Functional and Aesthetic Comparison of Surgical Nasal Reconstruction Versus Nasal Prosthesis (Epithesis) After Total or Subtotal Nasal Amputation

Total or subtotal nasal amputation - defined as loss of at least three nasal subunits, or two subunits including the dorsum - results in major aesthetic and functional consequences with a significant impact on quality of life and social reintegration. Currently, two main rehabilitation approaches exist: surgical reconstruction (paramedian forehead flap as the gold standard, or free flaps such as the radial forearm free flap for larger defects) and nasal epithesis (implant-retained or adhesive prosthesis).

The choice between these techniques is often guided by the surgeon's experience and patient preference, in the absence of clear consensus, as very few studies have directly compared both options using standardised, patient-reported outcome measures.

The primary objective of this study is to compare functional and aesthetic outcomes between surgical reconstruction and epithesis groups using the SCHNOS questionnaire validated in French. Secondary objectives include comparison of subgroups by complications, comorbidities, patient profile, and identification of patients who switched rehabilitation modality.

Eligible patients will be identified via medical records by investigators at each participating centre. Those meeting inclusion criteria will be contacted by phone and then sent the information letter and questionnaire by mail or email. They may complete the questionnaire in paper form or via the secure Microsoft Forms platform. Questionnaire data will be exported to a centralised, password-protected Excel database for statistical analysis.

• SCHNOS score (Other): Total score on the validated French version of the SCHNOS (Standardized Cosmesis and Health Nasal Outcomes Survey) questionnaire, comparing surgical reconstruction versus epithesis groups after total or subtotal nasal amputation.

Primary outcomes

• SCHNOS total score [Single assessment at inclusion (at least 1 year after nasal reconstruction or epithesis placement)]: Total score on the validated French version of the SCHNOS (Standardized Cosmesis and Health Nasal Outcomes Survey) questionnaire, comparing surgical reconstruction versus epithesis groups after total or subtotal nasal amputation.

Secondary outcomes

• Subgroup comparison by complications and comorbidities [Single assessment at inclusion]: Comparison of SCHNOS scores between subgroups defined by complications, comorbidities, and patient profile (age, sex, aetiology of amputation, treatment history).
• Description of Clinical Profiles [Single assessment at inclusion]: Subgroup analysis of the profiles of patients who opted to change their rehabilitation treatment
• Benefit-risk balance of each rehabilitation technique [Single assessment at inclusion]: Comparative analysis of each technique based on implementation modalities, time to rehabilitation, complications, and reversibility.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Patients aged 18 years or older
* Patients who have undergone total or subtotal nasal amputation (defined as loss of at least three nasal subunits, or of two subunits including the dorsum) and who have been rehabilitated either by surgical reconstruction or by nasal epithesis for more than one year

Exclusion Criteria:

* Ongoing tumour progression or tumour recurrence
* Non-French-speaking patients
* Patients under legal protection measures (guardianship, legal safeguarding, limited or full legal incapacity)
* Patients unlikely to cooperate with the study (e.g. presenting with a psychiatric disorder)

• Laureline DESABRES, Doctor, Principal investigator, Hôpital NOVO
• Benjamin VERILLAUD, Pr, Principal investigator, Hôpital LARIBOISIERE
• Vincent BEDARIDA, Doctor, Principal investigator, Groupe Hospitalier Paris St Joseph
• Maxime HUMBERT, Doctor, Principal investigator, University Hospital, Caen