Pediatric Nasal Reconstruction for Nasal Tip Hemangioma

Abstract

Sir: We read with great interest Dr. Burget's recent article on pediatric nasal reconstruction. Dr. Burget is well known for his special interest and phenomenal results in nasal reconstruction. We would like to congratulate him for the unique and very detailed case presentation and the excellent result achieved. We have had a similar case of nasal tip hemangioma extending to the upper lip on a female pediatric patient (Fig. 1). Our approach was completely different from Dr. Burget's. We chose to follow a “wait-and-see” approach initially, until involution of the hemangioma was evident. Our experience with this patient contrasts with Dr. Burget's observations, that “when a hemangioma necroses, collagen contraction shrinks the nasal lining skin and displaces the alar cartilages posteriorly and superiorly.”Fig. 1.: The patient at age 6 months.The patient was followed up until the age of 9 years (Fig. 2), when a very conservative excision of the excess skin on the nasal tip and dorsum was performed, following the shrinkage of the hemangiomatic tissue (this was probably the reason why tissue shrinkage was minimal).Fig. 2.: The patient at age 9 years.At the age of 16 years (Fig. 3), a second operation was performed, where the nose was reconstructed using an open rhinoplasty method. We used a columella strut graft, spreader grafts, and lower lateral grafts with the septum as a donor site.Fig. 3.: The patient at age 16 years.At the age of 24 years (Fig. 4), a third operation was performed for the second stage of the nasal reconstruction. The hump was reduced and lateral crural strut grafts were used. We believe our approach has achieved acceptable results, and we would like to add our experience to the excellent and fascinating case presented by Dr. Burget.Fig. 4.: The patient at age 24 years.Apostolos D. Mandrekas, M.D. George J. Zambacos, M.D. Dimitrios A. Hapsas, M.D. Artion Plastic Surgery Center Athens, Greece