Restoring the integrity of the external nose presents a complex surgical challenge due to its three-dimensional structure and subunit divisions. The most frequent causes of nasal defects include basal or squamous cell carcinoma, animal bites and trauma. The reconstruction approach varies depending on factors such as the defect’s size, the affected subunit of the nose, the condition and quality of the surrounding tissues and the surgeon’s expertise. Commonly employed surgical techniques for nasal reconstruction include the forehead flap, nasolabial flap, Rieger flap, bilobed flap, and free autologous skin graft. We present a clinical case of a patient with a full-thickness nasal alar defect who underwent three-layer reconstruction with a combination of an inverted skin flap- for the internal lining, a conchal graft to substitute the missing alar cartilage and a forehead flap for external coverage. One of the challenges of nasal reconstruction surgery is to restore a full-thickness defect, especially the internal nasal lining. We offer a different perspective on this problem, showcasing considerable advantages, as there are limited literature data on this method.

Background: Restoring the integrity of the lower eyelid presents a complex surgical challenge due to its lamellar structure and the high risk of complications. Among these, ectropion is the most frequent and troublesome outcome. Objective: This study aims to present a case of lower eyelid reconstruction following the excision of squamous cell carcinoma using Mohs micrographic surgery combined with the Mustardé cheek rotation flap technique, highlighting its advantages, limitations, and applicability in elderly patients. Case presentation: A 93-year-old female patient with right lower eyelid squamous cell carcinoma underwent Mohs micrographic surgery. The resulting defect was reconstructed using a Mustardé cheek rotation flap, chosen for its suitability in patients with adequate skin laxity. Patient-specific risk factors, including advanced age, a history of ischemic stroke, and class II heart failure (NYHA classification), were considered in the surgical planning stage. Results: The Mustardé cheek rotation flap provided a reliable closure with a favorable esthetic outcome and inconspicuous scarring, aligned with natural anatomical margins. The technique was technically straightforward in this patient owing to age-related skin laxity. No major postoperative complications were observed. Conclusions: The Mustardé cheek rotation flap represents a safe and effective reconstructive option for elderly patients with lower eyelid defects following tumor excision. This case illustrates the esthetic and functional benefits of the technique while emphasizing the need to tailor reconstruction strategies to patient comorbidities and defect characteristics.

Background: Oro-nasal fistula formation remains one of the most common complications following primary palatoplasty, while the influence of surgical technique on fistula incidence and characteristics remains controversial. This study aimed to compare the occurrence and features of oro-nasal fistulas after two primary palatal repair techniques. Methods: A retrospective comparative analysis was conducted in patients undergoing one-stage primary palatoplasty using either closed intravelar palatoplasty or a modified Veau–Wardill–Kilner pushback technique. Oro-nasal fistulas were evaluated according to presence, size, anatomical location, and functional impact. Secondary corrective procedures, including fistula repair and pharyngoplasty, were also analyzed. Results: Oro-nasal fistula formation was significantly associated with the surgical technique. Closed intravelar palatoplasty demonstrated a significantly lower fistula rate compared with the modified Veau–Wardill–Kilner technique. Cleft type and syndromic status were not independently associated with fistula development. Rates of secondary corrective procedures and pharyngoplasty were significantly lower in the intravelar group. Conclusions: Surgical technique plays a decisive role in oro-nasal fistula development after primary palatoplasty. Muscle-oriented repair with limited incisions is associated with reduced fistula formation and a lower need for secondary surgical interventions.

Background: Cleft lip with or without cleft palate (CL ± P) is a common congenital anomaly requiring a multidisciplinary team approach from birth into adulthood. Many patients undergo multiple secondary procedures on the lip, nose, and alveolus, representing a substantial long-term “burden of care” for families and health systems. The relationship between preoperative cleft severity and the cumulative number of surgical interventions into late adolescence remains insufficiently characterized. Methods: A retrospective cohort study was conducted on 166 patients with cleft lip ± cleft palate treated at a single tertiary cleft center. All patients underwent primary cheiloplasty, with or without concomitant gingivoperiosteoplasty (GPP), and had follow-up extending to a mean age of 18 years. Preoperative nasolabial deformity was graded into four categories (mild, moderate, severe, and very severe) using standardized photographic assessment. The primary outcome was the total number of cleft-related surgical interventions on the lip, nose, and alveolus, including the primary operation and all subsequent corrective procedures. Associations between preoperative severity and surgery counts were analyzed using the Kruskal–Wallis test and Bonferroni-adjusted pairwise comparisons. Results: All 166 patients underwent a primary procedure, either cheiloplasty alone (n = 86; 51.8%) or cheiloplasty combined with GPP (n = 80; 48.2%). A second surgical intervention was performed in 111 patients (66.8%), yielding 138 procedures, most commonly GPP with bone grafting (n = 54), corrective cheiloplasty (n = 48), GPP without graft (n = 23), and rhinoplasty (n = 12). A third intervention was performed in 48 patients (28.9%; 70 procedures), predominantly rhinoplasty and additional cheiloplasties, and a fourth intervention in 13 patients (7.8%; 17 procedures), mostly staged rhinoplasty and lip revisions. Overall, 56 patients (33.7%) had only one (primary) operation, 50 (30.1%) had two, 27 (16.3%) had three, 18 (10.8%) had four, 13 (7.8%) had five, and one patient (0.6%) had six surgical interventions. The total number of operations differed significantly across severity grades (Kruskal–Wallis p < 0.001). Patients with mild and moderate severity had significantly fewer surgeries than those with severe or very severe deformities (all p ≤ 0.023), whereas differences between mild vs. moderate and severe vs. very severe were not significant. Conclusions: In this cohort of patients with cleft lip followed to a mean age of 18 years, two-thirds required at least one secondary procedure, and nearly one-fifth underwent four or more surgeries. Higher preoperative severity was strongly associated with greater surgical burden, particularly when comparing mild or moderate deformities to severe and very severe clefts. These findings underline the importance of preoperative severity assessment for family counseling, expectation management, and the design of treatment protocols aimed at minimizing the long-term burden of care while preserving functional and esthetic outcomes.

Background/Objectives: Speech outcome is a major functional endpoint following primary palatoplasty. This study compared long-term speech outcomes after closed intravelar minimal-incision palatoplasty and the modified Veau–Wardill–Kilner procedure. Methods: This retrospective observational study evaluated speech using a standardized perceptual protocol adapted to the Bulgarian phonetic system across eight domains. Outcomes were compared between surgical groups, with additional analyses stratified by age and cleft type. Results: The minimal-incision group showed higher unadjusted proportions of normal speech intelligibility (29.4% vs. 17.6%, p = 0.020), normal resonance (73.2% vs. 54.9%, p = 0.001), and normal consonant articulation (37.8% vs. 19.0%, p < 0.001), whereas compensatory articulation was less frequent (49.6% vs. 65.5%, p = 0.008). Hypernasality, voice quality, and vowel articulation were comparable between groups. After adjustment for cleft type and age group, no significant association was observed between surgical technique and normal speech intelligibility (aOR 1.33, 95% CI 0.73–2.43; p = 0.357), whereas the minimal-incision technique was associated with higher odds of normal consonant articulation (aOR 1.79, 95% CI 1.01–3.18; p = 0.047) and normal resonance (aOR 1.73, 95% CI 1.02–2.94; p = 0.043). Conclusions: Both techniques were associated with broadly comparable long-term functional speech outcomes across most evaluated domains. After adjustment for cleft type and age group, differences remained in normal consonant articulation and normal resonance, whereas no significant adjusted association was observed for normal speech intelligibility. These findings should be interpreted cautiously given the historical treatment patterns, non-random distribution of cleft type between groups, and potential residual confounding.

Background: Auricular carcinomas often require extensive surgical resection, resulting in complex three-dimensional defects,in some cases involving mastoid process exposure. Reconstruction aims to restore contour, protect underlying structures, and maintain patency of the external auditory canal (EAC). Case presentation and methods: We present a 45-year-old male patient, without comorbidities, who underwent subtotal auricular resection and wide retroauricular excision for basal cell carcinoma, resulting in mastoid bone exposure. Reconstruction was achieved using a temporal muscle flap covered by a skin graft, combined with a Z-plasty of the external auditory meatus to prevent postoperative stenosis. Recovery was uneventful, and 4 year follow-up demonstrated stable structural outcomes, preserved diameter of the meatus, without recurrence of the disease.The patient is prepared for autologous or prosthetic auricular reconstruction. Conclusion: A temporalis muscle flap with skin graft coverage offers a reliable, vascularized solution for large post-oncologic auricular defects while preserving the external auditory canal. Z-plasty remains a critical technique for preventing meatal stenosis.