title: [Reconstruction of proximal nasal defect after deep carcinological resection. Interest to combine titane mesh with fat grafting].
abstract: BACKGROUND
  The mucosal cylindroma or adenoid cystic carcinoma is the second sinonasal non-epithelial malignant tumor frequency argument. Due to the achievement of the nasal mucosa and a late diagnosis reconstructions are often complex. We report the case of a mucous cylindroma recurrence of nasal septum requiring a wide and deep excision of the root of the nose with nasal reconstruction.
  
  
  METHODS
  A patient aged 66 years whose history resection two years ago with a mucous adenoid cystic carcinoma of the right side of the nasal septum, had a local recurrence T2NOM0 imposing a wide excision with amputation nasal septum own bones of nose, the anterior portion of the triangular cartilages. The reconstruction was carried out in three areas: a musculocutaneous forehead flap to the mucosal level, a titanium plate to the bone plane, nasal native skin to skin level. Histological examination confirmed the existence of a recurrence cylindroma infiltrating the bone. The surgical margins were however in sano. Adjuvant radiotherapy to 60Gy dose of the surgical area was indicated after surgery. The consequences of surgery and radiotherapy were simple. However local changes to show a progressive refinement of the nasal skin due to irradiation leading to a small titanium plate exposure revision surgery with coverage by a glabellar flap associated with a time of lipomodeling unexposed areas have improved and trophism of soft tissue. Two further lipomodeling sessions have yielded a good quality and stable skin. From an oncological point of view, no recurrence was detected with a decline of 10 years. Aesthetic and functional point of view the results were highly satisfactory.
  
  
  CONCLUSIONS
  Oncologic resections subtotal nasal pyramid are complex, we will see the benefits and disadvantages of the different techniques used in the different stages.
  
  
  CONCLUSIONS
  This case report illustrates the difficulties of reconstruction after wide excision of mucosal lesions root of the nose carrying the mucous plan and nasal bones. It stresses the importance of bone reconstruction titanium plate and innovative element, the efficiency of fat transfer to restore the quality and trophicity soft tissue. Fat transfer in addition to reconstructions by titanium plates and splints may thus expand the indications of these types of techniques in complex facial and cranial reconstructions.
authors.affiliation: Unité de chirurgie plastique et reconstructrice, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France. Electronic address: aimardrom1@hotmail.fr.
authors.forename: R
authors.initials: R
authors.lastname: Aimard
authors.affiliation: Unité de chirurgie plastique et reconstructrice, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France.
authors.forename: C
authors.initials: C
authors.lastname: Lalloué
authors.affiliation: Unité de chirurgie plastique et reconstructrice, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France.
authors.forename: C
authors.initials: C
authors.lastname: Ho Quoc
authors.affiliation: Service d'ORL, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France.
authors.forename: D
authors.initials: D
authors.lastname: Girodet
authors.affiliation: Service d'ORL, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France.
authors.forename: P
authors.initials: P
authors.lastname: Zrounba
authors.affiliation: Unité de chirurgie plastique et reconstructrice, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France; Cabinet, 50, rue de la République, 69002 Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Delay
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000368:Aged; D003528:Carcinoma, Adenoid Cystic / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D009300:Nasal Septum / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D019736:Prostheses and Implants; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods*; D012225:Rhinoplasty / Q000379:methods*; D013526:Surgical Mesh; D014025:Titanium
chemical_list: D014025:Titanium
keywords: Cylindroma; Cylindrome; Lipofilling; Lipomodelage; Lipomodeling; Mesh titane; Nasal reconstruction; Pyramide nasale; Reconstruction; Titane Mesh