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.

Restoring the integrity of the calvaria due to diploic cavernous hemangioma removal possesses surgical complexity regarding the location of the tumor and the intricacy of the reconstruction method. We report a case of a 36-year-old male with a recurrent cavernous hemagioma, affecting the frontal bone. The patient had undergone surgical extirpation of the primary lesion six years ago in a different plastic surgery department with histological verification. He presented to our department with local recurrence at the same site. The lesion was completely resected, followed by calvarial reconstruction using autologous non-vascularized bone graft harvested from the iliac crest. Histology confirmed the recurrence of a benign cavernous hemangioma. Postoperative recovery was devoid of complications, and a follow-up CT scan after 6 months revealed no recurrence, with stable graft integration. A major insight of this manuscript includes the discussion of the benefits of using autologous bone in young patients instead of synthetic counterparts.

Large congenital melanocytic nevi (LCMN) of the face can pose significant functional, esthetic, and psychosocial challenges in childhood. In selected patients, staged excision offers a practical reconstructive strategy when primary closure is not feasible without distortion of nearby facial landmarks. We report the management of a child with a facial LCMN using a planned multistage surgical approach aimed at lesion removal while preserving contour and minimizing scar burden. The lesion was excised sequentially over three procedures, with careful attention given to relaxed skin tension lines and facial esthetic units. When required, adjunctive reconstruction was performed to optimize closure and support tissue healing. This approach allowed a gradual reduction in the nevus, improved tissue accommodation, and avoidance of excessive tension on the surrounding skin. Postoperative recovery was uncomplicated, and the final esthetic outcome was satisfactory for both the patient and parents. Staged excision was selected over tissue expansion and skin grafting because it allowed progressive lesion reduction while preserving adjacent facial landmarks and minimizing donor-site morbidity. This technical case highlights the importance of individualized surgical planning, preservation of facial esthetic units, and staged scar placement when managing large facial congenital melanocytic nevi in pediatric patients. The educational value of the report lies in illustrating the decision-making process used to balance lesion removal, esthetic outcomes, and long-term surveillance in a challenging facial location.