This article describes the successful use of pedicled nasolabial. Superiorly based nasolabial flap for nose reconstruction. Inferiorly based nasolabial flap is a reliable, economical option for the management of oral submucous fibrosis borle et al, 2009. A nasolabial flap, when used to cover the entire alar subunit, is a very good donor material for the convex alar lobule. The flap was then rotated across the midline of the nose and secured to the perichondral flap with sutures of 50 nylon. The color and texture of the cheek tissue are similar to that of the nose, due to roughly equivalent sun exposure and tissue characteristics. Ohtsuka editorial comment in treating defects of the face, the possibility of primary closure and even the use of split or fullthickness skin grafts should be considered first. Results a total number of 40 patients 24 females and 16 males were included fig.
A new twist to the nasolabial flap for reconstruction of. The nasolabial flap is a pedicled flap with a wide description and application for use in lateral nasal wall, ala, columella, and intraoral reconstruction. Cameron editorial comment the versatility and usefulness of the nasolabial flap are well known. Superior nasalabial flap reconstruction in a patient with a nasal skin carcinoma. Nasolabial and cheek skin flaps plastic surgery key. Nasolabial island flap in the management of oral submucous fibrosis a clinical study nagendra srinivas chunduri1, venkateswarulu reddy goteki2, shiva srinivas3, krishnaveni madasu4 associate professor1 department of oral and maxillofacial surgery, bharati vidyapeet dental college, sangli, maharashtra, india. I got dermal filler for my nasolabial folds the file.
Various surgical modalities have been used in the surgical management of oral submucous fibrosis with variable results. Lower lip reconstruction using unilateral nasolabial gate flap. Lower lip reconstruction using unilateral nasolabial gate flap fujimori technique. What are my options for improving nasolabial folds. She is shown preop left, after the nasolabial flap middle, and 3 months after the resection of the nasolabial flap right. Technique for the reconstruction of oral commissure ijsrp. If it is superiorly based for resurfacing of the nose, it should be based on the angular vessels and swung like a pendulum, rather than as a rotation flap, to avoid an excessive dogear. Cheek skin has a similar color and texture to nasal skin, and the donor site scar can be hidden in a naturally occurring cheek fold. Often overlooked as an option to use in nasal reconstruction, the nasolabial flap can be very advantageous. A orkhorse for the reconstruction skin margins whereas squamous cell carcinomas were excised with 6mm normal skin margins. The topography of the external nose is a graceful blend of convexities, curves, and. A nasolabial flap was designed, raised and turned in to reconstruct the defect figures 911. The nasolabial interpolation flap is an essential flap in nasal reconstruction.
Pedicled nasolabial flap is a reliable flap for the reconstruction of small and mediumsized defects in the oral cavity after excision of primary tumours. We commonly use radiesse and restylane in the nasolabial folds. A single vy advancement flap was designed, following the vermilion border and the nasolabial fold to advance. Fiftyseven years later, esser 1921 described the use of the inferiorly based nasolabial flap to close palatal fistulae esser, 1921. Application of nasolabial flap in the oral commissure reconstruction has also been described.
In this procedure, skin is transplanted from the cheek to the nose in two outpatient procedures. Pdf the nasolabial flap was described 170 years ago and still remains. I thought that perhaps this was owing to my burgeoning sophistication and dd s, but it was only when i spotted myself in the background of a photo that i was directed to a new face annoyance. The details of the technique of harvesting the craniallybased nasolabial flap have previously been described elsewhere 5,6. Nasolabial flap nlf cover is one of the oldest techniques to replace orofacial soft tissue defects. Designed as a true myocutaneous flap pedicled on the facial artery, the nasolabial flap is a robust and versatile flap that is well suited to singlestage reconstruction of oral cavity defects or to staged recon structions of facial defects figure 1. To evaluate the usefulness of the nasolabial fold interpolation flap for alar reconstruction after mohs micrographic surgeryespecially in an outpatient setting and.
Use of nasolabial flap in the management of oral submucous. Both flaps having distinct advantage of relative ease in elevating flap and robust vascularity with acceptable aesthetic and functional outcome. Nasolabial medical definition merriamwebster medical. The nasolabial flap may be superiorly or inferiorly based.
This prospective study evaluates the efficacy of nasolabial flap in the reconstruction of fibrotomy defect in surgical treatment of oral submucous fibrosis in terms of functional and esthetic outcomes. The nasolabial flap is a pedicled flap with a wide description and. The skin between the defect and the flap is excised to allow the flap to reach the defect. The nasolabial flap may be raised as an axial flap, a random flap, or as an island flap. Anterior abdominal wall crossectional anatomy and arcuate line when harvesting a rectus flap, the anterior rectus sheath is incised vertically over the midportion of the rectus muscle, whereas the posterior sheath is preserved. This video demonstrates the use of a superiorly based islanded nasolabial flap for intraoral reconstruction.
Raising a supraclavicular flap is a simple quick procedure, usually done in less than an hour, and is a relatively easy to learn procedure. The bilateral inferiorly based nasolabial flap has utility in the reconstruction of the anterior defects of the floor of the mouth. Besides providing a good colour match, the flap is easy to dissect and inset. Nasolabial flap inset into the defect and donor site and lipsplit closed figure 12 illustrates a penrose drain left in. Reconstruction of the ala begins by designing a nasolabial flap with its base as close as possible to the site fo the proposed ala. The nasolabial fold flap was raised from the nasolabial fold 2cm in width up to the base of the ala.
All the cases were treated by nasolabial flap for nasal defects 32 cases were partial. In our experience nasolabial flap is a very reliable flap for the alar defects after tumor resection. Nasolabial flap is an arterialized local flap in head and neck region with axial blood supply provided either by facial artery, transverse facial artery inferior based or superficial temporal artery and infraorbital artery superior based. Nasolabial skin flaps to the cheek plastic surgery key. The flap is highly reliable and since the procedure is shorter than free flap recon. The nasolabial flap has certain qualities that make it ideal for nasal reconstruction. The histopathology revealed all margins free of tumor in the excised specimens. Case report reversed vascular nasolabial flap pedicled. Reconstruction of the nasal defects by nasolabial flaps. Reconstruction of the nose again emerged in 1597 when tagliacozzi published a technique of. It matches the skin characteristics of the nose and cheek well, and provides sufficient soft tissue for the coverage of mod eratelysized defects.
Title nasolabial flap reconstruction of floor of mouth. The nasolabial flap is a very simple flap used for reconstruction of intraoral defects in the floor of the mouth 2,3, the tongue, cheek, commissures, nose tip, nasal ala, and lower eyelids. Nasolabial flap, ala reconstruction, skin tumors structive surgeon 4,5,6. Pdf the reverse nasolabial flap with a cartilage graft for the. Due to both swelling and the thickness of the flap most patients will require a secondstage reduction rhinoplasty. The reverse or turnover nasolabial flap is a variant of the conven tional nasolabial flap. Pdf a 65yearold woman with a deeply infiltrating basal cell carcinoma in the right ala underwent fullthickness excision of most of the ala. These procedures include rhytidectomy with undermining of the flap medial to the nasolabial fold,7 direct excision of the nasolabial fold,8 suture resuspension of the malar fat pad,9 placement of expanded polytetrafluoroethylene ptfe strips,10 liposuction of the malar fat pad,11 and placement of dermal or fascial grafts beneath the nasolabial.
Injecting at the upper cheek can often relieve some of the downward pull which contributes to the nasolabial folds. The flap receives its blood supply from the angular artery a branch of the facial artery, the infraorbital artery, and the transverse. In all the cases a superiorly based nasolabial flap was performed. This flap is difficult to achieve a good cosmetic result in a single stage. The history of nasal reconstruction mirrors the history of plastic surgery, beginning with what commonly is believed to be the earliest plastic surgery procedure recordednasal reconstruction by sushruta in india during 600700 bc, as reported by rogers. Oral submucous fibrosis, osmf complete trismus nasolabial flap microvascular surgery failed duration. Nasolabial flap for tongue reconstruction pjmhs online. The twostage nasolabial flap for subunit reconstruction. A retrospective analysis of 26 cases of oral cancer treated with primary excision and nasolabial flap reconstruction was carried out.
This chapter will focus on oral cavity recon struction. Reconstruction of the nasal defects by nasolabial flaps 68 3. Nasolabial flap for tongue reconstruction 321 p j m h s vol. Defect in the anterior face, nose and upper lip, floor of the mouth oaf 48. It dawned on me about a year ago that i never get asked for id anymore. A nasolabial flap may be used by raising the flap along the nasolabial fold. Flap turned in to reconstruct the defect figure 11. The cases illustrated demonstrate a good alternative when the simpler techniques will not suffice. The nasolabial flap is designed so that the cheek scar is hidden within the nasolabial crease. The nasolabial flap is an axial flap but may be utilized as a random flap 4. We propose a novel surgical reconstructive technique of use of combine pectoralis major myocutaneous flap pmmc with nasolabial flap for full thickness cheek defect involving large lip commisure. Nasolabial flaps are frequently used to repair defects of the nostril and nasal tip.
Sushruta, an indian surgeon in 600 bc described a soft tissue flap very similar to what we know today as nasolabial flap. Design and preparation of reversed nasolabial flap after complete resection, a reversed nasolabial flap pedicled with the superior labial vessels was designed and centered on the nasolabial area proximal to the paranasal and infraorbital defect figure 1. The reverse nasolabial flap with a cartilage graft for the. The flap is a good asset for the surgeon, as it is versatile and can correct multiple types of defects. It is a versatile flap that is well tolerated by the patient, with very acceptable donorsite scars. Nose is considered to be the most complex structure on a face, considering its threedimensional topography. In 22 cases, the excision was combined with neck dissection and facial artery ligation. O r nasolabial island flap in the management of oral. Craniallybased nasolabial flaps for the reconstruction of nasal.
The nasolabial flap is a simple flap used for reconstructing small intraoral defects created after the excision of malignant tumors. In addition to just injecting the folds, it may be wise to consider filling in the cheek or cheekbone area as it looks like this area has a lot of tissue volume loss. Disadvantages of the nasolabial flap are that there is a limited amount of tissue available, the reconstruction may lead to asymmetry, and a pincushioning effect of the cheek can occur when the flap is used for intraoral reconstruction. Nasolabial flap definition of nasolabial flap by medical.
Its blood supply can be based on muscular perforators so that the skin base can be narrowed or the flap converted to an island. Patients and methods fortyseven consecutive patients 46 men and 1 woman aged between 18 and 44 years of age, were. Nasolabial flap for intraoral reconstruction youtube. The rotation of the flap was done with the closure of the nasal dorsum, where a previous basal cell was removed. Nasolabial flap reconstruction in oral cancer world. A report of 18 cases yadranko ducic, md, frcs c, and mark burye, dds purpose. Replacement of the soft tissue loss after traumatic injuries or surgical excision requires soft tissue flaps. The nasolabial flap is a versatile flap that is most often used for reconstruction of the lowerthird nasal subunits and dorsum 3,4. The place of nasolabial flap in orofacial reconstruction. The soft and spongy nature of the flap, with its proclivity toward pincushioning, enhances its ability to recreate the. Reconstruction of its concave and convex contour is even more perplexed by its various tissue compositions with skin, mucosa, bone and cartilage most of all, nasal ala is a critical anatomical landmark in terms of function and cosmesis.
Efficacy of nasolabial flap in reconstruction of fibrotomy. Due to rich sub dermal plexus the flap can be used either a random flap based or as axial pattern flap. Reconstruction of nasal ala with nasolabial perforator. A total of 10 patients of oral submucous fibrosis were admitted and surgically treated in our hospital with due permission of the ethical committee.
The shape of the flap was generally consistent with aesthetic subunit of the defect. Versatility of nasolabial flaps in oral cavity reconstructions. A single vy advancement flap was designed, following the vermilion border and the nasolabial fold to advance medially into the defect figs. Research open access nasolabial flap reconstruction in. The nasolabial flap is an excellent choice for use in reconstruction of the nasal alar subunit due to its inherent properties that match skin tone and the convexity of the nose. Nasolabial flap for oral cavity reconstruction vula university of. We propose a new protocol for the management of oral submucous. Nasolabial folds are the lines on either side of the mouth that extend from the edge of the nose to the mouths outer corners. Nasolabial folds are sometimes referred to as smile or laugh lines. Its main indications are deep and extensive defects of the nasal ala. The nasolabial flap can also be used as an interpolation flap in either a single or a staged technique. The latter one was an epidermoid carcinoma located in the maxillary gingiva and its defect was reconstructed using a right nasolabial flap based on. It provides thin, local tissue for coverage of small defects.
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