Adult; Carcinoma, Squamous Cell; Endoscopy; Humans; Laryngeal Neoplasms; Nose; Nose Neoplasms; Papilloma; Pharyngeal Neoplasms; Pharynx; Retrospective Studies; Tomography, X-Ray Computed

This report describes an approach to the simultaneous retention of a nasal prosthesis and an intraoral prosthesis for a patient who had undergone a total rhinectomy with resection of the upper lip and premaxilla. At the time of the nasal resection, 2 dental implants were placed adjacent to the resection margins in the first premolar positions. These were used to anchor an intraoral, milled titanium bar and overdenture to replace the missing anterior teeth and provide support for the upper lip, which had been reconstructed with a vascularized radial forearm free-flap. The titanium bar also incorporated a connection for a tissue-penetrating percutaneous nasal extension, which pierced the radial forearm flap near the junction with the hard palate. Magnetic attachments screwed to the nasal extension retained a nasal prosthesis. The predictable and straightforward implementation of this novel concept with digital design and manufacture of the titanium components and guided placement of the nasal extension was made possible with software planning.

Topics: Aged; Carcinoma, Squamous Cell; Female; Humans; Maxillofacial Prosthesis; Maxillofacial Prosthesis Implantation; Nose; Nose Neoplasms; Prosthesis Retention

Advanced nasal cancers usually demand partial or total rhinectomy followed by radiotherapy. Reconstruction of the resulting defects can be achieved by means of reconstructive plastic surgery and/or epithetic surgery. The data of 22 patients who had been treated after nasal ablation by means of custom-made silicone nasal epithesis fixed by bone-anchored magnets between 2003 and 2014 were evaluated retrospectively. There were 15 male (68.2 %) and 7 (31.8 %) female patients. The most common etiology that led to epithetic rehabilitation was a squamous cell carcinoma in 16 patients. An operative revision was necessary in two patients due to screw loss. Twenty patients were still alive with no evidence of disease after minimum follow-up of 2 years (90.9 %). Epithetic rehabilitation after nasal ablation to treat nasal malignancies is an interesting alternative to plastic and reconstructive surgery. Bone-anchored fixation using magnets can achieve a stable epithetic fixation after nasal ablation necessitating, in numerous cases, additional adjuvant therapy like radiation.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Prostheses and Implants; Retrospective Studies; Treatment Outcome

Squamous cell carcinoma is the most common carcinoma in the oral cavity. Resection of these cancers often requires reconstruction. Nasolabial flaps are a robust and reliable local flap that provide a satisfactory outcome. We report two cases where an epidermoid cyst developed within the scar of the nasolabial flap and review the literature.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Epidermal Cyst; Female; Humans; Lip; Mouth Neoplasms; Nose; Postoperative Complications; Surgical Flaps

Nasal carcinoma extending into the premaxilla requires radical surgical excision including rhinectomy and partial maxillectomy. Rehabilitation is complex and involves the use of removable prostheses. Three patients treated with zygomatic implants and custom-milled bars to retain an obturator and nasal prosthesis are presented.

Topics: Aged; Carcinoma, Squamous Cell; Computer-Aided Design; Female; Humans; Male; Maxilla; Maxillofacial Prosthesis; Nose; Nose Neoplasms; Palatal Obturators; Prosthesis Design; Zygoma

Defects of the nasal ala and upper lip aesthetic subunits can be challenging to reconstruct when they occur in isolation. When defects incorporate both the subunits, the challenge is compounded as subunit boundaries also require reconstruction, and local soft tissue reservoirs alone may provide inadequate coverage. In such cases, we used nasolabial flaps for upper lip reconstruction and a forehead flap for alar reconstruction.. Three men and three women aged 21-79 years (average, 55 years) were treated for defects of the nasal ala and upper lip that resulted from cancer (n = 4) and trauma (n = 2). Unaffected contralateral subunits dictated the flap design. The upper lip subunit was excised and replaced with a nasolabial flap. The flap, depending on the contralateral reference, determined accurate alar base position. A forehead flap resurfaced or replaced the nasal ala. Autologous cartilage was used in every case to fortify the forehead flap reconstruction.. Patients were followed for 25.6 months (range, 1-4 years). All the flaps survived, and there were no complications. Satisfactory aesthetic results were achieved in every case. With the exception of a small vertical cheek scar and a vertical forehead scar, all incisions were concealed within the subunit borders.. From preliminary experience, we advocate combining nasolabial flap reconstruction of the upper lip with a forehead flap reconstruction of the ala to preserve normal facial appearance. This combination addresses an important void in the algorithmic approach to central facial reconstruction.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Esthetics; Female; Forehead; Humans; Lip; Lip Neoplasms; Male; Middle Aged; Nasal Cartilages; Nose; Nose Neoplasms; Rhinoplasty; Skin Transplantation; Surgical Flaps; Treatment Outcome; Young Adult

To evaluate the effect of nasolabial flap with Facial artery perforator for repairing defects after resection of midface tumor.. Between January 2012 and June 2015,31 cases with midface tumor, including base cell carcinoma(18 cases),squamous cell carcinoma(13 cases).The tumor size ranged from 0.8 cm × 2.0 cm to 2.0 cm × 3.5 cm. The extended resection of the tumor tissue was performed according to the characters of tumor. Intraoperative frozen specimen was used to make sure no invasion at margin and wound base. According to the location and size of the defect, nasolabial flap with perforator was designed to repair the defect, the defect at donor site was directly closed. The flaps size ranged from 1.5 cm × 3.0 cm to 3.0 cm × 5.0 cm, and the pedicle length was 1.0 cm to 2.5 cm.. All the 31 flaps survived completely, including 5 cases with vascular crisis at the flap tip, which resolved after active procedure. All the patients were followed up for 6-36 months with unconspicious scar at nasolabial fold and no deformities. The flap had satisfactory appearance with good match of texture and color.. Nasolabial flap with facial artery perforator is an optimal choice for reconstruction of facial defects with good appearance and flexible transfer.

Topics: Arteries; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cicatrix; Face; Head; Humans; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Surgical Flaps

Reconstruction of tongue defects after cancer resection is challenging for reconstructive surgeons. Conventional local flaps are usually compromised in patients with suspected ipsilateral neck metastasis. To extend the application of the nasolabial flap, especially in circumstances in which a free flap is unavailable, the contralateral nasolabial island flap was used, with favorable outcomes.. Seven patients presenting with tongue carcinoma underwent surgical resection and neck dissection. Tongue defects were simultaneously reconstructed using a contralateral nasolabial island flap. Clinical outcomes, including locoregional recurrence and distant metastasis, were recorded. Subjective functional outcomes were investigated using the University of Washington Quality of Life Questionnaire.. All flaps survived without partial or complete necrosis. All patients survived without locoregional recurrence or distant metastasis during follow-up (6 months to 2 years). Functional outcomes were satisfactory, especially swallowing and speech functions. Donor-site morbidity was minimal and the scars were inconspicuously hidden in the nasolabial fold.. The contralateral nasolabial island flap is technically feasible and can be an excellent option for tongue reconstruction without compromising oncologic safety.

Topics: Aged; Carcinoma, Squamous Cell; Cicatrix; Deglutition; Feasibility Studies; Follow-Up Studies; Graft Survival; Humans; Lip; Male; Middle Aged; Neck Dissection; Neoplasm Recurrence, Local; Nose; Patient Satisfaction; Plastic Surgery Procedures; Quality of Life; Skin Transplantation; Speech; Surgical Flaps; Survival Rate; Tongue; Tongue Neoplasms; Transplant Donor Site; Treatment Outcome

A large proportion of malignancies involving the external nose can be managed with limited resection and local autologous reconstruction or, in some cases, radiotherapy as primary or adjuvant treatment. We highlight a small cohort of patients undergoing total rhinectomy for advanced nasal malignancies.. A retrospective review of all patients undergoing total rhinectomy in our institution from 2006 to 2014 was undertaken. We reviewed patient demographics, surgical management, adjuvant treatment, histology, reconstruction and outcomes.. Nine patients underwent total rhinectomy over an 8-year period, three of whom were being treated for recurrent disease. Eight patients had squamous cell carcinoma (SCC) and a single patient had an angiosarcoma. Two patients completed adjuvant radiotherapy. Seven patients underwent nasal prosthetic rehabilitation. All nine patients are alive and disease free at latest follow-up.. Total rhinectomy is an uncommon procedure usually undertaken for extensive nasal malignancy. Nasal prosthetic rehabilitation is a viable method of reconstruction.

Topics: Aged; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Radiotherapy, Adjuvant; Retrospective Studies; Rhinoplasty; Treatment Outcome

To describe a technique using labial mucosal flaps to correct stenosis of the nares subsequent to bilateral rostral maxillectomy and nasal planum resection.. Case report. Client-owned dog.. A 10-year-old, neutered male Golden Retriever developed repeated stenosis of the nares, at first after bilateral rostral maxillectomy and nasal planum resection, and again after revision surgery. Bilateral, superior labial mucosal transposition flaps were created and interpolated between the nasal mucosa and skin after debridement of scar tissue.. The stenosis did not recur after mucosal flap transposition and the dog returned to normal quality of life (last follow-up 25 months postoperative).. Single-stage, superior labial mucosal transposition flaps can be used to correct nares stenosis subsequent to previous surgery.

Topics: Animals; Bone Neoplasms; Carcinoma, Squamous Cell; Constriction, Pathologic; Dog Diseases; Dogs; Male; Maxilla; Nose; Reoperation; Surgical Flaps

This article evaluates malignant transformation of lesions presenting in the periocular skin under the eye spectacle nose pad. A non-comparative retrospective chart review of clinical features and pathological findings of patients presenting with periocular malignancies in the exact vicinity where the nose pads of their eye spectacles rested was completed. The study took place in one tertiary oculoplastic referral center between 2007-2013. Ten patients were included, six of whom were male. All subjects wore eye spectacles while awake for at least 15 years, and had an evident suspicious lesion in the exact area that coincided with the resting place of the nose pad. The mean age was 73.5 years (range 65-85 years) and all patients had the lesion present for at least one year. Most cases were squamous skin malignancies (five squamous cell carcinomas [SCC], 2 intra-epidermal carcinomas [IEC], while 3 basal cell carcinomas [BCC]). Treatment involved surgical excision of the lesion with frozen section for margin control and reconstruction with a myocutaneous flap. Periocular malignancies of the inferior medial canthal area, where the nose pad of eye spectacle places pressure, can be easily missed or misdiagnosed. Marjolin ulcers (MU) classically present as an aggressive SCC in area of chronic inflammation, which has been previously correlated to constant pressure, repetitive trauma, or non-healing wounds in other areas of the body. We propose that the traumatic chronic pressure in the infero-medial canthal region from long-term eye spectacle nose pad use, may induce poor lymphatic regeneration leading to an immune system deficiency that predisposes this skin to a malignant transformation. The presence of chronic eye spectacle nose pads also prevents proper and timely detection of such malignancies. Complete excision of these lesions with margin control, adequate follow-up for possible recurrence, and surveillance for new lesions on the patient's contralateral side, is crucial for adequate management.

Topics: Aged; Aged, 80 and over; Carcinoma in Situ; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Eyeglasses; Female; Humans; Male; Nose; Retrospective Studies; Skin Neoplasms

The glabella is an aesthetic subunit placed on the forehead between the eyebrows. The reconstruction of this area can be challenging for cosmetic outcomes. In our experience, moderate glabellar defects reconstruction should introduce extra skin to preserve the interciliary space.. Under local anesthesia, tumoral excision with safety margins on the glabellar area was performed in 5 patients. The oncologic resection resulted in moderate sized glabellar defects. We used a myocutaneous nasal root island flap based on the periocular muscles for the reconstruction of these defects with primary closure of the donor site.. Five nasal root island flaps were successfully performed for glabellar defects reconstruction after tumoral excisions. The aesthetic results were satisfactory with respect to color and texture match and scars qualities. The eyebrow junction was successfully avoided.. We present an alternative method for the reconstruction of central and moderate sized glabellar defects. The nasal root island flap is a reliable and easy to perform 1-stage technique with satisfactory aesthetic outcomes.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Esthetics; Facial Neoplasms; Female; Follow-Up Studies; Forehead; Head and Neck Neoplasms; Humans; Hutchinson's Melanotic Freckle; Male; Middle Aged; Myocutaneous Flap; Nose; Plastic Surgery Procedures; Pseudolymphoma; Skin Neoplasms; Squamous Cell Carcinoma of Head and Neck; Treatment Outcome

Nasolabial flaps based on the lateral side of the nose for the reconstruction of lateral nasal defects in a single-stage procedure have been described. Similarly, in midline defects, nasolabial flaps can be used but a 2-stage procedure is classically required. The Midline-based Nasolabial Transposition (MNT) flap is presented as a new single-stage procedure for nasal tip reconstruction.. Between 2009 and 2011, an MNT flap was used as a single-stage procedure in 3 cases of large nasal defects of the tip where the forehead flap was either contraindicated or rejected as an option by the patient.. There were no complications and a satisfactory aesthetic result was achieved in all cases.. The MNT flap is a new single-stage procedure for large nasal tip defects and as such represents an interesting alternative to the classical 2-stage forehead and nasolabial flaps, especially in elderly patients.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Lip; Male; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Squamous Cell Carcinoma of Head and Neck; Surgical Flaps; Treatment Outcome

Angular artery, lateral nasal artery, and infraorbital artery pedicled nasolabial flaps have been used for reconstruction of lower nose and medial cheek defects. An alternative pedicle to raise a flap in the nasolabial area is the superior labial artery. Superior labial artery is a constant branch of the facial artery, arising above or at the angle of mouth and anastomoses with its counterpart in the middle of the upper lip. This makes a reverse superior labial artery pedicle possible for elevation of a nasolabial flap.. Reverse superior labial artery island flaps were used for reconstruction of lower nose and medial cheek defects in 12 patients. Eleven patients presented with malignant skin lesions and 1 with a traumatic defect of the lower nose. Auricular cartilage graft to support the alar rim and nasal tip was combined to the flap in 3 patients.. All flaps survived completely. Temporary venous congestion was observed in 3 flaps in the early postoperative period but this resolved in 3 to 5 days. All patients healed without any postoperative complications and the final results were considered satisfactory.. Reverse superior labial artery pedicled nasolabial island flap proved to be a good choice for reconstruction of the lower nose and moderate sized medial cheek defects. This pedicle should be considered where the defect is located on the course of lateral nasal artery or angular artery. Arc of rotation and reliability of this new flap is considered superior to angular artery and infraorbital artery-based nasolabial flaps where these arteries could also be used as pedicle.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Ear Cartilage; Facial Neoplasms; Female; Humans; Lip; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Local skin flaps can be divided into two types: random flaps and axial flaps. An axial flap is defined as a flap containing a named artery in its pedicle. For the paramedian forehead flap (PMFF) a lot of surgeons insist on the point that the pedicle must contain the supratrochlear artery. To demonstrate that median forehead flaps (MFF) need not contain a named artery, we selected first 8 patients with a PMFF and further 12 patients who had undergone reconstructive surgery using a MFF. After division, we analysed the pedicle of the flap histologically and measured the diameter of the arteries or arterioles and compared them to anatomical descriptions of the frontal arteries. In none of the 12 cases could we find a functional artery of approximately 1 mm in diameter that could correspond to the supratrochlear artery. The MFF is an axial flap but not in accordance with the current definition of this term. In contrast to published literature, we show that only in a part of cases a named artery was present in the pedicle. Despite this fact, the MFF is a secure flap for full thickness defect repair on the nose.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Forehead; Histological Techniques; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Ophthalmic Artery; Plastic Surgery Procedures; Postoperative Complications; Skin Neoplasms; Surgical Flaps; Treatment Outcome; Wound Healing

Oncologic outcomes for sinonasal and skull base squamous cell carcinoma (SCC) treated with an endoscopic endonasal approach (EEA) needs investigation.. Patients with SCC treated with EEA were stratified by treatment strategy and tumor etiology and reviewed.. Thirty-four patients were treated with EEA, or which 27 had definitive resection and 7 had debulking surgery. In the definitive group, 17 had de novo tumors and 10 had tumors arising from inverted papilloma. Definitive resection was associated with better 5-year disease-free survival (DFS) and overall survival (OS) than debulking (62% vs 17%; p = .02; and 78% vs 30%; p = .03). Patients with de novo tumors had similar 5-year DFS and OS to those arising from inverted papilloma (62% vs 62%; p = .75; and 75% vs 86%; p = .24).. Definitive resection of sinonasal SCC with EEA provides sound oncologic outcomes. SCC arising from inverted papilloma does not have prognostic significance.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Neoplasm Invasiveness; Neoplasm Staging; Nose; Paranasal Sinus Neoplasms; Retrospective Studies; Skull Base Neoplasms; Survival Analysis; Treatment Outcome

This study aimed to describe management of esophageal stenosis after chemoradiation therapy for head and neck squamous cell carcinoma (HNSCC), with particular emphasis on techniques and outcomes with the use of the transnasal esophagoscope (TNE) in the office as well as operating room settings.. Retrospective analysis of all patients with esophageal stenosis following head and neck cancer radiation, with or without chemotherapy, and managed with TNE-assisted esophageal dilation over a 5-year period. Preoperative and postoperative swallowing function were assessed objectively with the Functional Outcome Swallowing Scale (FOSS; ranging from score 0, a normal diet, to score 5, complete dependence on nonoral nutrition).. Twenty-five patients met inclusion criteria. The mean pretreatment FOSS score was 4.4, whereas the mean posttreatment FOSS score was 2.7 (Wilcoxon signed-rank test, P<.001). Prior to dilation, 16 patients were completely gastrostomy-tube dependent (FOSS 5), of whom 12 (75%) were able to tolerate oral nutrition for a majority of their diet following treatment according to our protocol. No complications were noted.. Dysphagia following chemoradiation therapy for HNSCC is often related to esophageal stenosis. With the aid of TNE, we have developed a successful treatment strategy for esophageal stenosis with improved success rates.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Chemoradiotherapy; Deglutition; Dilatation; Esophageal Stenosis; Esophagoscopy; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Male; Middle Aged; Nose; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck; Treatment Outcome

Topics: Aged, 80 and over; Carcinoma, Squamous Cell; Esthetics; Female; Humans; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps; Suture Techniques

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Male; Nose; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Suture Techniques; Treatment Outcome

We have used the retroangular flap for the reconstruction of facial defects after excision of tumours. Important variables such as vascular mapping, type of anaesthesia, duration of stay in hospital, and the diagnosis and treatment of complications were taken into account in assessing its effectiveness. We studied 187 patients, 103 men and 84 women, who were treated with the retroangular flap, and the morphological and cosmetic results analysed. There are many vascular variations of the flap The patients were followed up for a median of 12 (range 12-125) years and their reconstructions were successful. The technique can be considered as one of first methods of choice for the reconstruction of cutaneous defects of the middle third of the face.

Topics: Anesthesia, Local; Angiography; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Face; Facial Neoplasms; Female; Follow-Up Studies; Graft Survival; Humans; Male; Microsurgery; Necrosis; Nose; Perforator Flap; Plastic Surgery Procedures; Postoperative Complications; Skin; Skin Transplantation; Surgical Flaps

Titanium mesh has been employed in neurosurgery, plastic surgery, and maxillofacial surgery as a bone replacement in diverse conditions. We first reported on its use as a substitute for osteocartilaginous nasal structure with satisfactory functional and aesthetic results in 2009.. To assess the utility and tolerance of titanium mesh as a substitute of the osteocartilaginous portion of the nose.. Eleven patients were identified who had a nasal reconstruction with titanium mesh. We retrospectively searched for infection, extrusion, nasal valve collapse, second surgery, and patient satisfaction in the patients' records. All patients presented with various types of non-melanoma skin cancer in the nasal pyramid. In the reconstruction of full-thickness nasal defects, local flaps were used, employing titanium mesh as a support structure.. No mesh extrusions, infections, or collapse of the nasal valve were noted in patients with a mean follow-up of five years. Only one patient needed a second surgery to debulk the flap. Patient satisfaction achieved a mean score of 7.5 out of 9 in 10 patients.. As cartilage grafts need a second surgical site, with consequent morbidity, the use of titanium mesh proves useful and safe in the reconstruction of nasal full-thickness defects. The results of our series of patients demonstrate the suitability of this material in the repair of nasal osteochondral defects, as well as its low rate of complications.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Dermatologic Surgical Procedures; Female; Follow-Up Studies; Humans; Male; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Patient Satisfaction; Prostheses and Implants; Reoperation; Retrospective Studies; Skin Neoplasms; Surgical Flaps; Surgical Mesh; Titanium

Topics: Aged; Antigens, Fungal; Asthma; Blastomyces; Blastomycosis; Carcinoma, Squamous Cell; Delayed Diagnosis; Diagnosis, Differential; Dyspnea; Glucocorticoids; Humans; Lung; Male; Nose; Nose Neoplasms; Pulmonary Embolism; Radiography; Venous Thrombosis

The repair of full-thickness nasal alar defects presents difficulties because of their complex 3-dimensional structure. Reconstructions using inappropriate methods may lead to asymmetries and dissatisfying functional results. In this study, our aim was to present the repairs of full-thickness alar defects performed using cartilage-supported nasolabial perforator flaps.. Eight patients who presented to our clinic between January 2011 and April 2014 with full-thickness defects in the alar wings were included in this study. The nasolabial perforator flap was prepared on the basis of the closest perforator to the defect area and in a way to include 2 to 3 mm of subcutaneous adipose tissue. The medial section of the flap was adapted to form the nasal lining. In the 7 patients in whom cartilage support was used, the cartilage graft was obtained from the septum nasi. After the cartilage was placed on the flap, the lateral section of the flap was folded over the medial section and the defect was repaired. In 1 patient in whom cartilage support was not required, the flap was folded over itself before the repair was performed. The flap donor area was primarily repaired.. No detachment around the suture lines, infection, venous insufficiency in the flap, or partial or total flap losses were observed in any of the patients. Retraction developed in 1 patient in whom no cartilage support was used. No retraction was observed in any of the patients in whom cartilage support was used. The results were functionally and esthetically satisfying in all the patients.. The greatest advantage of perforator-based nasolabial flaps is the greater mobilization achieved in comparison with the other nasolabial flaps. Thus, full-thickness defects can be repaired in 1 session in some patients, no revision is required around the flap pedicle, and much less donor area morbidity occurs. Nasal alar reconstructions performed using this type of flap lead to both esthetically and functionally satisfying results.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Humans; Lip; Male; Middle Aged; Nasal Cartilages; Nose; Nose Neoplasms; Perforator Flap; Rhinoplasty; Skin Neoplasms; Treatment Outcome

To explore the anatomic basis and clinical application of the horn shaped perforator flap pedicled with the angular artery for the reconstruction of midface defect.. (1) 10 fresh cadavers were perfused with a modified guiding oxide gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise' s interactive medical image control system, MIMICS). The origin and distribution of the angular artery perforator were observed. (2) Between July 2012 and July 2014, twenty-one patients underwent operations for the reconstruction of midface defect. Ten patients had squamous cell carcinoma, nine patients had basal cell carcinoma and two patients had nevus. The flaps' size ranged from 1.5 cm x 3.5 cm to 2.5 cm x 5.0 cm.. The facial artery branches the lateral nasal artery 1 cm from the outside corner of the mouth, subsequently strenches to inner canthus continuing as the angular artery. The angular artery anastomoses extensively with the dorsal nasal artery and the infraorbital artery. All the flaps survived. The patients were satisfied with the final aesthetic and functional results.. The flap can be designed flexibly and simply with reliable blood supply. The donor sites could be closed directly without skin graft, it is a simple and fast method for the reconstruction of midface defect.

Topics: Anastomosis, Surgical; Arteries; Cadaver; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Face; Facial Neoplasms; Humans; Nevus; Nose; Perforator Flap; Skin Neoplasms; Skin Transplantation; Software; Tomography, Spiral Computed

Pseudoaneurysm is a well-known complication of trauma and iatrogenic injury to the vasculature. We report 3 cases of postsurgical pseudoaneurysm after Mohs surgery.. Three patients who underwent Mohs surgery for nonmelanoma skin cancers presented between 2 and 4 weeks after surgery with several days' history of painful, enlarging, pulsatile subcutaneous masses. The lesions were diagnosed as postsurgical pseudoaneurysm. During surgical repair of each lesion, we identified vascular outpouchings that were connected to the injured arteries by sinus tracts. In all 3 patients, we ligated the affected artery and the neck of each lesion and reapproximated the skin. All wounds healed well without further recurrence.. Most reported cases of pseudoaneurysm formation in the head and neck involve the superficial temporal artery and its branches, and they typically occur secondary to blunt force trauma. Our cases are unique in that they included 1 case of a superficial temporal lesion but also 2 cases outside this system: 1 of the lateral nasal artery and 1 of the angular artery. We propose operative repair as the treatment of choice for facial pseudoaneurysms that complicate dermatologic surgery.

Topics: Aged; Aged, 80 and over; Aneurysm, False; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Follow-Up Studies; Humans; Iatrogenic Disease; Male; Middle Aged; Mohs Surgery; Nose; Postoperative Complications; Risk Assessment; Sampling Studies; Skin Neoplasms; Treatment Outcome; Vascular Surgical Procedures

Topics: Carcinoma, Squamous Cell; Endoscopes; Endoscopy, Gastrointestinal; Humans; Medical Illustration; Nose; Oropharynx; Tongue Neoplasms

Describe the techniques involved and the results obtained witn nasolabial flaps in small and medium-sized defects of the oral cavity. The procedure is an easy resconstructive option with a high success rate and with very good aesthetic and functional outcomes.. A retrospective analysis of 16 nasolabial flap reconstructions in 15 oncological patients with oral cavity defects undergoing single-stage surgical interventions. We evaluate the tumor type, its location, size, the resective and reconstructive techniques involved, as well as any complications.. Out of 15 patients, 9 were male and 6 female, with ages ranging from 60-85 years. The primary tumor was located in the mandibular or maxillary gingiva in 7 patients, the lateral margin of the tongue in 5, the floor of the mouth in 3 and the mandibular symphysis in a single patient. The tumors were of a small to medium size. All patients underwent intraoral resections. In most cases, a cervical dissection was performed. All flaps were completed as single-stage surgical interventions, with 14 unilateral and 2 bilateral procedures. Five patients had received radiotherapy treatment for previous tumors. During the follow up period, which ranged from 4 months to 8 years, only one patient required their flap to be thinned, there were two incidents of surgical wound dehiscence, two hematomas and one orocutaneous fistula, none of which affected the survival of the flap.. The nasolabial flap proves highly versatile in oral cavity reconstructions, coupled with a minimal morbidity of the donor region and good aesthetic and functional results. Its high vascularity allows for cervical dissections to be carried out or even for radiotherapy to be administered prior to it. It is straightforward, safe, and carrying it out as a single-stage intervention makes it the ideal surgical option for small to medium intraoral defects in edentulous patients with other comorbidities.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Lip; Male; Middle Aged; Mouth; Mouth Neoplasms; Nose; Plastic Surgery Procedures; Retrospective Studies; Surgical Flaps

Nasolabial flaps have been widely used for nasal reconstruction. However, transposition of the nasolabial flap to lower nasal defects may be challenging because of functional and aesthetic concerns. The upper part of the alar crease joins with the nasolabial fold seamlessly, forming the nasolabial-alar crease line, which provides a natural strategy for easy concealment of the surgical scar. In this article, we would like to introduce a method for transferring a nasolabial flap along the nasolabial-alar crease to reconstruct lower nasal defects.. Incision was made along the nasolabial-alar crease, and the nasolabial flap was transferred for lower nasal reconstruction in 9 patients. Subcutaneously based nasolabial flaps were designed, and undermining of the superolateral skin was made along the nasolabial-alar crease to obtain a robust subcutaneously based pedicle, so as to readily achieve flap transposition without tension and concealment of the subcutaneous pedicle. The nasolabial fold could be reproduced by closing the donor site.. Lower nasal defects were successfully repaired with nasolabial flap in 9 patients. Good nasal contour and appropriate symmetry of the reconstructed nasolabial fold were achieved, and there were no conspicuous scars in the 9 cases.. The natural nasolabial-alar crease can serve as a useful incision line to facilitate the nasolabial flap transposition for lower nasal reconstruction while minimizing the scar.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Lip; Male; Middle Aged; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Treatment Outcome

The iliac crest free flap is one of the most reliable flaps for maxillary reconstruction because of the large amount of bone provided and the chance to harvest both muscle and skin. However, reconstruction of maxillary through-and-through defects requires special skills to be managed. Simultaneous replacement of oral lining and external tissue with the same features as the resected skin is difficult to achieve with conventional techniques and the use of flaps association is often necessary to ensure acceptable cosmetic and functional results. In the case presented the submental island flap was a good choice to overcome these difficulties.

Topics: Aged; Alveolar Process; Anastomosis, Surgical; Carcinoma, Squamous Cell; Female; Humans; Ilium; Maxillary Neoplasms; Microsurgery; Muscle, Skeletal; Nose; Palate, Hard; Perforator Flap; Surgical Flaps

The refashioning of the many distinct structures necessary for successful anatomical and aesthetic reconstruction of the nose after total rhinectomy is difficult. Several significant operations are needed to produce good aesthetic results with functional patency of the nasal airway. We describe a method using autologous grafts that has produced good results on both occasions when it was done. It has the advantage of only one major operation and one subsequent minor revision.

Topics: Aged; Carcinoma, Squamous Cell; Forehead; Free Tissue Flaps; Humans; Male; Nose; Nose Neoplasms; Rhinoplasty; Tissue Transplantation

Xeroderma pigmentosum is a rare genetic disorder, characterized by cutaneous, ocular and neurological symptoms. Squamous cell carcinoma and melanoma are also its secondary characters. This case report is about maxillofacial prosthetic management of a 10 years old child presented with xeroderma pigmentosum. The nose of the patient was excised surgically due to melanoma. This case report elaborates the role of prosthodontist and the whole procedure of constructing the nasal prosthesis via conventional technique by using the patient's sibling nasal form as template. Regular follow up revealed marked improvement in esthetics, function and ultimately patient's quality of life.

Topics: Carcinoma, Squamous Cell; Child; Face; Humans; Male; Melanoma; Nose; Plastic Surgery Procedures; Prostheses and Implants; Prosthesis Design; Skin Neoplasms; Treatment Outcome; Xeroderma Pigmentosum

The nasal vestibule tumors are not very frequent. The pronostic can be severe if the first treatment is not effective. The authors present a personnal nine pateints' serie. They point out the clinical aspect, the evolutivity of these tumors and more specially the local extension which can produce recurrencies. The differents aspects of the treatment are analysed and more specially the surgical reconstruction procedures. reconstruction.

Topics: Carcinoma, Squamous Cell; Cohort Studies; Female; Humans; Male; Middle Aged; Nasal Cavity; Nose; Nose Neoplasms; Rhinoplasty

The common anterior paralateronasal approach for malignant maxillo-mandibular tumors extending to the infratemporal fossa is usually difficult, insufficient, or even dangerous.. We report a new approach for tumors extending to the infratemporal fossa. It combines a paralateronasal and a cervical approach indicated for tumors extending to the infratemporal fossa, requiring a total monoblock excision of the tumor with as little esthetic sequel as possible.. The main interest of this technique is to offer a large exposure of the facial skeleton and the tumor, and to spare cervical vascular structures.

Topics: Carcinoma, Squamous Cell; Humans; Male; Mandibular Neoplasms; Maxillary Neoplasms; Middle Aged; Neck; Neoplasm Invasiveness; Nose; Oral Surgical Procedures; Temporal Bone

Reconstruction of nasal tip support and internal lining after excision of nasal carcinoma is challenging. Since its original description by Menick in 1989, the outcomes of bipedicled septal pivot flap are rarely reported in the literature. Objective of this work is to review our results using the Septal pivoted flap in nasal reconstruction. It is a retrospective case series, Dalhousie University, Halifax, Nova Scotia. We studied six patients who underwent significant resection of the tip and dorsum of the nose for squamous or basal cell carcinoma. All involved nasal subunits were removed. Nasal reconstruction was subsequently performed using an inferiorly bipedicled pivoted composite nasal septal flap combined with a regional flap for skin coverage. The bipedicled SPF provided excellent support of the nasal tip in all six cases. All flaps in the cohort survived. Five patients had good mucosal lining from the septal flap alone and only one patient required a concurrent pericranial flap. Three patients experienced bleeding and required additional nasal packing. A bipedicled septal pivoted flap is exceptionally useful in providing a good tip support and well-vascularized nasal lining for reconstruction after major resection of the nasal tip. Bleeding is common and should be anticipated in the majority of patients.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Retrospective Studies; Rhinoplasty; Surgical Flaps

Nasolabial flaps have been recognised as versatile flaps for a variety of defects in the face, nose, lip and the oral cavity. Random pattern inferiorly based nasolabial flaps (NLF) have been utilised for covering small defects on the anterior floor of the mouth, but usually require a second stage procedure to divide the flap base. A subcutaneous pedicled inferiorly based nasolabial flap can provide a one stage repair of moderate sized defects of the floor of the mouth after de epithelialisation of the base of the flap.. To evaluate the feasibility of a single stage reconstruction of intermediate sized defects in the oral cavity with an inferiorly based pedicled NLF. The study includes the indications of use of the flap, flap design, technique, and the complications rate. The incidence of secondary procedures and the final functional and the aesthetic results will also be evaluated.. A group of 20 patients presented with (T1-2) squamous cell carcinoma of the oral cavity have been treated at the Department of Surgery, National Cancer Institute, Cairo; in the period between January 2008 and September 2010. The pathology was confirmed with an incision biopsy and all metastatic work were carried out confirming that all patients were free from distant metastasis at presentation. Preoperative assessment also included assessment of the stage of the disease, the flap design and patient fitness for general anaesthesia. All patients underwent surgical excision combined with reconstruction of the defect with a subcutaneous inferiorly based pedicled NLF. The proximal part of the flap was routinely de epithelialised before it has been tunnelled through the cheek so a one stage procedure could only be required.. The mean age of the patients was 62.3±6years, range (52-69years). All patients were diagnosed with squamous cell carcinoma. The anterior floor of the mouth constituted 40% of the defects, the lateral floor of the mouth 20% and the inner surface of the cheek 40%. There was no reported major complication; and only one patient suffered a reactionary haemorrhage that required re-exploration to secure the bleeder. A single procedure was adequate in most patients (80%), only 20% of patients required revision of the scar at the donor site or release of the tongue. The overall aesthetic results were either very satisfactory or satisfactory in the majority of patients (90%). Two patients were not satisfied with the final aesthetic results, one suffered from ectropion and the other had a donor site wound healing problem. The functional results (deglutition, speech) were satisfactory in most patients (70%), all were edentulous.. An inferiorly based pedicled NLF is a reliable flap for the reconstruction of small and medium sized defects in the oral cavity. The flap can be best utilised for old edentulous and high risk patients where it can be used as a single stage procedure which is particularly useful in those types of patients. The flap can be safely combined with neck dissection even when the facial artery was ligated.

Topics: Aged; Carcinoma, Squamous Cell; Cheek; Female; Humans; Lip; Male; Middle Aged; Mouth; Mouth Neoplasms; Nasolabial Fold; Nose; Oral Surgical Procedures; Skin Transplantation; Surgery, Plastic; Surgical Flaps; Tongue

Reconstruction of nasal defects is an antique challenge for surgeons. The first reported technique is dated 600 B.C. Since then a number of reconstructive options have been proposed in the literature. Some principles, first stated by Buget and Menick must be always taken into account when planning such reconstructions. In detail, every reconstruction should respect the subunit principle and the scars should always be well hidden in the passage between adjacent subunits. The flap proposed in the present paper adheres to the cited principles and leads to optimal nasal dorsum reconstruction in selected cases.. From April 2008 to March 2009, 5 patients were reconstructed with Lemmo's flap after local excision of 3 basal cell carcinomas and 2 squamous cell carcinomas affecting the the skin of the nasal dorsum in its caudal portion.. In all cases a pleasing aesthetic result was obtained, no postoperative deformity was observed and all the scars were unnoticeable.. The Lemmo's flap described in the present paper can be considered a valid choice for nasal dorsum skin reconstruction and is preferable over other techniques for reconstruction of small to medium sized defects of the skin of the caudal dorsum.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Esthetics; Female; Humans; Male; Nose; Nose Deformities, Acquired; Nose Neoplasms; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps

This study describes a new microvascular flap combination from the medial femur and ear to reconstruct the nose after subtotal resection and presents the first clinical results. In four patients a squamous cell carcinoma of the nose was registered. In three patients this was diagnosed for the first time while in the fourth patient it was the second relapse after two resections and local flap surgery. In every case, tumour resection ended up in an extended defect of the nose, cheek and upper lip region. For skeletal reconstruction and the inner lining of the nose, a microvascular osteocutaneous femur flap was used. After reconstructing the nasal skeleton, the remaining defect was covered by a microvascular composite flap from the left ear and preauricular region. Both flap pedicles were anastomosed to the facial vein and artery. In every case, the flaps healed without complications. There was no tumour relapse. 12 months after reconstruction, minor surgical corrections were made. The patients showed a satisfying functional and aesthetic result. The combination of a microvascular osteocutaneous femur flap and a microvascular ear flap can be used successfully for reconstructing the nose after subtotal resection.

Topics: Anastomosis, Surgical; Bone Transplantation; Carcinoma, Squamous Cell; Cheek; Ear Cartilage; Esthetics; Femur; Follow-Up Studies; Graft Survival; Humans; Lip; Microvessels; Middle Aged; Nasal Bone; Nasal Cartilages; Nasal Septum; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Patient Satisfaction; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps; Wound Healing

Postoperative evaluation of results of reconstructive procedures of the lips mainly consists of describing the technique, complications and subjectively interpreted patient photographs. The authors present a photo-assisted pre- to postoperative evaluation of reconstructive procedures of the lips based on anthropometric measurements and functional outcome. Forty-eight patients underwent partial or full thickness excision of tumours of the lips and subsequent reconstruction. An analysis of standardized pre- and postoperative photographs included measurements of intercanthal width, mouth width, philtrum width, lateral upper lip height, upper and lower lip height, cutaneous upper and lower lip height, upper and lower vermilion arc and upper and lower vermilion height. Assessment of functional outcome consisted of the evaluation of oral competence, changes of oral opening and sensation. The effects on the described parameters were analysed, when partial or full thickness reconstruction had to be performed. Intercanthal mouth width index, vermilion arc index, vermilion and cutaneous total lower lip height index showed statistically significant effects postoperatively which indicates a postoperative tightened lower lip, when full-thickness excision was performed. In all patients the indices were proven reproducible and reliable. The standardized measurements described are accurate and objective for evaluating postoperative results.

Topics: Aged; Anatomic Landmarks; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cephalometry; Dissection; Female; Follow-Up Studies; Humans; Hypesthesia; Keratoacanthoma; Lip; Lip Diseases; Lip Neoplasms; Male; Mouth; Mouth Mucosa; Nose; Photography; Plastic Surgery Procedures; Postoperative Complications; Sensation; Skin; Surgical Flaps; Treatment Outcome

Before undergoing a reconstructive procedures of the nose most patients ask how they will look postoperatively. Anthropometric measurements of the nose described by Farkas represent standard values. A comparison of pre- and postoperative anthropometric measurements may help to double-check the correctness of intraoperative "eye-balling" measurements with regards to postoperative appearance. Sixty-three patients underwent reconstruction of nasal ala, tip or dorsum. An analysis of standardized pre- and postoperative photographs included measurements of nose width, nose height, nasal tip protrusion, columella width, ala length, intercanthal width, mouth width, philtrum width, upper lip height, lateral upper lip height, cutaneous upper lip height and upper face height. Preoperative measurements were compared to data given by Farkas in young adults. Postoperative changes were evaluated clearly distinguishing between reconstruction of nasal ala, tip and dorsum. All anthropometric indices showed significant differences compared to the Farkas population. There was no significant pre- to postoperative change in any reconstructed region observed, indicating adequate intraoperative measurements. The application of Farkas' anthropometric measurements described in this study showed reliable and objective results and can help to double-check the previous intraoperative measurements. The correct application of these surgical techniques leads to a satisfying and near to normal postoperative look of the patient.

Topics: Adolescent; Aged; Anatomic Landmarks; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cephalometry; Facial Dermatoses; Female; Humans; Lip; Male; Nasal Cartilages; Nose; Nose Diseases; Nose Neoplasms; Photography; Plastic Surgery Procedures; Reproducibility of Results; Surgical Flaps; Treatment Outcome; Vertical Dimension

Topics: Carcinoma, Squamous Cell; Forearm; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Radius; Rhinoplasty; Surgical Flaps; Wounds and Injuries

The authors report an unusual case of intrafollicular collagenous crystalloids in an 86-year-old woman. The presence of collagenous crystalloids within the follicular epithelium is intriguing and has not been described previously.

Topics: Aged, 80 and over; Carcinoma, Squamous Cell; Collagen; Crystallization; Crystalloid Solutions; Diagnosis, Differential; Female; Hair Diseases; Hair Follicle; Humans; Isotonic Solutions; Nose; Skin Neoplasms

The forehead is acknowledged to be one of the best, if not the best, donor sites for reconstruction of postoperative nasal defects after ablation in cancer patients. The versatility, color match, and texture are among the benefits of this flap. However, it has 2 major disadvantages: 1) it is stiff, flat, and thicker than normal nasal skin, and thus molding from a 2-dimensional to a 3-dimensional shape is difficult, and 2) there is a donor-site defect that requires coverage using a split-thickness skin graft.. In this 5-year study (2004-2009), we modified the 2-stage technique and added an operation before tissue transfer and pedicle division in 48 patients with nasal defects. During the first stage, the tumor was completely excised, and a tissue expander was inserted in the subgaleal plane. After 3 weeks, expansion was initiated. The second operation was performed 12 weeks later. A full-thickness forehead flap was elevated and transposed with primary closure of the donor site. In a third or final stage 3 weeks later, the pedicle was divided. Patient satisfaction and donor site scar was evaluated.. Over the past 5 years, 48 reconstructions for nasal defects were performed using this technique. Nasal defects of the dorsum, alar, tip, columella, and septum were successfully treated. Graft take was successful in all patients.. The forehead flap technique, in conjunction with tissue expander for nasal repair, has both advantages and disadvantages. The esthetic benefits of this technique must be weighed against the disadvantages.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cartilage; Cicatrix; Esthetics; Facial Muscles; Female; Forehead; Graft Survival; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Patient Satisfaction; Plastic Surgery Procedures; Retrospective Studies; Skin Transplantation; Subcutaneous Fat; Surgical Flaps; Tissue and Organ Harvesting; Tissue Expansion; Tissue Expansion Devices; Treatment Outcome

The site, size, and depth of tissue loss, irradiation, or composite injury to adjacent cheek and lip may make local tissues inadequate or unavailable for the repair of major nasal defects.. In 13 patients, a single, folded, horizontal radial forearm flap was used to line the vault and columella, with an incontinuity fasciocutaneous extension to resurface the nasal floor, with or without primary dorsal support. Later, excess external forearm skin was turned over to adjust the nostril margin and alar base positions. Delayed primary cartilage grafts completed subunit support. A three-stage full-thickness forehead flap provided covering skin. Three-dimensional contouring of the midlayer framework was performed over the entire nasal surface, during an intermediate operation, before pedicle division.. Good to excellent aesthetic and functional results were obtained in total and subtotal defects in five operations over 8 months, including a late revision. Partial necrosis of the folded columellar lining (n = 2) and dehiscence of unilateral alar lining (n = 1) were salvaged at forehead flap transfer by hinging over excess external forearm skin (n = 2) or by folding the extension of the forehead flap for columellar lining (n = 1). Indolent cartilage infection necessitated débridement (n = 4) and partial support replacement (n = 3). No free flaps were lost or required to salvage a complication.. The approach is reliable, efficient, and applicable to varied defects and has the ability to correct design errors and complications before pedicle division. An unscarred lining sleeve, defined three-dimensional contour, and thin conforming skin cover are restored.

Topics: Adolescent; Adult; Aged; Carcinoma, Squamous Cell; Cartilage; Child; Female; Free Tissue Flaps; Humans; Male; Microsurgery; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Plastic Surgery Procedures; Sweat Gland Neoplasms; Tissue Expansion; Young Adult

Topics: Aged; Carcinoma, Squamous Cell; Forehead; Humans; Lip; Male; Melanoma; Nose; Nose Neoplasms; Surgical Flaps

Several different methods can be applied for repairing total nasal defects. Most of them are based on some common principles and techniques widely accepted and adopted by experienced surgeons. We have been using most of these techniques during the past two decades, however modifying and refining them several times. Our observations and sometimes disappointing experiences led to a concept that has remained unchanged for the past 6 years. It comprises three regular operative steps and sometimes a fourth surgical intervention for repair and refinement. First stage: Reconstruction of the septum using a bipedicled composite septal pivot flap (SPF), of the intranasal lining (INL), and the cover being established by elevating a full-thickness paramedian forehead flap (PMFF). Second stage: Re-elevation of the PMFF, thinning of its layers, and reconstruction of the subsurface framework using autogenous rib cartilage. Third stage: Division of the pedicle and minor corrections. We have been using this technique presented here since 2004 in nine consecutive patients with subtotal to supratotal nasal defects. Seven cases have been repaired completely by now and can be evaluated carefully. With this technique, results have significantly improved and have been stable to date.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cartilage; Follow-Up Studies; Forehead; Humans; Middle Aged; Nasal Mucosa; Nasal Septum; Nose; Nose Neoplasms; Patient Care Planning; Plastic Surgery Procedures; Prostheses and Implants; Skin Transplantation; Surgical Flaps; Time Factors; Tissue and Organ Harvesting; Treatment Outcome

Various surgical options are available for reconstruction of intraoral soft tissue defects. For smaller defects of the oral mucosa in different anatomic locations of the oral cavity the nasolabial flap is a very useful and simple alternative to other pedicled flaps and free flaps.. The results of reconstruction of oral mucosal defects or facial skin defects using 29 nasolabial flaps in 22 patients were reviewed retrospectively.. The patient group consisted of 16 patients (70%) with squamous cell carcinoma of the oral cavity, 2 patients (10%) with cystic lesions of the maxilla, 3 patients (15%) with osteonecrosis of the jaw, and 1 patient with an oral metastasis of a lung carcinoma. Healing was uneventful in 93%, partial or complete flap loss was observed in 7%.. The nasolabial flap is a valuable alternative for reconstruction of smaller defects of the oral cavity in particular in older and medically compromised patients.

Topics: Aged; Aged, 80 and over; Carcinoma; Carcinoma, Squamous Cell; Cohort Studies; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Mouth; Mouth Mucosa; Neoplasms, Squamous Cell; Nose; Orthognathic Surgery; Plastic Surgery Procedures; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck; Surgical Flaps

Surgical site infections (SSIs) after dermatologic surgery cause pain, prolong healing, result in unaesthetic complications, and lead to excessive use of antibiotics. The pathogenesis of wound infections is complex and is dependent on bacterial load and diversity, among several factors.. To investigate bacterial dynamics at dermatosurgical sites at different time intervals and assess the correlation with postoperative outcomes and to examine different endo- and exogenous factors that may contribute to SSIs.. Eighteen patients undergoing skin grafting of the face were studied. The following SSI-related factors were registered: age and sex of the patient, ulceration of the lesion, diabetes, immunosuppressive therapy, smoking, anticoagulative therapy, and use of antibiotic prophylaxis. Wounds from each patient were swabbed preoperatively, intraoperatively, and postoperatively. The bacterial composition of the swabs was then analyzed quantitatively and qualitatively.. Sixteen of 18 surgical sites contained varying quantities of surface-associated bacteria. Coagulase-negative staphylococci and Propionibacterium acnes were the predominant bacteria isolated at all times. Intraoperative analysis was not predictive of SSIs. Use of antibiotic prophylaxis was the only registered SSI-related factor that showed significant variation in bacterial load between pre- and postoperative samples. Postoperative bacterial load was found to be lower than preoperative load in patients who received antibiotics. This was in contrast to patients who did not receive antibiotics, who had significantly higher postoperative levels (p=.02). The presence of high postoperative bacterial loads, regardless of the bacterial species isolated, showed a statistically significant positive correlation with a complicated postoperative outcome (p≤.001).. This study provides novel insights into the bacterial dynamics of dermatologic surgery-induced wounds and the variation of this over time. The results highlight the potential relevance of quantifying bacterial loads, as well as determining specific types of bacteria, in dermatologic surgery.

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Bacterial Load; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Facial Neoplasms; Female; Floxacillin; Forehead; Humans; Keratosis, Actinic; Male; Middle Aged; Nose; Perioperative Period; Propionibacterium acnes; Skin Neoplasms; Skin Transplantation; Skin Ulcer; Staphylococcus; Surgical Wound Infection; Treatment Outcome

Mucocutaneous squamous cell carcinoma (SCC) may rarely exhibit intracellular mucin production. Extracellular mucin production is an even rarer finding in SCC that is not well documented in the literature. Here, we report six cases of primary cutaneous and mucocutaneous SCC with prominent extracellular stromal mucin deposition and an epithelial spindle cell component. We propose the term 'yxoid spindle cell SCC' (MSC SCC) to describe the histologic characteristics of these six cases. We also propose a set of histologic and immunohistochemical findings for distinguishing MSC SCC from primary cutaneous and metastatic spindle cell neoplasms including other sarcomatoid carcinomas, myxoid sarcomas and the spindle cell variant of atypical fibroxanthoma (AFX). The criteria can also help discern MSC SCC from spindle cell melanomas, which may rarely show a prominent myxoid stroma. Given the small numbers of cases reported to date, the presence of prominent myxoid stroma in primary cutaneous spindle cell SCC has unknown prognostic significance at this time.

Topics: Aged; Aged, 80 and over; Arm; Biomarkers, Tumor; Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Nasal Mucosa; Nose; Penis; Skin Neoplasms

The authors report their experience with 34 patients who had large full thickness nasal defects reconstructed with an implant-retained prosthesis. Their technique of modifying post-rhinectomy defects is described and factors influencing implant success are evaluated. 111 implants were placed to retain a nasal prosthesis. Age, sex and tumour histology did not affect the outcome. Smoking, extent of rhinectomy, use of radiotherapy (pre- and post-implant), hyperbaric oxygen, length and location of the implant and type of retention (bar/magnets) influenced implant success. The overall success rate was 89% (99/111); 94% in patients who did not receive radiotherapy and 86% in those who did. The prosthesis was in place in all patients (100%) at the time of last follow up. Post-rhinectomy defect modification enables adequate access for safe placement of long implants with good primary stability and helps the maintenance of good hygiene (further enhanced by the use of skin grafts). The authors think implant-retained prosthesis is a reliable option for reconstructing large full thickness rhinectomy defects. They suggest their technique of modifying the defect, use of long implants and magnets for retention is responsible for the high success rate of implants used to retain a nasal prosthesis.

Topics: Age Factors; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Humans; Hyperbaric Oxygenation; Magnetics; Male; Middle Aged; Nasal Septum; Nose; Nose Neoplasms; Plastic Surgery Procedures; Prostheses and Implants; Prosthesis Design; Prosthesis Failure; Prosthesis Implantation; Radiotherapy, Adjuvant; Retrospective Studies; Sex Factors; Skin Care; Skin Transplantation; Smoking; Treatment Outcome; Turbinates

Few published reports have addressed the issues related to upper lip reconstruction. The present clinical report describes the maxillofacial rehabilitation of an edentulous patient who had been diagnosed with squamous cell carcinoma of the nasal septum and contiguous structures. The patient underwent total rhinectomy, anterior maxillectomy, and maxillary lip resection. Her maxillary lip was reconstructed with a bilateral cheek advancement flap, which allowed primary closure of the lip and aided in maintaining function of the orbicularis oris muscle. Microstomia was anticipated and was a consequence of this procedure. During primary resection, and before chemoradiotherapy, dental implants were successfully placed in the maxilla. These implants helped to retain a maxillary obturator prosthesis, which, in turn, helped to retain a silicone nasal prosthesis that restored the nasal defect. An intranasal acrylic resin framework with magnets aided in connecting the extraoral prosthesis with the intraoral prosthesis. The surgical and prosthodontic advantages of a cheek advancement flap and the treatment challenges in a microstomic patient are discussed.

Topics: Aged; Carcinoma, Squamous Cell; Cheek; Dental Implants; Female; Humans; Lip; Magnetics; Maxilla; Maxillary Neoplasms; Maxillofacial Prosthesis; Maxillofacial Prosthesis Implantation; Microstomia; Mouth, Edentulous; Nasal Septum; Nose; Nose Neoplasms; Oral Surgical Procedures; Palatal Obturators; Plastic Surgery Procedures; Prosthesis Design; Surgical Flaps

reconstruction of a total nasal defect presents a significant challenge to the reconstructive surgeon. The form, function, and aesthetic appeal of all the nasal subunits must be addressed. Classic teaching emphasizes the importance of restoring the internal lining of the nose, the rigid scaffolding, and the outer skin and soft tissue layer.. a restrospective review was undertaken in eight patients who had undergone total nasal reconstruction in two Canadian tertiary care centres. All eight patients had their nasal defect reconstructed with a radial forearm free flap for internal lining, titanium mesh for structural support, and a paramedian forehead flap for skin and soft tissue cover. Nasal function, graft survival, patient satisfaction, and complications were recorded.. seven of eight patients were satisfied with the cosmetic outcome of their nasal reconstruction. Two patients reported poor nasal breathing owing to nasal stenosis. Two cases of minor titanium extrusion required operative intervention for repair. There were no cases of loss of the radial forearm free flap or paramedian forehead flap in this series.. reconstruction with a radial forearm free flap, titanium mesh, and a paramedian forehead flap is a reliable, cosmetically appealing, and functional method for total nasal reconstruction. Minor surgical revisions should be anticipated to achieve the best cosmetic outcome. This is the first reported series using these three entities together to reconstruct total and subtotal rhinectomy defects.

Topics: Adult; Aged; Biocompatible Materials; Carcinoma, Squamous Cell; Female; Forearm; Forehead; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Radiotherapy, Adjuvant; Retrospective Studies; Rhinoplasty; Surgical Flaps; Surgical Mesh; Titanium

Because of minimal donor region morbidity, pliability, the presence of long and large caliber vessels, and lack of visible scar, the free anterolateral thigh flap provides an ideal option for restoration of full-thickness nasal defects.. Full-thickness nasal defect reconstruction requires internal nasal lining and external cover. In large defects, internal nasal lining replacement with traditional sources may not be expedient. We describe reconstruction of full-thickness nasal defects with free anterolateral thigh flap.. From August 2005 to July 2007, six patients with full-thickness nasal defects underwent nasal reconstruction using free anterolateral thigh flap. All defects resulted from tumor resections. Four patients had a basal cell carcinoma, one an epidermoid carcinoma, and the other patient had recurrent malignant fibrous histiocytoma.. All flaps survived completely. The average hospitalization time was 3 days. No complication was observed.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Histiocytoma, Benign Fibrous; Humans; Length of Stay; Male; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps; Thigh

Skin cancers on the nose are very common. Excision of these tumors results in surgical defects that can pose a challenge to repair.. To present the authors' experience of using linear closures (LC) to repair surgical defects on the nose in patients who underwent Mohs micrographic surgery (MMS).. A retrospective analysis was conducted of 4765 patients with skin malignancies on the nose that were treated with MMS between July 1997 and January 2006. The following variables were examined: type of repair, age, and sex of the patients, postoperative size of the defect, type of malignancy, location of the defect, and final length of the closure. Short-term and long-term complications were evaluated and discussed. In a second study arm, a limited prospective cosmetic outcome assessment of patients with nasal defects repaired by LC compared to flaps and grafts was also conducted.. There were 2053 patients (1020 men and 1033 women) who underwent LC of nasal defects after MMS. The average postoperative defect size was 1.7 x 0.9 cm, with an average closure length of 2.7 cm (range: 0.6 cm to 8.5 cm). The 2 major malignancies treated were basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Short-term complications were minimal. Nasal asymmetry and/or raising of the nasal alae were occasionally seen, which improved over time. The cosmetic outcomes of the LC group were rated higher than the flap/graft group for lesions on the nose, although this was not statistically significant.. A vertical or slightly vertical linear closure for nasal defects after Mohs micrographic surgery is a robust and reliable method to deliver excellent cosmetic and functional results. Linear closure should be considered for small and mid-sized cutaneous nasal defects whenever possible.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Prospective Studies; Retrospective Studies; Rhinoplasty; Skin Transplantation; Surgical Flaps; Young Adult

Topics: Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Mesh

Proper selection of reconstruction method is the key point to get a successful result in nasal reconstruction. The purposes of this study are to report the author's experience and to present a surgical algorithm in reconstruction of the nasal defects in Asian.. Retrospective medical record analysis was performed for 40 patients who underwent nasal reconstruction between March 1996 and February 2006 at a tertiary referral hospital. Male to female ratio was 24:16, average age was 56 years, and average follow-up period was 25 months. Etiology, location, size, reconstruction method and surgical results were analyzed.. Majority of the defects (36/40) resulted from resection of a neoplasm. Among tumors, basal cell carcinoma accounted for 75% (27/36) followed by squamous cell carcinoma 8% (3/36). The defect was located in the dorsum in 11 cases, lateral wall in 9, ala in 8, tip in 4, and involved more than two sites in 8. In 2/3 of the cases, the defect size was less than 2cm. Local flap was used in 29 cases, primary closure in 6 cases, and skin graft in 5 cases. Among local flaps, nasolabial flap was useful for defects of the ala and multiple subunits while large nasal tip defects needed forehead flap. Transposition flaps were used for the small to medium sized defects of the nasal sidewall or dorsum. Reinforcement cartilage graft was used in 9 cases. Second stage refinement procedure was performed in 2 patients. Partial necrosis resulted in 2 cases but none ended up in total loss.. A local flap is the most versatile method for reconstruction of cutaneous defects of the Asian nose. The site and size of the defect are key considerations in choosing the local flap. Asian skin characteristics influence the design, execution, and the outcomes of the local flap.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Asian People; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cartilage; Child; Dermatologic Surgical Procedures; Female; Humans; Male; Middle Aged; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Retrospective Studies; Skin; Skin Neoplasms; Surgical Flaps; Surgical Procedures, Operative; Young Adult

After a life-threatening complication of an injection for neck pain several years ago, Ms W experienced a wrong-site surgery to remove a squamous cell lesion from her nose, followed by pain, distress, and shaken trust in clinicians. Her experience highlights the challenges of communicating with patients after errors. Harmful medical errors occur relatively frequently. Gaps exist between patients' expectations for disclosure and apology and physicians' ability to deliver disclosures well. This discrepancy reflects clinicians' fear of litigation, concern that disclosure might harm patients, and lack of confidence in disclosure skills. Many institutions are developing disclosure programs, and some are reporting success in coupling disclosures with early offers of compensation to patients. However, much has yet to be learned about effective disclosure strategies. Important future developments include increased emphasis on institutions' responsibility for disclosure, involving trainees and other team members in disclosure, and strengthening the relationship between disclosure and quality improvement.

Topics: Carcinoma, Squamous Cell; Communication; Ethics, Medical; Fear; Female; Humans; Medical Errors; Middle Aged; Nose; Physician-Patient Relations; Physicians; Quality of Health Care; Skin Neoplasms; Truth Disclosure

Reconstruction of the nose is a two-step process; first, the implant is positioned, and secondly a prosthesis is made to be implanted within three months. This ensures a better cosmetic result from only two operations; the prosthesis may be better placed; and the position can be corrected. Our results suggest that a craniofacial prosthesis anchored to bone is a viable alternative to conventional prosthetic surgery, and offers considerable benefits compared with existing support systems.

Topics: Carcinoma, Squamous Cell; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Prostheses and Implants; Prosthesis Implantation; Rhinoplasty

Inverted papillomas are primarily benign neoplasms that occur in the nasal cavity and paranasal sinuses. Many aspects of sinonasal inverted papillomas are still controversial and active fields of research. Inverted papillomas generate considerable interest because they are locally aggressive, have a propensity to recur and are associated with malignancy. However, neither the etiology and pathogenesis of these tumors nor the putative role as a precursor to carcinoma and the factors responsible for associated malignancy have been clarified. Whether carcinomas in inverted papillomas arise meta- or synchronous is also still unknown.. In a retrospective study we reviewed the charts of 93 patients with sinonasal inverted papillomas who were treated at our department between 1990 and 2007. Comparison was made between the group of patients with inverted papillomas and associated squamous cell carcinomas and the group of patients with benign inverted papillomas. We undertook a critical analysis of our results compared with the international medical literature.. Associated malignancy was found in 11 patients (11.8 %). In each one case a metachronous carcinoma with and without recurrent inverted papilloma was diagnosed, the remaining 9 carcinomas were determined to be synchronous malignancies. Our data suggest, that the association between carcinoma and inverted papilloma is indirect and that the gradual progression from inverted papilloma to a malignant neoplasm is if at all infrequent. Male gender, advanced age and recurrent inverted papilloma do not per se present risk factors for the development of associated malignancies.. Sinonasal carcinomas arise in about 10 % of patients with inverted papillomas, but the ratio of metachronous carcinomas has possibly been overrated up to now. Nevertheless, regular follow-up investigations after surgical resection of inverted papillomas are mandatory. The assumption, that carcinomas in inverted papillomas are less aggressive than carcinomas alone and the definition of high-risk groups for the development of carcinomas seems hazardous.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Maxillary Sinus; Maxillary Sinus Neoplasms; Middle Aged; Neoplasm Staging; Neoplasms, Multiple Primary; Neoplasms, Second Primary; Nose; Nose Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms; Retrospective Studies; Risk Factors; Sphenoid Sinus; Time Factors

Recently, Boron neutron capture therapy (BNCT) was successfully applied to treat experimental squamous cell carcinomas (SCC) of the hamster cheek pouch mucosa, with no damage to normal tissue. It was also shown that treating spontaneous nasal planum SCC in terminal feline patients with low dose BNCT is safe and feasible. In an extension of this work, the present study aimed at evaluation of the response of tumor and dose-limiting normal tissues to potentially therapeutic BNCT doses. Biodistribution studies with (10)B-boronophenylalanine (BPA enriched in (10)B) as a (10)B carrier were performed on three felines that showed advanced nasal planum SCC without any standard therapeutic option. Following the biodistribution studies, BNCT mediated by (10)BPA was done using the thermalized epithermal neutron beam at the RA-6 Nuclear Reactor. Follow-up included clinical evaluation, assessment of macroscopic tumor and normal tissue response and biopsies for histopathological analysis. The treated animals did not show any apparent radiation-induced toxicity. All three animals exhibited partial tumor control and an improvement in clinical condition. Enhanced therapeutic efficacy was associated with a high (10)B content of the tumor and a small tumor size. BNCT is therefore believed to be potentially effective in the treatment of spontaneous SCC. However, improvement in targeting (10)B into all tumor cells and delivering a sufficient dose at a greater depth are still required for the treatment of deep-seated, large tumors. Future studies are needed to evaluate the potential efficacy of the dual mode cellular (e.g. BPA-BNCT) and vascular (e.g. GB-10-BNCT) targeting protocol in a preclinical scenario, employing combinations of (10)B compounds with different properties and complementary uptake mechanisms.

Topics: Animals; Boron; Boron Neutron Capture Therapy; Carcinoma, Squamous Cell; Cat Diseases; Cats; Dose-Response Relationship, Radiation; Female; Isotopes; Male; Neoplasm Staging; Neutrons; Nose; Nose Neoplasms; Phenylalanine; Treatment Outcome

Patients with advanced skin cancer present a unique challenge to neurosurgeons. Treatment involves aggressive surgical intervention and lengthy reconstructive procedures with considerable morbidity to obtain adequate and safe oncological margins. We reviewed our experience with BioGlue Surgical Adhesive, a protein-based adhesive, as an adjunct in free tissue transfer procedures to prevent CSF leakage and seroma formation.. Between January 2000 and June 2004, 11 patients ranging in age from 32 to 87 years presented with advanced skin cancer tumors in the head and neck. Pathology included squamous (7) and basal (3) cell carcinoma and malignant schwannoma (1). Of the 11 patients, 8 had undergone previous surgery and/or radiation therapy. All were treated with a combination of craniotomy, skull base, and craniofacial approaches with reconstruction of the large defects using muscular or myocutaneous free flaps in a single operation. Fat, muscle, and a 1-mm epidural layer of BioGlue were used to seal the dural sutures and to obliterate any potential seroma-forming dead space.. A total of 6 patients underwent craniofacial resection with orbital exenteration and partial rhinectomy, whereas the remaining 5 underwent frontal, parietal, and/or occipital craniotomies. All patients required dural repair. Three patients required additional brain resection because of tumor infiltration. No patient developed a CSF leak or seroma. There were no adverse events related to the use of BioGlue. Three patients died of medical complications (pulmonary embolism, myocardial infarction, late-onset myelodysplasia). The remaining patients are alive, and our follow-up (range, 9-58 months) has revealed no recurrence or distal metastasis.. Advanced skin cancer tumors in the head and neck region are associated with complex and disfiguring surgical procedures with increased morbidity. We demonstrate that an adjunctive use of a sufficiently strong tissue adhesive can yield acceptable outcomes and minimize comorbidity in this challenging patient population.

Topics: Adult; Aged; Aged, 80 and over; Brain; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Craniotomy; Dura Mater; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Neurilemmoma; Neurosurgical Procedures; Nose; Orbit; Plastic Surgery Procedures; Postoperative Complications; Proteins; Skin Neoplasms; Tissue Adhesives

Squamous cell carcinoma of the skin (SCCS) is rarely encountered by medical oncologists owing to success of local therapies. When advanced SCCS requires systemic palliation, treatment with conventional chemotherapy, such as cisplatin, is often precluded by a patient's age or medical comorbidities. Cetuximab is a human and mouse chimeric antibody against epidermal growth factor receptor, a tyrosine kinase receptor richly expressed by SCCS cells, including lymph node metastases. This drug, approved for treatment of squamous cell carcinoma of the upper aerodigestive tract as well as colorectal cancer, is well tolerated. Toxic effects include acneiform rash and diarrhea. Preclinical data suggest that epidermal growth factor receptor is important in SCCS carcinogenesis.. Herein, we report 2 cases of elderly patients with extensive, in-transit recurrence of SCCS who have been treated with palliative cetuximab. The drug was well tolerated, with the exception of acneiform rash requiring dose reduction in 1 patient. Both patients had excellent responses to cetuximab: the first patient had complete response by week 16 of treatment and the second a near-complete response by week 12. In both cases, initial response to cetuximab was evident by week 4 of therapy.. To our knowledge, these are the first reported cases of cetuximab use in patients with SCCS. The encouraging responses justify the prospective study of cetuximab in SCCS.

Topics: Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Carcinoma, Squamous Cell; Cetuximab; Combined Modality Therapy; Epidermal Growth Factor; Face; Female; Humans; Male; Neoplasm Recurrence, Local; Nose; Scalp; Skin Neoplasms

To describe a novel reconstructive technique after nasal planum and premaxilla resection.. Case report.. Dogs (n=2) with squamous cell carcinoma (SCC) of the nasal planum.. A 9-year-old neutered female Labrador retriever (dog 1) and an 11-year-old neutered male Golden retriever (dog 2) had resection of the nasal planum and premaxilla for treatment of locally invasive SCC. Reconstruction of a nasal planum facsimile was based on use of the nonhaired pigmented margins of bilateral labial mucocutaneous rotation-advancement flaps.. Reconstruction of the premaxilla by construction of a nasal planum facsimile resulted in uncomplicated wound healing and improved cosmesis. There was no tumor recurrence at 1290 (dog 1) and 210 (dog 2) days after surgery.. Reconstruction of a nasal planum facsimile was successfully performed without complications in 2 dogs with high owner satisfaction with cosmetic appearance.. This technique represents a significant advancement in surgical cosmetic outcome, may potentially reduce postoperative complications, and should be considered for dogs requiring nasal reconstruction after nasal planum resection with premaxillectomy.

Topics: Animals; Carcinoma, Squamous Cell; Cosmetic Techniques; Dog Diseases; Dogs; Female; Male; Maxilla; Maxillary Neoplasms; Nose; Nose Neoplasms; Plastic Surgery Procedures; Treatment Outcome

Facial reconstruction with only free microvascular flaps has rarely produced an aesthetic result. Menick stated, "Distant skin always appears as a mismatched patch within residual normal facial skin." In addition, earlier techniques using a single large nasal lining flap or bilateral nasal lining vaults incurred a high incidence of airway obstruction.. The authors describe 10 consecutive patients requiring reconstruction of the nasal vestibule and columella lining from October of 1997 through May of 2005. Most of them also required reconstruction of the floor of the nose, the platform on which the alar bases and columella rest, and defects of the facial units adjacent to the nose. Aesthetic nasal reconstruction used two separate skin paddles to reconstruct the lining for the nasal vestibule and columella, an artistically constructed nasal framework made of cartilage, a forehead flap for cover, and other flaps and grafts to reconstruct adjacent facial unit defects.. The average patient age was 41.8 years (range, 10.4 to 65.3 years). Follow-up (from the time of the first operative stage) averaged 26.4 months (range, 4 to 49 months). Nine patients had functional airways, and one required nasal airway support with internal silicone tubes. At the time of publication, eight patients had normal-appearing noses, and two were awaiting secondary surgery to correct persistent deformity.. Microvascular free flaps have proved to be highly reliable and efficacious for restoration of missing elements of the nasal lining and adjacent facial soft-tissue defects in total and subtotal nasal reconstruction. Combined with a forehead flap, this aesthetic approach allows for reconstruction of the center of the face layer by layer and facial unit by facial unit. Specific attention is paid to the artistic creation of normal nasal dimensions, proportion, and form using carved and assembled cartilage grafts and by secondary subcutaneous contouring. In addition, this technique produces a patent airway.

Topics: Adolescent; Adult; Aged; Amputation, Traumatic; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cartilage; Child; Humans; Ischemia; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps

To date, the retroangular flap has been used only for reconstruction of defects of the nose and the glabella.. The objective was to expand the indications of the retroangular flap in facial reconstruction.. We repaired the facial defects of 11 patients using 12 retroangular flaps. These defects were located on the nose in 4 patients, the lower eyelid in 4 patients, the upper eyelid in 2 patients, and the cheek in 1 patient.. The mean follow-up time was 13.2 months. All of the flaps survived, and no revisional procedures were required. Cosmetic and functional outcomes were satisfactory in all patients.. The retroangular flap is a valuable alternative for the management of small- to moderate-sized defects of the midface. We strongly suggest extending the use of this flap to include reconstruction of nasal, eyelid, and cheek defects.

Topics: Adolescent; Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Child; Child, Preschool; Eyelids; Follow-Up Studies; Humans; Keratoacanthoma; Male; Middle Aged; Nose; Plastic Surgery Procedures; Skin Diseases; Surgical Flaps; Treatment Outcome

Malignant tumours of the nose occasionally require rhinectomy. Implant retained prostheses can give good aesthetic results. Predictable biomechanical retention of nasal prostheses can be achieved using osseointegrated implants and Brånemark intra-oral and craniofacial implants have been used previously. Zygomaticus implants are traditionally used for dental rehabilitation of the partially edentulous maxilla with severe bone resorption. We describe two patients in whom zygomaticus implants have been used to aid salvage in prosthetic reconstruction of the nose.

Topics: Aged; Carcinoma, Squamous Cell; Esthetics; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Osseointegration; Prostheses and Implants; Prosthesis Design; Salvage Therapy; Zygoma

Topics: Carcinoma, Squamous Cell; Female; Humans; Middle Aged; Mohs Surgery; Nose; Radiotherapy Dosage; Radiotherapy, Adjuvant; Skin Neoplasms

Topics: Carcinoma, Squamous Cell; Ethmoid Sinus; Female; Fibula; Humans; Middle Aged; Nose; Paranasal Sinus Neoplasms; Plastic Surgery Procedures; Surgical Flaps

There are only a few reports on the outcome with full-thickness skin grafts (FTSG) in defect reconstruction after Mohs micrographic surgery (MMS).. The objective was to evaluate the complications with FTSG in patients treated with MMS for cutaneous tumors.. This study is based on a prospective data collection of all patients in Australia treated with MMS and monitored by the Skin and Cancer Foundation, between 1993 and 2002. Primary outcome measures were FTSG recipient-site complications (partial/complete graft failure, graft infection, acute bleeding/hematoma, graft hypertrophy, and graft contracture).. The study group included 2,673 patients (50.2% men) with a mean age of 64+/-14 years. Most tumors were basal call carcinoma (90.9%) and were located on the nose (63.8%), periocular area (14.8%), or auricular area (8.1%). A total of 11.7% of cases had recipient-site complications (graft hypertrophy, 42.3%; partial graft failure, 27.2%; graft contraction, 15.3%). Only 45.2% of complicated cases required treatment.. Short-term recipient-site complications occurred in less than 12% of reconstructions with FTSG. Graft hypertrophy and partial graft failure accounted for most cases of complications. The authors have indicated no significant interest with commercial supporters.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Australia; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Databases, Factual; Ear, External; Female; Forehead; Graft Survival; Humans; Male; Middle Aged; Mohs Surgery; Nose; Postoperative Complications; Prospective Studies; Skin Neoplasms; Skin Transplantation; Treatment Outcome

Malignant neoplasms of the nose and paranasal sinuses occur rarely but due to late diagnosis and poor treatment effects still remain a serious problem. The aim of the study was the analysis of all nose and paranasal sinus neoplasms treated at Lower Silesia in the years 1992-2001.. In the years 1992-2001 in Lower Silesia region there were 182 patients treated for malignant nose and paranasal sinus tumors. Males outnumbered females significantly with male : female ratio was 1.9:1. Principal management was combined therapy--surgery with radiotherapy in 84% of the cases. Radiotherapy alone was performed in 8.8% and chemotherapy as palliative treatment in 7.1%. Fifteen patients (8.2%) underwent radical neck dissection followed by radiotherapy.. The analysed group constituted 79.6% patients with epithelial tumors and 20.4% with nonepithelial tumors. Cases T3-T4 predominated in the material in amount of 77.9% (113). There were 15 T2 cases (10.4%) and none of T1. Most of the tumors (57%) arose from middle segment of ethmomaxillary sinuses. Upper segment tumors constituted 18.6% of cases and lower segment--10.4%. Enlarged lymph nodes were diagnosed in 8.2%. Survival rate analysis in patient treated in the years 1992-2001 revealed 37.9% (69) of 3-year survival and 30.2% (55) of 5-year survival.. Unsatisfactory results of treatment are an effect of a high advanced stage of the tumor while diagnosed. Its direct causes are: asymptomatic course of the disease, localization in complex anatomical structure, not enough experience among medical staff dealing with the disease very rarely.

Topics: Carcinoma, Squamous Cell; Disease-Free Survival; Female; Humans; Lymphatic Metastasis; Male; Neoplasm Staging; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Poland; Radiotherapy, Adjuvant; Retrospective Studies; Sex Distribution; Survival Rate

Topics: Aged; Biopsy, Needle; Carcinoma, Squamous Cell; Fatal Outcome; Humans; Immunohistochemistry; Male; Neoplasm Invasiveness; Nose; Skin Diseases, Papulosquamous; Toes; Tonsillar Neoplasms

Topics: Biopsy; Carcinoma, Squamous Cell; Chemotherapy, Adjuvant; Humans; Hypopharyngeal Neoplasms; Lymph Nodes; Male; Middle Aged; Neck Dissection; Nose; Skin Neoplasms

Nasal reconstruction options are often dictated by size and location of the defect. Local flaps are often considered of little utility for larger or more complex defects. The authors' modification of the island rotation flap allows increased versatility and single-stage reconstruction for many more defects of varied sizes and locations.. A retrospective review of all cases of nasal reconstruction using the island rotation flap over a 3.5-year period was undertaken.. Ninety-two island flap reconstructions were performed for defects ranging from 0.8 to 4.0 cm. For defects smaller than 2.5 cm, there were no cases of flap loss. Five percent of the patients required a second procedure, whereas 95 percent were reconstructed in a single stage. Five percent required treatment for prominent scars. Follow-up was over 2 years.. The laterally based blood supply of the nasal island rotation flap is reliable and robust. Patients treated with this flap had good healing and good symmetry and required minimal revision. Single-stage reconstruction with this flap requires both proper flap design and extensive undermining of the entire nasal soft-tissue cover. Nasal symmetry is maintained despite the defect and donor flap being on the same side of the nose. The authors present their technique for the island rotation flap for nasal reconstruction and information on its reliability and acceptance.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cartilage; Female; Humans; Middle Aged; Nose; Nose Neoplasms; Reoperation; Retrospective Studies; Surgical Flaps

Topics: Anesthesia, Local; Anesthetics, Local; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Ear; Ear Neoplasms; Epinephrine; Female; Humans; Male; Nose; Skin Neoplasms

Total or near-total rhinectomy during tumor ablative surgery creates a large postsurgical defect. Surgical or prosthetic reconstruction may be considered. Surgical reconstruction of such a defect depends on support of the reconstructive tissues to prevent collapse. Without support, the esthetic results and airway patency are compromised. The purpose of this clinical report is to present the use of a nasal stent to support soft and hard tissues for the reconstruction of near-total rhinectomy in 2 patients.

Topics: Adult; Aged; Bone Transplantation; Carcinoma, Squamous Cell; Cartilage; Equipment Design; Fascia; Humans; Male; Nose; Nose Neoplasms; Papilloma, Inverted; Plastic Surgery Procedures; Skin Transplantation; Stents

In this study, the functional and aesthetic outcome of patients with nasolabial flaps in the floor of the mouth was examined. Sixteen patients underwent reconstruction of the floor of the mouth with 19 nasolabial flaps after resection of a squamous cell carcinoma. Eight patients received postoperative radiotherapy. The patients were questioned concerning oral disabilities. Speech, mastication, deglutition, oral continence and the aesthetic result were evaluated. Two-point discrimination, temperature sensation and blunt-sharp discrimination of the intraoral flaps were tested. Speech and the wearing of dentures were hardly affected. Consumption of solid foods caused moderate problems in half of the patients. No sensibility problems were found. The aesthetic deformity was minimal. The use of nasolabial flaps in patients with limited defects of the anterior floor of the mouth after tumor resection showed adequate functional and aesthetic results.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Esthetics; Female; Humans; Lip; Male; Middle Aged; Mouth; Mouth Neoplasms; Nose; Plastic Surgery Procedures; Sensory Thresholds; Surgical Flaps; Treatment Outcome

Topics: Abnormalities, Multiple; Adult; Carcinoma, Squamous Cell; Diagnosis, Differential; Humans; Ichthyosis; Male; Nose; Skin Neoplasms

Mohs surgeons are occasionally confronted by challenging pathology ideally requiring the advice of a dermatopathologist. The Internet transmission of digital images of the pathology (telepathology) allows for such opinions to be easily and rapidly obtained.. The objective was to obtain images utilizing a digital camera focused directly through one microscope eyepiece with subsequent e-mail to a pathologist for an immediate opinion.. The particular area of interest on the slide is selected. The lens of the digital camera is placed directly on one eyepiece of the microscope and using the zoom and autofocus options of the camera a sharp image is obtained. The camera flash must be disabled. The images are immediately downloaded to computer and e-mailed to the pathologist for an opinion.. Three case reports illustrate that the pathologist is able to offer suggestions on a diagnosis with a high degree of confidence using the e-mailed images.. Digital camera technology now allows for images to be taken directly through an eyepiece of the microscope. These images can be almost instantaneously e-mailed to a pathologist anywhere in the world for an immediate opinion. The technique provides for greater surety where doubt exists about the pathology during Mohs surgery.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Diagnosis, Differential; Ear, External; Humans; Image Processing, Computer-Assisted; Internet; Lip; Male; Middle Aged; Mohs Surgery; Nose; Skin Neoplasms; Telepathology

Topics: Anesthesia, Inhalation; Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Male; Masks; Nose; Nose Neoplasms; Postoperative Complications; Prostheses and Implants; Prosthesis Design; Reoperation

Retinoids have the capacity to accelerate the involution of multiple keratoacanthomas, including unusual variants such as keratoacanthoma marginatum centrifugum and keratoacanthoma en plaque that may persist and be associated with progressive growth and provide difficulties in diagnosis and management.. We describe 3 patients who had unusual infiltrated and keratotic plaques affecting the lower legs or nasolabial area that persisted or recurred that may be related to this group of unusual keratoacanthomas. The 3 patients had differing clinical lesions that did not resemble classic keratoacanthomas, but were linked by their biopsy findings of hypertrophic lichen planus-like reaction and pseudoepitheliomatous hyperplasia with a prominent infundibulocystic component that progressed to multiple keratoacanthomas or infundibulocystic squamous cell carcinoma. Polymerase chain reaction analysis of biopsy material from 2 patients failed to detect human papillomavirus. All 3 presentations provided a therapeutic dilemma, but responded rapidly to acitretin treatment at a dosage of 10 to 25 mg daily, which was continued for 15 to 24 months.. These cases illustrate an unusual reaction pattern that is hypertrophic lichen planus-like but, instead of evolving to classic lichen planus, progresses to infundibulocystic hyperplasia and the development of multiple keratoacanthomas or infundibulocystic squamous cell carcinomas. Retinoids represent a therapeutic option for this difficult clinical problem and may obviate repeated and extensive surgery.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Humans; Hypertrophy; Keratoacanthoma; Lichen Planus; Lower Extremity; Male; Nose; Skin Neoplasms

Many techniques have been described to restore through-and-through alar defects both for the vestibular lining and the lobular skin. This study aimed to present our results with medially based nasolabial turnover flaps in the reconstruction of alar defects.. Medially based nasolabial turnover flaps were used in 11 patients (3 females, 8 males; age range 27 to 65 years) who had through-and-through alar defects due to trauma (n=3) and carcinoma (3 squamous cell, 5 basal cell carcinoma) excisions. The mean follow-up period was 17 months (range 8 to 24 months).. Infection was encountered in only one patient and was successfully treated with antibiotic therapy. All the flaps survived and no recurrence occurred during the follow-up period. The patients were content with the outcome and, despite recommendations, were not willing to have a revision surgery. No problems were seen associated with nasal obstruction.. Despite the need for minor revisions, esthetic and functional results with medially based nasolabial turnover flaps were satisfactory from the patients' standpoint.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Treatment Outcome

The clinical characteristics and prosthetic rehabilitation of a patient with squamous cell carcinoma of the nasal septum after combined radiation therapy and a total rhinectomy is presented.

Topics: Carcinoma, Squamous Cell; Denture Design; Denture, Complete, Upper; Female; Humans; Middle Aged; Nasal Septum; Nose; Nose Neoplasms; Prostheses and Implants; Prosthesis Design

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Humans; Male; Mohs Surgery; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

The aim of this study was to analyse, with particular consideration to functional aspects, the results of treatment following the reconstruction of intraoral soft tissue using a pedicled nasolabial flap. Over a period of 10 years (1.1.1990-31.12.1999) the intraoral repair of the defect was carried out in 20 patients in the region of the anterior floor of the mouth, using a unilateral nasolabial flap in 13 cases and a bilateral nasolabial flap in 7 cases. The reasons for the defects were resection of squamous cell carcinomas (T1-T2) of the intraoral mucosa in 19 cases and osteoradionecrosis with soft tissue defect in one case. Local wound healing disturbance was observed in two cases. In 18 patients the prosthetic rehabilitation was successful and allowed a return to masticatory function. In another three cases a secondary operation for flap remodelling was needed. In one case three ITI-Implants were inserted between the foramina 12 months following the placement of the flap. A magnetically retained full denture has been functioning normally for more than four years. The nasolabial flap for the replacement of soft tissue in the mouth appears to represent a functionally and aesthetically satisfactory alternative to reconstruction by microsurgery, in cases of small to medium-sized defects, especially in older, medically compromised patients with an enhanced surgical risk

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Dental Implantation, Endosseous; Dental Prosthesis, Implant-Supported; Female; Humans; Lip; Male; Mastication; Middle Aged; Mouth Floor; Mouth Mucosa; Mouth Neoplasms; Nasal Mucosa; Nose; Oral Surgical Procedures; Osteoradionecrosis; Plastic Surgery Procedures; Surgical Flaps

J. M. Converse described the scalping forehead flap in 1942 with the aim of using it in total nasal reconstruction. A rich net of arterial and venous vessels constitute the basic pattern of its blood supply through three principal pedicles: (1) temporal superficial, (2) supraorbital, and (3) supratrochlear. It was described for nasal reconstruction, but due to its characteristics, such as color of the frontal skin, texture, hairless skin, and reliable irrigation, it can be used in the reconstruction of other facial areas. According to these particularities, the Converse flap was used in the reconstruction of a total left lower lid and adjacent lateral nose and cheek areas in a patient with an extended squamous carcinoma. The tumoral resection included the removal of (1) complete lower lid, (2) lacrimal lower canaliculus, sac, and nasolacrimal duct, (3) lower ocular conjunctiva, (4) intraorbitary fat and both inferior oblique and inferior rectus muscles, and (5) adjacent skin of the nose and cheek. Postoperative controls showed an excellent aesthetic and functional result. A hypochromic frontal skin graft was the only sequela; definitive skin coloration was obtained by a dermopigmentation technique. The versatility of this forehead flap allows it to be successfully used for reconstruction not only in the nasal area but also in other facial ones.

Topics: Aged; Carcinoma, Squamous Cell; Cheek; Conjunctiva; Eyelid Neoplasms; Eyelids; Forehead; Humans; Lacrimal Apparatus; Male; Neoplasm Invasiveness; Nose; Oculomotor Muscles; Skin Pigmentation; Skin Transplantation; Surgical Flaps

Topics: Aged; Bone Transplantation; Carcinoma, Squamous Cell; Humans; Male; Maxillofacial Prosthesis; Mouth Neoplasms; Nose; Nose Neoplasms; Orbital Implants; Plastic Surgery Procedures; Prostheses and Implants; Radiotherapy, Adjuvant; Zygoma

Twenty-five facial arteries were examined radiographically in 19 fresh cadavers that had been injected systemically with a lead oxide-gelatin mixture. Major branches of the facial artery in the upper lip and nose were investigated, and the anatomical variations were classified into three types on the basis of the anatomy of the lateral nasal artery, which was determined as an artery running toward the alar base. In 22 cases (88 percent), the facial artery bifurcated into the lateral nasal artery and superior labial artery at the angle of the mouth. In two cases (8 percent), the facial artery became an angular artery after branching off into the superior labial artery and the lateral nasal artery sequentially. In one case (4 percent), the facial artery became an angular artery after branching off into the superior labial artery, and the lateral nasal artery then branched off from the superior labial artery. Branches from the lateral nasal and superior labial arteries were observed stereographically. Vascular anastomoses between those branches were created in the upper lip, columella base, and nasal tip, and an intimate vascular network was formed. With a vascular network in the mucosa of the upper lip, a bilobed upper-lip flap was created for a clinical case with a full-thickness defect of the ala.

Topics: Arteries; Cadaver; Carcinoma, Squamous Cell; Humans; Lip; Nose; Nose Neoplasms; Surgical Flaps

Topics: Carcinoma, Squamous Cell; Humans; Male; Maxilla; Maxillofacial Prosthesis; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Osseointegration; Otorhinolaryngologic Surgical Procedures; Palate, Soft; Plastic Surgery Procedures; Prostheses and Implants; Treatment Outcome

Mohs surgery defects on convex nasal surfaces do not reliably heal well by second intention. Prior to the availability of laser resurfacing we found that immediate postoperative dermabrasion improved the predicted outcome from second intention healing for these defects.. To determine the ability of immediate postoperative CO2 and Er:YAG laser resurfacing to improve predicted healing by second intention.. Seventy-four patients with Mohs surgical defects on the nose underwent immediate postoperative resurfacing with either a scanned CO2 or long-pulsed Er:YAG laser. Thirty patients had photographs of appropriate quality and follow-up for evaluation by a panel of nine objective physicians.. All 74 patients were satisfied with their result and none have requested scar revision. Of the 30 patients evaluated by the panel, all were scored acceptable to excellent.. Immediate laser resurfacing can improve the predicted outcome from second intention healing on the nose and should be considered for select patients.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Laser Therapy; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Postoperative Care; Wound Healing

Topics: Acrylic Resins; Adhesives; Aged; Carcinoma, Squamous Cell; Denture Design; Denture Retention; Denture, Complete, Upper; Female; Humans; Maxillary Neoplasms; Maxillary Sinus Neoplasms; Nose; Oroantral Fistula; Palatal Obturators; Prosthesis Design; Prosthesis Fitting; Surface Properties

A study was undertaken to investigate the treatment of superficial squamous cell carcinoma of the nasal planum, pinna and eyelid in cats by photodynamic therapy, using topical 5-aminolaevulinic acid cream, with subsequent exposure to red light of wavelength 635 nm, supplied by a light-emitting diode source. A total of 13 squamous cell carcinomas were treated, including 10 nasal planum lesions, two pinnal lesions and one eyelid lesion. After a single treatment, complete responses were seen in nine out of 10 nasal planum lesions, one out of two pinnal lesions and the eyelid lesion. The overall complete response rate for lesions managed with a single photodynamic therapy treatment was 85 per cent. Seven of the 11 lesions (63.6 per cent) showing a complete response subsequently recurred; the time to recurrence ranged from 19 to 56 weeks (median 21 weeks, mean 26.7 weeks).

Topics: Administration, Topical; Aminolevulinic Acid; Animals; Carcinoma, Squamous Cell; Cat Diseases; Cats; Ear, External; Eyelid Neoplasms; Light; Neoplasm Recurrence, Local; Nose; Photochemotherapy; Photosensitizing Agents; Skin Neoplasms; Time Factors; Treatment Outcome

To determine a putative role and relation between human papilloma virus (HPV) and p53 in the etiology of sinonasal carcinomas associated with papillomas.. The study group consists of all patients with sinonasal carcinomas associated with papillomas diagnosed in Denmark from 1980 to 1998. After reviewing our national pathological files, tumor tissues from 36 patients were collected, comprising 15% of the total cases of sinonasal carcinomas. In 35 cases a squamous cell carcinoma was demonstrated and in one case an adenocarcinoma was evident. Inverted papilloma was associated with carcinoma in 31 cases and exophytic papillomas in 5 cases. The material was investigated for HPV using polymerase chain reaction analyses with two sets of consensus primers (GP5+/GP6+ and MY09/MY11). The HPV-positive cases were submitted to dot-blot hybridization to establish the HPV type. Using immunohistochemistry, the p53 expression was determined. A p53 overexpression is defined as positive staining in 10% or more of the tumor cells.. Among 30 examined cases of carcinomas associated with inverted papillomas, 4 cases were HPV-positive (13%). P53 overexpression was not shown among the HPV-positive cases, whereas p53 overexpression was seen in 21 of the 24 (88%) examined HPV-negative cases. Among the 5 carcinomas associated with exophytic papillomas, HPV was demonstrated together with p53 overexpression in 3 cases (60%). In addition, one case more was with p53 overexpression.. An inverse relation between HPV and p53 overexpression in sinonasal carcinomas associated with inverted papillomas appears to have been demonstrated. HPV and p53 might also have an etiological role among the carcinomas associated with exophytic papillomas.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Denmark; Female; Humans; Immunoenzyme Techniques; Male; Middle Aged; Nose; Nose Neoplasms; Papilloma; Papilloma, Inverted; Papillomaviridae; Papillomavirus Infections; Paranasal Sinus Neoplasms; Paranasal Sinuses; Polymerase Chain Reaction; Retrospective Studies; Tumor Suppressor Protein p53; Tumor Virus Infections

Topics: Administration, Cutaneous; Aged; Aged, 80 and over; Aminoquinolines; Antineoplastic Agents; Carcinoma in Situ; Carcinoma, Squamous Cell; Female; Humans; Imiquimod; Keratosis; Male; Middle Aged; Nose; Photosensitivity Disorders; Precancerous Conditions; Skin Neoplasms; Thorax

Bazex syndrome is a paraneoplastic acrokeratosis appearing mostly at the same time as the underlying neoplasm. We report a typical case with a squamous cell carcinoma of the tongue and classical cutaneous symptoms disappearing with the treatment of the tumour.

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Cisplatin; Ear, External; Fluorouracil; Foot; Hand; Humans; Keratosis; Male; Middle Aged; Nose; Paraneoplastic Syndromes; Tongue Neoplasms

We present our experience using conchal composite grafts in major and minor nasal reconstruction. We believe that composite grafts have an important and under-utilized role as an adjunct to the paramedian forehead flap on total and subtotal nasal reconstruction, as well as in providing an internal lining and support in stenosis of the nasal vestibule. The use of a composite conchal graft as an inner lining and support is often preferential to a septal composite or hinge flap that often results in a septal perforation with its associated morbidity. We recognize that a composite conchal graft used for reconstruction of the alar margin provides a suboptimal result after several months. This is because it is not always possible to replace a whole aesthetic subunit and whilst the site the graft is harvested from often allows the correct contour to be chosen, the quality of skin is often different and this can be seen after several weeks when any post-operative oedema has settled.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Child, Preschool; Ear, External; Female; Humans; Male; Middle Aged; Nose; Nose Deformities, Acquired; Nose Neoplasms; Plastic Surgery Procedures; Radiation Injuries; Retrospective Studies; Treatment Outcome

Lymphoepithelioma-like carcinoma (LELC) is prototypically represented by "undifferentiated" nasopharyngeal carcinoma, but it has also been described in many other anatomic locations, including the skin. In the last of these sites, primary LELC has been assumed in the past to show dermal adnexal differentiation.. The authors present a case wherein LELC of the skin (LELCS) instead appeared to be a morphologic manifestation of squamous carcinoma of the skin surface, as supported by the results of immunohistology and in situ hybridization.. Like other examples of LELCS, it showed no evidence of integration of the Epstein-Barr viral genome, and its behavior was indolent.. The heterogeneous nature of LELC as seen in different body sites is reviewed in this report, resulting in the conclusion that this tumor probably represents a morphologic pattern rather than a distinct clinicopathologic entity.

Topics: Aged; Aged, 80 and over; Antigens, CD; Biopsy; Carcinoma, Squamous Cell; Female; Humans; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps

The respective indications for oral or extra-oral implants lead to no confusion: stabilization of dental prostheses for the first, stabilization of maxilo-facial epitheses for the others. We demonstrate that the complementarity of the two types of implants can prove to be very useful in maintaining the maxillary dental prosthesis and the epithesis in a case of severe loss of facial substance affecting particularly the pre-maxilla. This complementary characteristic made it possible to recover fairly rapidly phonation and deglutition, and to remedy somewhat the esthetic damage. In other words to create the essential conditions for a return to everyday life.

Topics: Aged; Carcinoma, Squamous Cell; Dental Implantation, Endosseous; Dental Prosthesis Design; Eye Enucleation; Facial Neoplasms; Humans; Lip; Male; Maxilla; Maxillofacial Prosthesis Implantation; Neoplasm Invasiveness; Nose; Orbit; Patient Care Planning; Prosthesis Design; Zygoma

Malignant tumors frequently occur on the tip of the nose and may represent considerable therapeutic challenges.. Dermatologic surgical approaches are outlined to achieve maximum cure rates with optimal cosmesis.. Different excision techniques are shown to remove basal and squamous cell carcinomas as well as other malignant lesions on the tip of the nose. All operations can be performed under local anesthesia in a dermatologic surgical setting.. Excisions with direct wound closure are sufficient for small tumors and may even enhance the appearance off the nose. Large tumors may require full-thickness skin grafts after extensive removal yielding acceptable cosmetic results. Multiple different local flaps are available for medium sized defects whereas large wounds including the nasal skeleton require loco-regional flap repair.. Selection of the best defect repair allows the majority of nasal tip defects to be repaired with excellent functional and cosmetic results.

Topics: Anesthesia, Local; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Curettage; Dermatologic Surgical Procedures; Esthetics; Female; Humans; Male; Nasal Bone; Nose; Nose Neoplasms; Skin Transplantation; Surgical Flaps

Topics: Carcinoma, Squamous Cell; Female; Humans; Karyotyping; Middle Aged; Nose; Osteoarthropathy, Primary Hypertrophic; Skin Neoplasms

The usefulness of the inferiorly or superiorly based nasolabial flap for the unilateral or bilateral reconstruction of local extraoral and intraoral defects was evaluated.. In a 10-year period, 22 flaps were used in 15 patients to cover defects of the floor of the mouth, nose, and chin. Fourteen bilateral and two unilateral flaps were inferiorly based, and six unilateral flaps were superiorly based.. Dehiscence, which occurred in one case, and obstructive sialadenitis which occurred in another, were the main complications.. The nasolabial flap is a useful procedure for the reconstruction of moderate-sized oronasal defects because of its simple elevation, proximity to the defect, and versatility.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Chin; Evaluation Studies as Topic; Female; Graft Survival; Humans; Male; Middle Aged; Mouth; Mouth Floor; Mouth Neoplasms; Nose; Sialadenitis; Skin Transplantation; Surgical Flaps; Surgical Wound Dehiscence

The nose is particularly vulnerable to cutaneous malignancies, making it the most common location for presentation. Recurrence of these cutaneous lesions is not uncommon, often compromising the timing of nasal restoration. It is the purpose of this report to reexamine the safety of primary nasal reconstruction in selected patients.. Seventy-one patients who underwent nasal reconstruction at The University of Texas M. D. Anderson Cancer Center between 1987 and 1995 were retrospectively reviewed. There were 35 men and 36 women with an average age of 60 years. All nasal reconstructions were performed for defects secondary to malignancies. Basal cell carcinoma was the most common lesion (n = 49), followed by squamous cell carcinoma (n = 10) and melanoma (n = 7), with five additional variable malignancies. The most common location of the cutaneous lesions was the nasal dorsum, and the forehead flap was the most common adjacent tissue used for reconstruction. Immediate reconstruction was performed for 42 of the basal cell carcinomas, 6 of the squamous cell carcinomas, 6 melanomas, and 3 other lesions. Delayed restoration was performed for 7 basal cell carcinomas, 4 squamous cell carcinomas, 1 melanoma, and 2 additional lesions. The average time between surgical extirpation and the start of nasal reconstruction was 8.2 months for basal cell carcinoma, 29 months for squamous cell carcinoma, and 10 months for melanoma.. Twenty-six recurrent lesions were identified at an average of 36 months after extirpation. Despite these numbers, only three recurred after nasal reconstruction at our institution. Follow-up averaged 41 months, with none less than 1 year. Seventy patients are still alive with no evidence of disease.. Primary reconstruction is safe in selected patients. Surgical delay in reconstruction should be considered if margins are questionable, the pathology is determined to be aggressive, if there is perineural or deep bony invasion, or if postoperative radiotherapy is to be initiated. Nasal reconstruction ultimately is based upon a complex series of issues but can be performed with few complications in an effort to restore self-image.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Disease-Free Survival; Evaluation Studies as Topic; Female; Humans; Male; Melanoma; Middle Aged; Neoplasm Recurrence, Local; Nose; Prognosis; Retrospective Studies; Risk Factors; Skin Neoplasms; Surgery, Plastic; Surgical Flaps; Survival Rate

Topics: Acrylic Resins; Biocompatible Materials; Carcinoma, Squamous Cell; Cobalt; Denture Design; Denture, Complete, Upper; Dimethylpolysiloxanes; Head and Neck Neoplasms; Humans; Magnetics; Male; Middle Aged; Nose; Palatal Obturators; Polyurethanes; Prostheses and Implants; Prosthesis Design; Samarium; Silicone Elastomers; Surface Properties

A large cutaneous horn was excised from the left side of the nose and cheek of a 68-year-old woman. Reconstruction was performed with a split-thickness skin graft. Histologically the lesion represented squamous cell carcinoma. The nature of malignant degeneration in cutaneous horns is discussed.

Topics: Aged; Carcinoma, Squamous Cell; Female; Humans; Keratosis; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation

Mid-facial surgical defects can adversely affect a patient's esthetics and psychological well-being. Fabrication of a definitive mid-facial prosthesis can be a time-consuming procedure. It is crucial to minimize the time between the tumor resection and initial prosthetic rehabilitation. This article describes a method for rapid fabrication of a transitional facial prosthesis for mid-facial defects.

Topics: Aged; Carcinoma, Squamous Cell; Humans; Male; Maxillofacial Prosthesis; Maxillofacial Prosthesis Implantation; Nose; Nose Neoplasms; Prosthesis Design

We report an unusual repair of a massive midface defect resulting from resection of a recurrent squamous cell carcinoma of the nasal vestibule. The defect included both maxillas, the hard palate, the upper lip, and all nasal and perinasal tissues. After treatment, reconstruction was accomplished using prostheses and autologous tissue transferred from local and distant sites. The osseous component of the transferred tissue permitted placement of osseointegrated implants for fixation of maxillary and nasal prostheses. The rationale for this reconstruction and the problems associated with midface reconstruction after radical tumor resection are discussed.

Topics: Carcinoma, Squamous Cell; Humans; Male; Maxillofacial Prosthesis; Middle Aged; Nose; Nose Neoplasms; Surgical Flaps; Transplantation, Autologous

Superiorly based nasolabial flap is an interesting solution for reconstruction of moderate size maxillary defects. The operative technique and its results are described. Advantages (reliability in flap vascularity, versatility, easiness of elevation) and limits of this procedure for closure maxillary defects are mentioned. Then they are compared to the other reconstructive maxillary techniques.

Topics: Aged; Aged, 80 and over; Ameloblastoma; Carcinoma, Squamous Cell; Cheek; Facial Muscles; Female; Humans; Male; Maxilla; Maxillary Neoplasms; Middle Aged; Mouth Mucosa; Nose; Palate, Soft; Regional Blood Flow; Reproducibility of Results; Retrospective Studies; Surgical Flaps

The authors use a transposition island skin flap from the nasal dorsum for repair of the ala nasi. It is a modification of the stalk-flap advocated by Edgerton in 1967 to augment the columella. The flap is vascularized by branches of the anterior ethmoidal artery. The main modifications are;-the size of the flap which is 50 mm long and 15 mm wide;-the vascular pedicle is not dissected; this makes the flap very reliable;-the outstanding vascularization of this flap is corroborated by the fact that, in the same stage, it may be lined with a partially composite chondrocutaneous graft. The composite graft is taken from the concha and repaired with the Masson procedure. This flap is a very easy procedure for alar cutaneous repair for partial alar reconstruction, it is possible to fold the flap onto itself after resecting a 2 mm transverse skin strip, making the distal extremity a secondary skin island flap which ensures the lining of the proximal part. For total alar reconstruction and hemi-rhinoplasty; the flap is lined with a composite graft, which allows a one-stage thin reconstruction. The flap was used in 9 patients. In one case, there was a total skin necrosis, while half of the fasciomuscle layer survived.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Ear Cartilage; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Surgical Flaps

The sphenoid sinus has traditionally been considered a poorly accessible structure, situated deep in the center of the head and surrounded by vital structures. Aggressive benign and malignant tumors are usually considered to be inoperable because of the proximity of such structures, thus precluding the possibility of total extirpation. Using the transfacial-subcranial approach, lesions at this site can be totally excised. Significant tumor-free survival rates can be anticipated.

Topics: Carcinoma, Mucoepidermoid; Carcinoma, Squamous Cell; Cavernous Sinus; Craniotomy; Disease-Free Survival; Ethmoid Sinus; Head and Neck Neoplasms; Humans; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Nose; Papilloma, Inverted; Paranasal Sinus Neoplasms; Patient Care Planning; Patient Care Team; Prognosis; Sphenoid Sinus; Survival Rate

The nasolabial flap has frequently been used in many ways to repair the nostril. It has also been the subject of numerous criticisms, essentially related to the poor quality of the results obtained. However, the authors consider that it has an important place in the treatment of partial transfixing defects of the nostril. The nasolabial flap must be performed according to certain precise rules: strictly nasal superior pedicle, defatting of the entire flap, rotation of the flap around the external extremity of the pedicle, plication of the flap and modelling to recreate the alar margin and to reconstitute the lining. Several clinical examples illustrate this use of the flap and allow the indications to be defined.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

Topics: Adult; Bone Plates; Bone Transplantation; Carcinoma, Squamous Cell; Cartilage; Female; Follow-Up Studies; Humans; Male; Melanoma; Middle Aged; Nasal Bone; Nasal Septum; Nose; Nose Deformities, Acquired; Nose Neoplasms; Parietal Bone; Rhinoplasty; Titanium

A retrospective review of carcinomas of the nasal vestibule seen at the Queensland Radium Institute over a 30-year period was undertaken.. Twenty-nine patients with squamous cell carcinoma of the nasal vestibule who were treated with curative intent between 1960 and 1989 were analyzed. The 5-year actuarial survival and disease-free survival were 64% and 61%, respectively.. Seven patients were treated with combined modality treatment using surgery and post-operative radiotherapy and 22 were treated with radiation alone. The ultimate local control for those treated with combined modality treatment was 66% and for those treated with radiation alone was 68%. The 5-year actuarial survival was 57% and 67%, respectively.. In view of the similar local control rates and 5-year survival in the two groups, we suggest that combined modality treatment may not be warranted in the initial treatment of patients with these tumors. Radiation treatment alone with salvage surgery would appear to be the treatment of choice.

Topics: Carcinoma, Squamous Cell; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Nose; Nose Neoplasms; Prognosis; Radiotherapy Dosage; Retrospective Studies

A case-control study on cancer of the nose and paranasal sinuses, and several risk factors including previous nasal diseases and symptoms, was performed in France from January 1986 through February 1988. The frequency of previous nasal diseases and symptoms was analyzed by histologic type of cancer. Different results were observed for squamous cell carcinomas and adenocarcinomas. In men, there were statistically significant associations between squamous cell carcinomas and sinusitis, bleeding from the nose, polyps, rhinitis, and trauma to the nose; and between adenocarcinomas, bleeding from the nose, and rhinitis. In women, there was an association between squamous cell carcinomas and nasal polyps.

Topics: Adenocarcinoma; Aged; Carcinoma, Squamous Cell; Case-Control Studies; Epistaxis; Female; France; Humans; Male; Middle Aged; Nasal Polyps; Nose; Nose Diseases; Nose Neoplasms; Paranasal Sinus Neoplasms; Rhinitis; Risk Factors; Sex Factors; Sinusitis; Time Factors

A forehead neurovascular island flap has twice been used for reconstruction of minor full thickness nasal defects caused by surgical removal of malignant tumours. The flap was raised one month before transposition, and a split thickness skin graft was applied to the inner surface of the galea of the flap. The periosteum of the forehead was also grafted, thus repairing the donor site before the flap was removed. The flap is based on the supraorbital artery, which was dissected to its origin at the incisura or supraorbital foramen. The advantages are those of a small flap with external as well as internal lining and with preserved sensibility.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Forehead; Humans; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

Various surgical approaches to the region are discussed, and the procedure according to Hernandez Altemir (1986) described in detail. Six cases are presented to illustrate how this versatile osteoplastic technique may be adapted for individual patients.

Topics: Adenocarcinoma; Adenoma, Pleomorphic; Adolescent; Adult; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Ethmoid Bone; Face; Female; Head and Neck Neoplasms; Histiocytoma, Benign Fibrous; Humans; Male; Maxilla; Middle Aged; Neoplasms, Multiple Primary; Neurilemmoma; Nose; Nose Neoplasms; Osteoma; Osteotomy; Palatal Neoplasms; Pharynx; Skull Neoplasms

A retrospective study of 643 cutaneous horns examined in our department between 1970 and 1989 revealed that 38.9% were derived from malignant or premalignant epidermal lesions, and 61.1% from benign lesions. Four main features were associated with premalignant or malignant histopathological change at the base of a cutaneous horn (base pathology). These were: (i) age--the mean age of the patients whose cutaneous horns showed premalignant or malignant base pathology was 8.9 years greater than the mean age of the patients where base pathology was benign (P less than 0.0005); (ii) sex--males were more likely to develop a cutaneous horn with (pre)malignant base pathology (P less than 0.001); (iii) site--over 70% of all (pre)malignant lesions were found on the nose, pinnae, backs of hands, scalp, forearms and the face; a cutaneous horn found at these sites was 2.1 times more likely to have derived from a (pre)malignant base than from any other part of the body (P less than 0.0001); (iv) geometry of the lesion--lesions with a wide base or a low height-to-base ratio were significantly more likely to show (pre)malignant base pathology. Of those solar keratoses giving rise to cutaneous horns, 8.9% also showed histological evidence of change to squamous cell carcinoma (SCC); this figure was not significantly different from the 6.2% of solar keratoses without horns that showed SCC change during the same period (1970-89).

Topics: Age Factors; Carcinoma, Squamous Cell; Ear, External; Face; Female; Forearm; Hand; Humans; Keratosis; Male; Microcomputers; Nose; Precancerous Conditions; Retrospective Studies; Risk Factors; Scalp; Sex Factors; Skin; Skin Diseases; Skin Neoplasms

The nasolabial flap has been used for intraoral reconstruction since last century. In this paper, a modification is proposed in order to increase the amount of skin available in male patients. Simple closure of the donor area is not possible and a cheek rotation flap is suggested for closure.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Humans; Lip; Male; Maxillary Neoplasms; Mouth; Mouth Neoplasms; Nose; Skin Transplantation; Surgical Flaps

Buccal mucosal flaps provide a simple and effective method of replacing nasal mucosal lining. This technique has been used in 15 patients requiring reconstruction of full thickness defects of the lateral nasal wall and tip of nose, in combination with a variety of local flaps for skin cover. The buccal mucosal flap is of particular value in reconstructing the common defect of the lower lateral nasal wall and alar rim where more bulky reconstructions often distort the airway.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Humans; Middle Aged; Mouth Mucosa; Nasal Mucosa; Nose; Nose Neoplasms; Surgical Flaps

For the understanding of the CT findings of polymorphic reticulosis involving the upper respiratory tract, we reviewed eleven cases of this disease with initial CT study before treatment. CT revealed masses or swelling in the nose or nasal chamber, often with involvement of paranasal sinuses and medial parts of the orbit. In some, nonspecific minimal bony change (either bone destruction or bone sclerosis) was found. These CT findings are not specific. Any large mass in the nose and nasal fossa with little associated bone destruction should, however, raise the differential diagnosis of polymorphic reticulosis.

Topics: Adolescent; Adult; Aged; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Granuloma, Lethal Midline; Granulomatosis with Polyangiitis; Humans; Male; Middle Aged; Nasal Cavity; Nose; Nose Neoplasms; Tomography, X-Ray Computed

The nose is a difficult anatomic region in which to close defects resulting from resection of cutaneous malignancies. The V-Y flap is a technique for advancing adjacent tissue, thereby achieving wound closure while minimizing tension. A total of 120 V-Y flaps were used to close 114 nasal defects. The average defect size was 13.5 x 11 mm. Partial flap loss occurred in five patients, with total flap loss in one. One wound infection and two hematomas occurred.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Nose; Nose Neoplasms; Postoperative Complications; Surgical Flaps

In a 20-year experience with total rhinectomy for malignant disease, 27 of 51 patients had prior irradiation. In five patients, the tumor masqueraded as a dermatosis. Basal or squamous cell carcinomas were the usual histologic types (86%). There had been previous unsuccessful surgical therapy in 31 patients and radiation therapy in 17 patients. Twenty-two tumors recurred at a mean of 9.4 months after rhinectomy; 50% of these patients died. Despite rhinectomy, almost 25% (and 40% of patients with squamous cell carcinoma) died, usually of uncontrolled local disease. Results of surgical reconstruction after total rhinectomy were not satisfactory. In eight of 12 cases, attempts failed primarily or recurrent disease developed. Reconstruction should not be attempted before one year after rhinectomy, and use of a nasal prosthesis is the cornerstone of rehabilitation. Total rhinectomy is an oncologically sound operation for extensive nasal carcinoma.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms

In summary, the use of free tissue transfers for nasal reconstruction offers a wide variety of tissues that provide cutaneous coverage, underlying support, and nasal lining. Obtaining the final aesthetic result frequently requires defatting and other touch-up procedures, which usually can be done under local anesthesia on an outpatient basis.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Esthetics; Facial Neoplasms; Female; Follow-Up Studies; Humans; Lip Neoplasms; Male; Middle Aged; Nose; Nose Neoplasms; Surgical Flaps

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Male; Nose; Nose Neoplasms; Surgery, Plastic; Surgical Flaps

Two cases of unfavorable course of epithelioma of nose are reported. Predisposing factors, anatomoclinical diagnostic features and treatment of these lesions are analyzed, and emphasis placed on the need for early, radical surgery to prevent such a course.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Combined Modality Therapy; Electrons; Female; Humans; Male; Maxillofacial Prosthesis; Middle Aged; Nose; Nose Neoplasms; Radiotherapy Dosage

From 1956 to 1978, 646 patients were treated with radiotherapy for carcinoma of the nose (350 patients, 54 percent), eyelids (159 patients, 25 percent), pinna (93 patients, 14 percent), and skin adjacent to the lip (44 patients, 7 percent). The histologic distribution was 72 percent basal cell carcinoma, 18 percent squamous cell carcinoma, and 10 percent mixed basal and squamous cell features. Tumors less than 2 cm in diameter were found in 602 patients (93 percent), whereas 44 patients (7 percent) had larger tumors. Tumor involvement of cartilage and bone was seen in 23 patients at the time of diagnosis. The 5, 10, and 20 year control rates were 99 percent, 98 percent, and 98 percent, respectively, for 502 tumors less than 2 cm in diameter. This compared favorably with control rates of 92 percent at 5 years and 79 percent at 10 years for tumors from 2 to 5 cm in diameter and 60 percent at 5 years and 53 percent at 8 years for 12 patients with massive tumors (p less than 0.0001). The histologic characteristics of the lesion had a strong influence on tumor control (p less than 0.02). Of the patients with cartilage or bone invasion, tumor was controlled in 19 (83 percent). Of these 19 patients, 11 had no evidence of disease for 3 years or more. Of all 646 patients treated, failure was seen in 60 (9 percent). It correlated well with the size of the lesion, being 7 percent for tumors of less than 2 cm and 50 percent for tumors of greater than 5 cm. Of the 60 patients in whom treatment failed, 48 (80 percent) had prior definitive therapy. Radiotherapy was an efficient modality to control operative failures; however, it was not as efficient at control in patients in whom previous radiotherapy failed. Operation was the treatment of choice to salvage patients in whom radiotherapy failed. Of the patients in whom retreatment failed, 10 were known to have died from skin cancer, and an additional 6 patients were presumed to have died from the cancer. This study has demonstrated a good control rate and good cosmetic results for small tumors of the eyelids, pinna, and nose. In addition, a good control rate was obtained in patients with cartilage and bone involvement. Treatment of massive tumors should involve planned operative resection with adjuvant radiotherapy.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Basosquamous; Carcinoma, Squamous Cell; Ear, External; Eyelids; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Nose; Radiotherapy Dosage; Skin Neoplasms

Topics: Animals; Carcinoma, Squamous Cell; Elastic Tissue; Horse Diseases; Horses; Nose; Skin; Skin Diseases; Skin Neoplasms; Sunlight

During a period of over 20 years, 896 patients were treated with radiation in Wadsworth Medical Center, Los Angeles, for carcinoma of the lip and selected sites of skin of the head and neck. Basal cell carcinoma (BCC) was found in 467 (52%) patients, squamous cell carcinoma (SCC) in 362 (40%), and the remaining 67 (8%) had tumors with mixed basal and squamous cell features. BCC was the most common tumor (72%) among the 646 skin cancer patients while SCC predominated (99%) among the 250 lip cancer patients. Tumor control correlated well with the size of the lesion, p less than 0.0001. Histology of the lesion also had a significant (p = 0.021) influence on the tumor control rate, which was the highest among the BCC patients when compared with SCC or mixed cell patients. This study has again demonstrated the effectiveness of radiotherapy in controlling small and intermediate size epithelial tumors of the skin and lip. Additionally, irradiation, if administered properly, results in excellent cosmesis and a low incidence of treatment complications. Severe complications of radiotherapy reported in the literature took place at the beginning of this century and are no longer pertinent in the practice of modern radiation oncology. Larger lesions remain a challenge to radiation or surgical dermato-oncologists. A lack of tumor control in such lesions frequently results in a death of patient.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Facial Neoplasms; Humans; Lip Neoplasms; Middle Aged; Nose; Radiotherapy; Skin Neoplasms

Malignant tumours of the nasal cavity and paranasal sinuses are uncommon amounting to 0.3-1% of all tumours and 3%-5% of carcinomas of the upper respiratory tract. Modern diagnostic techniques include endoscopy and computer tomography. Prognosis and therapy depend on the histological type, site of origin and extent of the tumour. The variety of possible treatment modalities demands individual therapy planning. A combined surgical and radiotherapeutic approach, possibly supplemented by small volume intracavitary brachytherapy or polychemotherapy in some defined histological tumour types, has been generally accepted, enabling a five year survival rate of 35%-45% to be achieved. The causes for failure are firstly local persistence of tumour (18%) or a local recurrence (37%). The cumulative recurrence rate after one and two years was 76% and 95% respectively. Late recurrences occur in 2.5% of cases. The complication rate with combined-modality therapy reaches 27% with minor complications occurring in 12% and major complications in 15% especially affecting the irradiated homolateral eye. The present statistical results show a number of weak points that cast doubt on their validity. We recommend a controlled, prospective, randomised, multi-centre and multi-disciplinary study to define the prognostic parameters for tumours of the paranasal sinuses and to choose the most effective, individually tailored therapy.

Topics: Adenocarcinoma; Carcinoma, Squamous Cell; Combined Modality Therapy; Endoscopy; Humans; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses; Prognosis; Tomography, X-Ray Computed

Considerable interest and research have resulted from the finding that squamous cell carcinomas, polypoid adenomas, and a small number of other nasal neoplasms occurred in F-344 rats following chronic inhalation exposure to formaldehyde. These tumors were reported to originate in the anterior portion of the nasal cavity but their precise location in the nose was not determined. Histologic sections from the nasal passages of these rats have been reexamined and the location of each tumor has been recorded. The majority of squamous cell carcinomas occurred on the anterior portion of the lateral aspect of the nasoturbinate and adjacent lateral wall (57%) or the midventral nasal septum (26%). Polypoid adenomas were confined to a small region of the anterior nasal cavity and were restricted to the free margins of the naso-and maxilloturbinates and lateral wall adjacent to these margins. One neoplasm, considered to be the malignant counterpart of the polypoid adenoma, originated on the dorsal margin of the maxilloturbinate in the same region of the nose. Remaining neoplasms were generally too large or too poorly preserved for assessment of their site of origin. Mechanistic studies directed toward a better understanding of the nasal carcinogenicity of formaldehyde, or other nasal carcinogens. should take into account the anatomic sites of origin of the neoplasms whenever this can be determined.

Topics: Animals; Carcinoma, Squamous Cell; Female; Formaldehyde; Gases; Male; Nasal Polyps; Nose; Nose Neoplasms; Rats; Rats, Inbred F344

Topics: Aged; Carcinoma, Squamous Cell; Cheek; Female; Forehead; Humans; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

Inverted papilloma is notorious for recurrence and occasional association with malignancy, leading most authors to recommend lateral rhinotomy as the initial surgical approach in all cases; however, conservative surgery has been reported effective in selected cases. To assess the role of conservative procedures, 90 cases of inverted papilloma were retrospectively reviewed. Associated malignancy was rare. Conservative surgery was successful in controlling some cases, but often required two or three operations. All patients with clear sinus films were cured by a single procedure. Abnormal mitotic activity was seen in some aggressive lesions and some associated with malignancy. The surgical exposure in inverted papilloma should be adequate to ensure complete excision. Selected patients with localized disease can be satisfactorily managed by conservative procedures if they are carefully followed. All tissue should be inspected for possible malignancy.

Topics: Adult; Carcinoma, Squamous Cell; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Mitotic Index; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Nose; Nose Neoplasms; Papilloma; Prognosis; Radiography; Retrospective Studies; Risk

Twenty-five tumours sampled from various sites on sheep were implanted subcutaneously into nude mice. Of these, 10 were successfully transplanted and serially passaged. An association was found between the tumour growth site on the sheep and its acceptance as a xenograft, with those derived from the skin of the nose being the most successful. Both growth pattern (expansive or invasive) and the histological appearance of the xenografts were similar to that observed in the sheep although faster growth rates were observed after the tumour was serially passaged in the nude mouse.

Topics: Animals; Carcinoma, Squamous Cell; Cell Division; Ear, External; Female; Mice; Mice, Nude; Neoplasm Transplantation; Neoplasms, Experimental; Nose; Sheep; Sheep Diseases; Skin Neoplasms; Transplantation, Heterologous; Vulva

Dermatologic epithelioma of the nose is usually a basocellular and more rarely a spinocellular epithelioma. Small tumors less than 5 mm in diameter can be treated by electrocoagulation, whereas those over 1 cm should be treated by surgery or physical methods. Of a total of 144 cases of epithelioma operated upon, 10% were reconstructed by a flap. Increasing use is being made of local anesthesia with subsequent reduced hospital stay. The quality of the carcinologic results, similar to that of physical methods, and the excellent healing obtained, particularly in elderly patients, are arguments in favor of extensive surgery for epitheliomas in this region. The quality of the resection is difficult to evaluate, unless results of a fresh specimen examination are available. When not possible then it is preferable to await results of histology to show limits of excision before performing an autoplasty with flaps.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Nose; Skin Neoplasms; Surgery, Plastic; Surgical Flaps

Twenty-two patients with nasal septal carcinoma have been treated at the University of Texas Medical Branch, Galveston, during the 18-year period from 1961 to 1979. Squamous cell carcinoma of the nasal septum was found in 18 patients (82%), with single instances of reticulum cell sarcoma, basal cell carcinoma, histiocytic lymphoma, and transitional cell carcinoma. One of the squamous cell carcinoma group had palpable cervical metastasis at diagnosis, with metastatic neck disease developing in eight patients from three to 25 months after treatment. Squamous cell carcinoma of the nasal septum is aggressive and often undertreated. Our experience suggests that patients with septal carcinoma of any size should be treated by wide surgical excision (via lateral rhinotomy) and irradiation to the primary site and neck. Control of the primary tumor was achieved in 17 of 18 patients, with neck control in ten patients. The five-year absolute survival rate for squamous cell carcinoma of the nasal septum was 66%.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Combined Modality Therapy; Female; Humans; Lymphatic Metastasis; Male; Methods; Middle Aged; Nasal Septum; Nose; Nose Neoplasms; Radiotherapy Dosage

Lateral rhinotomy provides excellent exposure of the interior of the nose, the paranasal sinuses, and the nasopharynx with minimal postoperative deformity. A review of 226 lateral rhinotomies performed at the Mayo Clinic, Rochester, Minn, from 1970 through 1979, was made to determine the versatility of this incision and some of its limitations and risks. The suitability of this technique to approach the wide variety of pathologic conditions that occur in the midfacial structures was reaffirmed.

Topics: Aged; Carcinoma, Squamous Cell; Female; Humans; Male; Maxillary Sinus; Methods; Middle Aged; Nasal Septum; Nose; Paranasal Sinus Neoplasms; Prostheses and Implants; Silicones; Surgical Flaps

A series of large, midfacial, squamous cell and basal cell carcinomas treated by the Departments of Otolaryngology and Dermatology (Cleveland Clinic Foundation) are reported. Most cases required total/partial resection of the external nose, upper lip, hard palate, nasal septum, and adjacent midfacial soft tissues. Emphasis is placed on the principles of preoperative and intraoperative management as it relates to intraoral prosthetic design and total margin control of the surgical specimen. The immediate and delayed reconstructive philosophy and techniques employed here are discussed in detail. Recurrence rates and free-to-disease survival times are also reviewed.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Facial Neoplasms; Humans; Lip; Maxillofacial Prosthesis; Nose; Surgical Flaps

Topics: Adult; Aged; Amputation, Surgical; Carcinoma, Squamous Cell; Female; Humans; Male; Melanoma; Middle Aged; Nasal Septum; Nose; Nose Neoplasms; Prostheses and Implants

Topics: Adolescent; Adult; Carcinoma, Squamous Cell; Cheek; Child; Face; Facial Neoplasms; Female; Fibrosarcoma; Fistula; Humans; Male; Melanoma; Middle Aged; Mouth Neoplasms; Nose; Nose Deformities, Acquired; Surgical Flaps

Topics: Adult; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Hemangioma; Humans; Infant, Newborn; Male; Middle Aged; Nose; Nose Deformities, Acquired; Nose Neoplasms; Rhinophyma; Rhinoplasty

A patient developed a cutaneous deposit of leukaemic cells within a squamous cell carcinoma as the first presentation of acute myeloblastic leukaemia.

Topics: Aged; Carcinoma, Squamous Cell; Facial Neoplasms; Humans; Leukemia, Myeloid, Acute; Male; Neoplasms, Multiple Primary; Nose; Skin; Skin Neoplasms

Perineural spread of tumour has been demonstrated in 24% of an unselected series of 70 patients with squamous carcinomas of the head and neck treated by surgery. Slightly more than half the patients had primary tumours arising within the buccal cavity. Clinical features suggesting perineural infiltration were found in about two thirds of the cases; the symptoms and signs were usually sensory and occurred early in the disease. The mandibular division of the trigeminal nerve was most commonly affected. Perineural spread was more likely to occur with large carcinomas, moderate or poorly differentiated, showing local invasion and lymph node metastases. The associated pathological changes are described and a high incidence of damage to nerve fibres is recorded. The practical implications of perineural spread of tumour are discussed with reference to indications for more radical surgery or for more conservative measures supplemented with other modes of treatment.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Male; Mandibular Nerve; Maxillary Nerve; Middle Aged; Neoplasm Invasiveness; Nerve Fibers; Nose; Trigeminal Nerve

Topics: Adolescent; Age Factors; Carcinoma, Squamous Cell; Humans; Male; Nose; Skin Neoplasms; Skin Transplantation; Transplantation, Autologous

This study presents a retrospective look at 115 patients evaluated here from 1957 to 1974. In this series, 57 percent were males and 43 percent females, 84 percent were Caucasian and 16 percent Negro. Lesions confined to or originating in the antrum made up 67 percent while nonantral lesions were 33 percent. Mean age at diagnosis was 59.1 years. Smoking and drinking history did not appear to be contributory. Antral lesions were retrospectively staged according to Sisson's TNM classification. Sixteen tumor types were involved, with the most common being epidermoid. Diagnosis was most often made by intranasal or Caldwell-Luc biopsy. Most frequent symptoms, as well as earliest symptoms, were nasal obstruction, localized pain, and epistaxis. Average duration of symptoms was 6.4 months. Therapy was generally in the form of radiotherapy alone, preoperative radiotherapy and surgery, surgery and postoperative radiotherapy, or surgery alone. Local recurrences occurred in 44 percent of antral lesions and 50 percent of non-antral lesions. Regional (cervical) nodal metastases developed in 25 percent of antral lesions and 11 percent of non-antral lesions. Distant metastases developed in 30 percent of antral cases and 35 percent of non-antral cases. Five-year survival was 32 percent (35 percent determinate) for the total group. The more advanced the staging of the antral lesions, the worse the prognosis. Best survival figures were in the areas of preoperative radiotherapy and surgery at 38 percent (43 percent) and surgery alone at 56 percent (59 percent).

Topics: Adolescent; Adult; Aged; Carcinoma, Squamous Cell; Child; Cobalt Radioisotopes; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasal Cavity; Neoplasm Metastasis; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Prognosis; Radioisotope Teletherapy; Recurrence; Retrospective Studies

Topics: Carcinoma, Squamous Cell; Humans; Intubation; Intubation, Gastrointestinal; Intubation, Intratracheal; Jaw Neoplasms; Mandible; Methods; Mouth Floor; Mouth Neoplasms; Nose; Skin Neoplasms; Tongue; Tracheotomy

Topics: Adult; Aged; Carcinoma, Squamous Cell; Connective Tissue; Facial Injuries; Fibroma; Fibromyalgia; Humans; Laryngeal Neoplasms; Larynx; Male; Nose; Skin

The experience with 40 consecutive cases of cancer of the nasal cavity seen over a period of 15 years is presented. Males outnumbered females in a ratio or 5 to 3. Age ranged from 35 to 88 years, and the median age was 67 years. Epidermoid carcinoma accounted for 78% of the cases. Smoking from early age was a noticeable habit among these patients. The median length of smoking history was 51 years. Most lesions were diagnosed in an advanced stage of the disease, 58% of the cases being T3 lesions. Regional lymph nodes metastases were infrequent; only 12% of the patients presented nodes on admission; another 5% developed metastatic nodes during the follow-up period. An overall 5-year survival of 56% was obtained. The survival of cases with T1N0 lesions was 91%. Radiation therapy was the treatment of choice employed in 85% of the cases. A 5-year survival of 50% was obtained in these patients. Irradiation offers an additional means of salvaging recurrences after surgery. The special characteristics of tumors of the nasal cavity merit the evaluation of such lesions separately from tumors of the paranasal sinuses.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nasal Cavity; Neoplasm Metastasis; Nose; Nose Neoplasms; Prognosis; Remission, Spontaneous; Smoking

Topics: Carcinoma, Squamous Cell; Cystadenoma; Epithelial Cells; Epithelium; Humans; Melanocytes; Melanoma; Nasopharyngeal Neoplasms; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Papilloma

Topics: Carcinoma, Squamous Cell; Cobalt Radioisotopes; Female; Follow-Up Studies; Hemorrhage; Humans; Infections; Lacrimal Duct Obstruction; Lymphatic Metastasis; Male; Middle Aged; Neck Dissection; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Osteoradionecrosis; Radiation Injuries; Radiotherapy; Radiotherapy, High-Energy; Radium

Topics: Biopsy; Carcinoma, Squamous Cell; Diagnosis, Differential; Humans; Keratoacanthoma; Male; Middle Aged; Nose; Nose Neoplasms; Skin Transplantation; Transplantation, Autologous

Topics: Adolescent; Adult; Animals; Bites and Stings; Carcinoma, Squamous Cell; Cheek; Child, Preschool; Dogs; Facial Injuries; Female; Fistula; Humans; Lip; Lip Diseases; Lip Neoplasms; Male; Methods; Middle Aged; Nose; Nose Diseases; Nose Neoplasms; Skin Transplantation; Transplantation, Autologous

Topics: Adenocarcinoma; Adult; Auscultation; Biopsy; Carcinoma, Squamous Cell; Child; Endoscopy; Head and Neck Neoplasms; Humans; Laryngoscopy; Medical History Taking; Neoplasm Metastasis; Nose; Palpation; Pharynx; Radiography

Topics: Adenocarcinoma; Adenocarcinoma, Mucinous; Adenocarcinoma, Papillary; Adenoma, Pleomorphic; Adolescent; Adult; Aged; Carcinoma, Adenoid Cystic; Carcinoma, Intraductal, Noninfiltrating; Carcinoma, Papillary; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Child; Female; Follow-Up Studies; Humans; Larynx; Lymphatic Metastasis; Male; Middle Aged; Nasopharyngeal Neoplasms; Nasopharynx; Nose; Palatal Neoplasms; Palate; Salivary Gland Neoplasms

Topics: Adolescent; Adult; Aged; Airway Obstruction; Anesthesia, Intravenous; Carcinoma, Squamous Cell; Cough; Epistaxis; Female; Fracture Fixation, Internal; Fractures, Bone; Hemorrhage; Humans; Ketamine; Male; Mandibular Neoplasms; Nose; Orthopedic Fixation Devices; Pharynx; Reflex; Surgery, Oral

Topics: Age Factors; Aged; Carcinoma, Squamous Cell; Ear; Head; Head and Neck Neoplasms; Humans; Larynx; Middle Aged; Mouth; Nasopharynx; Neoplasms; Nose; Ophthalmologic Surgical Procedures; Postoperative Complications; Salivary Glands; Surgical Procedures, Operative

Topics: Adolescent; Adult; Aged; Calculi; Carcinoma, Squamous Cell; Child; Cysts; Diagnosis, Differential; Female; Fibrous Dysplasia of Bone; Headache; Humans; Male; Middle Aged; Mucocele; Nasal Polyps; Neck; Nose; Paranasal Sinus Neoplasms; Radiography; Respiratory Tract Diseases; Sinusitis; Sphenoid Sinus

Topics: Adolescent; Adult; Carcinoma, Squamous Cell; Connective Tissue; Edema; Ethmoid Sinus; Female; Frontal Sinus; Humans; Male; Methods; Middle Aged; Nasal Polyps; Nasal Septum; Nose; Nose Neoplasms; Osteomyelitis; Scalp; Sinusitis; Skull

Topics: Adenocarcinoma; Adult; Age Factors; Aged; Back; Brain Neoplasms; Breast Neoplasms; Carcinoma, Basal Cell; Carcinoma, Intraductal, Noninfiltrating; Carcinoma, Squamous Cell; Cecum; Colonic Neoplasms; Female; Gallbladder Neoplasms; Glioblastoma; Humans; Intestinal Neoplasms; Male; Middle Aged; Neoplasms; Nose; Oligodendroglioma; Skin Neoplasms; Stomach Neoplasms; Uterine Neoplasms; Vitiligo

Topics: Adenocarcinoma; Animals; Bronchial Neoplasms; Carcinoma, Squamous Cell; Mice; Mice, Inbred Strains; Neoplasms, Experimental; Nose; Orthomyxoviridae; Orthomyxoviridae Infections

Topics: Amputation, Traumatic; Carcinoma, Squamous Cell; Facial Injuries; Methods; Nose; Nose Neoplasms; Rhinoplasty; Skin Transplantation; Suture Techniques; Transplantation, Autologous

Topics: Adolescent; Adult; Aged; Bites and Stings; Bites, Human; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Face; Female; Humans; Male; Methods; Middle Aged; Nose; Nose Deformities, Acquired; Nose Neoplasms; Rhinoplasty; Skin Transplantation; Transplantation, Autologous

Topics: Animals; Brain Neoplasms; Carcinoma, Squamous Cell; Epithelium; Ethers; Hydrocarbons, Halogenated; Lung; Lung Neoplasms; Neoplasm Metastasis; Neoplasms, Experimental; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Occupational Diseases; Paranasal Sinus Neoplasms; Rats; Respiratory Tract Neoplasms

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Keratoacanthoma; Male; Methods; Nose; Nose Neoplasms; Prostheses and Implants; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Carcinoma; Carcinoma, Squamous Cell; Diagnosis, Differential; Humans; Methods; Nose; Nose Diseases; Nose Neoplasms; Paranasal Sinus Neoplasms; Radiography; Rhabdomyosarcoma

Topics: Adult; Aged; Arm; Blister; Carcinoma, Squamous Cell; Cheek; Diagnosis, Differential; Eosinophils; Epidermal Cyst; Epithelium; Facial Dermatoses; Female; Granulation Tissue; Humans; Keratosis; Male; Middle Aged; Nose; Skin; Skin Neoplasms

Topics: Aged; Carcinoma, Squamous Cell; Humans; Male; Middle Aged; Nasal Septum; Nose; Nose Neoplasms; Radiography; Radium

Topics: Alveolar Process; Carcinoma, Squamous Cell; Female; Humans; Maxillary Neoplasms; Methods; Middle Aged; Mouth Mucosa; Nose; Palate; Periosteum; Surgery, Plastic

Topics: Acne Vulgaris; Adult; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Facial Neoplasms; Female; Fibrosarcoma; Follow-Up Studies; Humans; Lymphoma; Neoplasm Recurrence, Local; Neoplasms, Radiation-Induced; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Adult; Age Factors; Carcinoma; Carcinoma, Squamous Cell; Female; Humans; Male; Nose; Nose Neoplasms; Papilloma; Paranasal Sinus Neoplasms; Paranasal Sinuses; Sex Factors

Topics: Animals; Carcinoma, Squamous Cell; Fishes; Male; Nose; Skin Neoplasms

Topics: Carcinoma, Squamous Cell; Humans; Nose; Nose Neoplasms; Papilloma; Paranasal Sinus Neoplasms; Paranasal Sinuses

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Melanoma; Nose; Nose Neoplasms

Topics: Carcinoma, Squamous Cell; Humans; Lip; Nose; Skin Neoplasms; Xeroderma Pigmentosum

Topics: Carcinoma; Carcinoma, Squamous Cell; Epithelial Cells; Ganglionectomy; Humans; Nose

Topics: Carcinoma; Carcinoma, Squamous Cell; Gallbladder; Humans; Neoplasms; Nose