However, these flaps have limited mobility and these limit their use in many instances. Its blood supply can be based on muscular perforators so that the skin base can be narrowed or the flap converted to an island. The reverse or turnover nasolabial flap is a variant of the conven tional nasolabial flap. The place of nasolabial flap in orofacial reconstruction. May 20, 2019 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. Oct 04, 2014 superiorly based nasolabial flap closure of the oro antral fistulae.
We treated two patients requiring nasolabial flap reconstruction. Anatomic dissections were performed on 12 cadaveric specimens and microangiography on six others. Nasolabial definition of nasolabial by medical dictionary. Arterial anatomy of the nasolabial flap keio university. Over time different modifications have been introduced to expand its usage. Superiorly or inferiorly based islanded nasolabial flap for buccal mucosa defects reconstruction. Pdf superiorly or inferiorly based islanded nasolabial. Nasolabial flap definition of nasolabial flap by medical. It provides thin, local tissue for coverage of small defects. Nasolabial flaps are frequently used to repair defects of the nostril and nasal tip. Nasolabial flap is a workhorse flap for coverage of many facial units. In 22 cases, the excision was combined with neck dissection and facial artery ligation. Vy or hatchet type advancement, transposition, subcutaneous pedicled, twostage interpolation, and propeller types are commonly used.
The nasolabial flap as a singlestage procedure jama network. The nasolabial flap as a onestage procedure for reconstruction of intermediatetolarge lip defects with functional and aesthetic assessments. The prefabricated nasolabial flap offers a superior esthetic and functional result and may be an appropriate reconstructive option in reconstruction of small. Reconstruction of the nasal defects by nasolabial flaps 66 the nasolabial flap can be taken from the area of redundancy that extends from the inner canthus to the inferior margin of the mandible, especially in old patients, this area is considered the good donor area to cover nasal defects because of its proximity, the color.
Oct 10, 2019 nasolabial flap is reliable flap in the reconstruction of oral defects over a period of time. Other options to treat osmf are palatal island flaps, bilateral tongue flaps 5, buccal fat pads, bilateral forearm free flaps. Inferiorly based nasolabial flap is a reliable, economical option for the management of oral submucous fibrosis borle et al, 2009. Case 2 the patient was a 74yearold man with recurrent acinic cell carcinoma originating in ikeda c et al. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Use of nasolabial flap in the management of oral submucous. A orkhorse for the reconstruction skin margins whereas squamous cell carcinomas were excised with 6mm normal skin margins. Excision of sc carcinoma of tip of the nose and reconstruction with island flap fron nasolabial fold.
Fiftyseven years later, esser 1921 described the use of the inferiorly based nasolabial flap to close palatal fistulae esser, 1921. Facial artery with its numerous small cutaneous perforators can be a source for free style skin flaps that can be islanded and have greater reach, one of which is nasolabial perforatory. This technically easy and maximally effective procedure has. A retrospective analysis of 26 cases of oral cancer treated with primary excision and nasolabial flap reconstruction was carried out. Failure particularly affected the irradiated patients. Nasolabial flap for oral cavity reconstruction vula university of. Pdf contralateral nasolabial flap for a large nasal.
The flap consist of skin subcutaneous tissue and underlying musculature the flap can be used unilaterally or bilaterally for reconstruction. Reconstructive management of the rare bilateral oral submucos. Twenty five 25 of these were reconstructed by nasolabial flap and twenty five25 were reconstructed by radial free forearm. Technique of nasolabial flap insetting using a tunnel. Pedicled nasolabial flap is a reliable flap for the reconstruction of small and mediumsized defects in the oral cavity after excision of primary tumours and results in good overall cosmetic and. The second patient was a 74yearold man with recurrent acinic cell carcinoma in the anterior oral floor.
Floor of the mouth carcinoma sulcus extension with nasolabial flap duration. Pedicled islanded nasolabial flap tunneled under mandible for. Navarro vilamandibular reconstruction with iliac crest free flap, nasolabial flap. The use of nasolabial flap nlf to reconstruct orofacial soft tissue. Mandibular reconstruction with iliac crest free flap. Nasolabial flap nlf cover is one of the oldest techniques to replace orofacial soft tissue defects. Still there is scanty literature available of using this flap for reconstruction of isolated defects of tongue. Lots of modifications of nasolabial flaps were defined. Often overlooked as an option to use in nasal reconstruction, the nasolabial flap can be very advantageous. Nasolabial flaps have been recognised as versatile flaps for a variety of defects in the face, nose, lip and the oral cavity. Nasolabial flap reconstruction in oral cancer world journal.
Oct 30, 2012 the nasolabial flap can also be used as an interpolation flap in either a single or a staged technique. Oct 30, 2012 the nasolabial flap is a simple flap used for reconstructing small intraoral defects created after the excision of malignant tumors. Excellent functional and aesthetic results were obtained with the iliac crest free flap, nasolabial flap and osseointegrated dental implants. N2 by using stereographic angiograms, the three dimensional structures of skin perforators originating from the facial, lateral nasal, dorsal nasal, angular, infraorbital, and transverse facial arteries were observed. 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. Mar 06, 2017 nasolabial island flap for nasal skin reconstruction. The use of the nasolabial flap appears to provide an improvement in overall functional outcome. The nasolabial flap is a pedicled flap with a wide description and application for use in lateral nasal wall, ala, columella, and intraoral reconstruction. Osmf complete trismus nasolabial flap microvascular surgery failed. The flap is elevated defatted and then advanced medially, transposing the flap into the nasal defect over a peninsula of remaining alar skin figure 1b. Reliability of the melolabial flap for alar reconstruction. Its main indications are deep and extensive defects of the nasal ala.
Reconstruction of oral mucosal defects using the nasolabial. Pdf reconstruction of the alae nasi by folded nasolabial. The nasolabial flap is well suited for reconstruction of the lower third of the nose. Prefabricated nasolabial flap for reconstruction of full. In onestage reconstruction used as transposition flap, complications can be caused by blunting of the normal concavity of the nasofacial sulcus, but also by trapdoor formation. 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. Case report reversed vascular nasolabial flap pedicled with. We propose a new protocol for the management of oral submucous.
Considerable confusion exists regarding the nature of the blood supply of the inferiorly based nasolabial flap. Delay of a flap augments its survival probably by improving the vascularity of the flap. The reverse nasolabial flap with a cartilage graft for the. The purpose of this study was to compare the mouth opening after the reconstruction with either nasolabial flap or radial free forearm flap. The first patient was a 75yearold man with mucoepidermoid carcinoma in the leftside floor of the mouth. The nasolabial flap was described 170 years ago and still remains one of the most frequently used methods in facial reconstruction. Jan 12, 2015 the nasolabial flap may be raised as an axial flap, a random flap, or as an island flap. Mandibular reconstruction with iliac crest free flap, nasolabial flap.
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. The nasolabial flap may be raised as an axial flap, a random flap, or as an island flap. Nasolabial flap is a versatile flap well suited for single stage reconstruction. Defect in the anterior face, nose and upper lip, floor of the mouth oaf 48.
Reconstruction of the nasal defects by nasolabial flaps. Pedicled nasolabial flap is a reliable flap for the reconstruction of small and mediumsized defects in the oral cavity after excision of primary tumours. Reconstruction of the alae nasi by folded nasolabial flap. The clinical application of free flaps eg forearm flap, postauricular flap, etc. In total, 11 patients with t1 and t2 tongue cancer were. 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. Plication of the cheek superficial musculoaponeurotic system facilitates a tension free advancement and a tension free closure of the donor site. It is a versatile flap that is well tolerated by the patient, with very acceptable donorsite scars.
Random pattern inferiorly based nasolabial flaps nlf have been utilised for covering small defects on the anterior floor of the mouth, but usually require a second stage procedure to divide the flap base. Jun 14, 20 the purpose of this study was to compare the mouth opening after thereconstruction with either nasolabial flap or radial free forearm flap. Nasolabial flap for facial reconstruction can transfer in three ways including. The histopathology revealed all margins free of tumor in the excised specimens. Full thickness skin grafts give a better cosmetic result than a nasal labial flap but should only be used for small superficial defects. Patients and methods fortyseven consecutive patients 46 men and 1 woman aged between 18 and 44 years of age, were. Nasolabial flap reconstruction in oral cancer ncbi. In all the cases a superiorly based nasolabial flap was performed.
An improved technique used in 32 patients is presented, which. In the nasolabial region are lines or creases that run between the nose and mouth and should be assessed for symmetry. In this procedure, skin is transplanted from the cheek to the nose in two outpatient procedures. The flap consist of skin subcutaneous tissue and underlying musculature the flap can be used unilaterally or bilaterally for reconstruction of alveolus, nose, floor of the mouth, buccal mucosa, palate and also in the. Redundant skin extends from the medial canthus of the eye to the inferior margin of the mandible. Nasolabial flaps are one of the most preferred methods for nasal reconstruction. The nasolabial flap is a simple option for the reconstruction of selected oral defects. The results of the search in this topic for anatomy, flap design, blood supply,nlf composition, flap motion, reconstructed area and donor site morbidity are presented. Cameron editorial comment the versatility and usefulness of the nasolabial flap are well known. Melolabial flap oral cavity reconstruction youtube. This study was carried out on fifty 50 patients with oral sub mucous fibrosis. One stage reconstruction of the floor of the mouth with a. The nasolabial flap is a useful reconstructive technique for the repair of defects on the nose.
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. Contralateral nasolabial flap for a large nasal defect. The shape of the flap was generally consistent with aesthetic subunit of the defect. Pdf the nasolabial flap as a onestage procedure for. Likewise, the radial forearm free flap has also become a preferable reconstruction. Reconstruction can be done by using nasolabial flap or radial free forearm flap. This flap is often classified as an axial flap because there is a named artery which runs deep to the flap angular artery. The nasolabial interpolation flap is an essential flap in nasal reconstruction. We carried out this study in our patients to assess the role of pedicled nasolabial flap in reconstruction of isolated tongue defects. Pdf nasolabial flap for reconstruction of intraoral. Nasolabial flaps in oral reconstruction journal of plastic. The bilateral inferiorly based nasolabial flap has utility in the reconstruction of the anterior defects of the floor of the mouth. Mar 11, 2018 excision of sc carcinoma of tip of the nose and reconstruction with island flap fron nasolabial fold.