This document summarizes Dr. Ahcene Madjoudj's experience with reconstructive rhinoplasty surgery following trauma or deformity. It describes various surgical techniques used for different types of injuries and conditions, including saddles, burns, cancer resections, and cleft lip/palate. Across cases, the goals are to reconstruct the nasal structure and shape while balancing aesthetic and functional concerns. The document emphasizes the challenges of meeting patient expectations given limitations of reconstructive surgery.

1. Rhinoplasties in reconstructive
surgery
Personal experience
Docteur Ahcene Madjoudj

2. Docteur Ahcene Madjoudj
 Plastic Surgeon.
 I practice in the liberal sector in Algiers (Algeria).
 I also collaborate with neuro-surgery departments of CHU
Blida and Bab-El-Oued mainly in spina-bifida and Cranio-
facial surgery.
 I am a member of the Canadian Society for Aesthetic
Plastic Surgery (csaps).

3. Definition
 Rhinoplasty is surgery of the nose shape which aims is
to harmonize it with the rest of the face.
 In this presentation we address more specifically the
reconstructive rhinoplasty, secondary to traumas or
deformities.

4. Issue
 Unlike cosmetic rhinoplasty, the reconstructive one, is not
codified.
 This surgery require technical gestures that will be
described on some clinical cases in this presentation.

5. Post-traumatic
Reconstructive rhinoplasties

6. Injuries are mostly caused by:
Traffic accidents , violence.
Mutilation.
•
Burns.
•
After Surgery for cancer.
•
•

7. Preoperative
The consultation:
 the patient must not wear nothing that could hide parts of his
face (glasses,cap..)
 Close attention will be paid to the patient's expectations,
explaining clearly the intervention outcomes and limits .
 Radiological exams are demanded if needed.
The nose exam will determine :
 Lesions on the nasal pyramidal structure ( bone, cartilage)
 The impact on the nasal respiratory .
 Speculum nasal exam must be conducted to look for possible
septal and endo-nasal bones lesions
 We will evaluate the associated lesions of the face.

8. Clinical cases

9. General Approach
 During the intervention both aspects, the aesthetical and
functional ,should be considered equally.
 Both aspects should be treated in the same operatory time
when it is posssible.

10. Post-traumatic rhinoplasties

11. General considerations
 Will use the hump to fill the isolated cartilaginous
dorsum saddles .(personal technique)
 the bone grafts are taken from the iliac crest or from the
skull(clavarial)
 In saddles ,Grafts are not always necessary.

12. The saddles
 They may concern the cartilage dorsum only or the
whole dorsum (bone and cartilage).

13. Post-traumatic saddle: case I
 Unilateral intercartilaginous incision.
 minimal dissection of skin and subperiostal dorsum .
 Removal of the hump with lateral osteotomies .
 Iliac bone graft is slept into the saddle .

15. Post-traumatic saddle:case II
 No bone graft.
 Hump removed , lateral osteotomies and bones drawn
together
 Hump reinclusion on the cartilaginous saddle.

17. Post-traumatic: case III
 Saddle dorsum osteocartilaginous from childhood.
 Intercatilaginous incision with a minima subcutaneous
dissection .
 Setting up of two two iliac bone grafts.
 No columellar strut .

19. Post-traumatic: case IV
 Post traumatic saddle
 No bone graft.
 No reinclusion
 paramedian osteotomies
 Lateral osteotomies
 draw together the bones on the median line .

21. Post-traumatic: case V
 Cartilaginous saddle post surgery
 lateral and paramedian osteotomies.
 auricular cartilage graft affixed on the saddle.

23. Post mutilation rhinoplasty

24. General considerations
• The forehead flap is often the best indication when the
mutilation is severe.

25.  Amputation of the cartilaginous portion of the nose due
to an act of mutilation.
 Placing the forehead flap weaned at day 21
 Defatting were needed .

27. Rhinoplasty after burn

28. General considerations
 Isolated nose burn is rare.
 Often burn spreads all over the face.
 The forehead flap reparation is often indicated when
lesions occur on the nose tip.
 The inflammatory and scarring processes make the
surgical repair very challenging.

29. Patient Case I
 Sequels of burns of the face with loss of the nasal tip.
 Tissues retraction on the nose and the upper lip.
 Short forehead .
 To bring the forehead flap to the nasal tip, we
performed :
 Rhinoplasty with resection of the osteocartilaginous
dorsum to lower it.
 Lateral osteotomies
 Placed the forehead flap with some difficulties due to
scarring problems.
 4 surgeries revisions were needed .

31. Post cancer surgery
rhinoplasty

32. General considerations
 We use the forehead flap technique when the
amputation is not important, otherwise we use the
forearm to make a composite free flap .

33. Patient case I
 Nose tip cancer.
 Wide resection with satisfactory extemporaneous
pathological examination.
 Placing the forehead flap weaned at day 21.
 sample’s pathological exam satisfactory.

35. Patient case II:
Sclero-dermiforme epithelioma case
 Recurrences are frequent despite pathological findings
oncologically satisfactory.
 sclero-dermiform ephitelioma recurence occurred each
and every time after surgery.
 After the third operation, the patient underwent a
radiotherapy which helped stop the cancerous process.

37. Rhinoplasty in malformations

38. Binder's syndrome

39. General considerations
 Lefort II is the best solution in malocclusions.
 In other cases , results are very gratifying by just
using bone grafts (nasal, maxillar and malar ).

40. Patient case I
• Minor case
• Bone graft apposition on the dorsum was enough.

42. Patient case II
 significant retrusion of nasomaxillary area without occlusion
problem .
 Open rhinoplasty.
 Taking of Iliac bone grafts.
 Thin and large bone graft is inserted between the septal
mucosas.
 Next we put a large bone graft to rebuild the dorsum.

44. Patient case III
 affixing of iliac bone grafts on malars, maxillary and the
nose

46. Rhinoplasty post lip and
palate cleft surgery

47. General considerations
 Those cases are very common and the surgery is very
challenging .

48. Patient case I
 lip alignment surgical revision .
For the nose:
 Open rhinoplasty , alar cartilages dissection
 Setting up of a columellar strut.
 suture both alar domes to create the nose tip.

50. Patient case II
 Open rhinoplasty
 No struts , just alars dissection .
 Suture of the hypoplasic alar to the septum and homolateral
triangular cartilage.
 suture both alar domes to create the nose tip.

52. Patient case III
 Setting up of a columellar strut.
 Suture of the hypoplasic alar to the septum and to the
homolateral triangular cartilage.
 suture both alar domes to create the nose tip.

54. Conclusion
Although the surgery greatly improves the patients appearance ,
results are often far below their expectations.
It is important to provide them with a rigorous and objective
information about the surgery limits to avoid future
disappointments.

55. Thank you.
The slides are available on :
www.chirurgieesthetiquealgerie.com