ENT 2026

Introduction: Malignant nasal tumors frequently require extensive surgical resection, resulting in significant aesthetic, functional, and psychosocial morbidity. Reconstruction of the nasal pyramid using local flaps, such as the paramedian forehead flap (PFF) and nasolabial flap (NLF), particularly when combined with cartilage grafting, allows restoration of the nasal tip projection and alar convexity, contributing to favorable aesthetic and functional outcomes.Materials and Methods: We present a case series involving different reconstructive approaches following partial rhinectomy (PR). Surgical techniques, imaging findings, and pre-, intra-, and postoperative photographic documentation were reviewed and documented.Discussion: Case 1: An 81-year-old woman underwent PR and bilateral supraomohyoid neck dissection for T4aN0M0 squamous cell carcinoma of the nasal dorsum. Reconstruction was performed in two stages using costal and conchal cartilage, a left PFF, and bilateral NLF. Costal cartilage and perichondrium were used to recreate the L-strut. Conchal cartilage harvested from the right auricle was used for reconstruction of the alar cartilages, while the nasal dorsum was reconstructed with a PFF. The columella was reconstructed using a left NLF, and the intranasal lining was reconstructed with a right NLF. The PFF pedicle was sectioned after 4 weeks. Four months later, secondary revision of the columella was performed using an inferiorly based nasolabial flap and a costal cartilage graft.Case 2: A 65-year-old man with a T1N0M0 squamous cell carcinoma of the nasal vestibule underwent PR and right supraomohyoid neck dissection. Reconstruction was performed using a nasal pyramid bilobed flap.Case 3: An 81-year-old man with a T2N0M0 squamous cell carcinoma of the nasal septum underwent PR followed by adjuvant radiotherapy. Subsequently, he developed a nasocutaneous fistula of the nasal dorsum and a saddle-nose deformity. Nasal pyramid reconstruction was performed using bilateral auricular cartilage grafts.Conclusion: Nasal pyramid reconstruction following PR remains a major surgical challenge. Local flaps represent effective reconstructive options owing to their reliable vascular supply and low donor-site morbidity. Their combination with cartilage grafts appears to provide superior aesthetic and functional outcomes.

Adriana Luísa Faria Cunha graduated in Medicine from the Faculty of Medicine of the University of Porto in 2020. Since January 2022, she has pursued specialist training in Otorhinolaryngology, initially at Unidade Local de Saúde do Tâmega e Sousa and subsequently at Unidade Local de Saúde São João. She also undertook training in ENT Oncology at the Portuguese Oncology Institute of Porto. She is currently in her final year of residency at Unidade Local de Saúde São João. She is actively involved in scientific research, with publications in national and international journals.