Table 1 Chronological overview of individual surgical steps (m months, LA local anaesthesia, GA general anaesthesia)

1

0

Resection of the tumour of the upper lip and nasal base with immediate reconstruction of the upper lip according to Abbé under GA

In the left nasal entrance, the tumour extended into the excision area; bilateral tight margins at the lip.

2

1 m

Resection of the nasal base and both margins of the upper lip under GA

Close resection margin, 1 mm at the right nasal wing.

3

2 m

Detachment of the pedicle of the Abbé flap from the lower lip, re-excision of the tumour in the area of the right ala, bilateral commissuroplasty under LA

Residual structures of syringoma up to 1 mm at the right nasal ala.

4

3 m

Re-excision of tumour margins on the right ala to half the height of the wing under LA

No residual tumour structures on histology.

5

7 m

Primary reconstruction of the nose with two nasolabial flaps, reinforcement of the columella with a septal graft and reconstruction of the right nasal ala with a composite auricular graft under GA

Loss of the composite graft of the right ala, limited patency of the right nostril, collapse of the columella and the tip of the nose, microstoma.

6

17 m

Commissuroplasty, elevation of both turbinate flaps from the inferior conchae, cartilage graft harvesting from both auricles and from the 6th right rib, reconstruction of the nasal framework and covering with the left paramedian forehead flap under GA

Prolonged healing, repeated capillary bleeding from the right nostril.

7

18 m

Re-elevation and thinning of the forehead flap under LA

8

20 m

Removal of the supply pedicle from the forehead under LA

9

27 m

Enlargement of both nostrils by Z-plasty in a soft triangle, Z-plasty of the right alar attachment and V-Y advancement of the left nasal ala under LA