The cases illustrated demonstrate a good alternative when the simpler techniques will not suffice. The authors report two cases of patients with skin cancer treated surgically with variations of the classic nasolabial flap by transposition bilateral and folded that highlight the broad applicability of this technique. 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. The rotation of the flap was done with the closure of the nasal dorsum, where a previous basal cell was removed. Nasolabial flap for tongue reconstruction 321 p j m h s vol. Nasolabial folds are the lines on either side of the mouth that extend from the edge of the nose to the mouths outer.
Thirtyeight flaps were used for partial or complete tip. Nasolabial flap for facial reconstruction can transfer in three ways including. In the nasolabial region are lines or creases that run between the nose and mouth and should be assessed for symmetry. A report of 18 cases yadranko ducic, md, frcs c, and mark burye, dds purpose. The proximal flap was sutured to the lining side of the defect. The flap was then rotated across the midline of the nose and secured to the perichondral flap with sutures of 50 nylon. Research open access nasolabial flap reconstruction in.
All the surgeries were performed under 4x loupe magnification. A nasolabial flap, when used to cover the entire alar subunit, is a very good donor material for the convex alar lobule. The senior author has a rich experience with the nasolabial flap for nasal tip reconstruction. Besides providing a good colour match, the flap is easy to dissect and inset. In our experience nasolabial flap is a very reliable flap for the alar defects after tumor resection. 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. The reverse or turnover nasolabial flap is a variant of the conven tional nasolabial flap. A similar flap harvestsurgical technique was utilized for all the cases.
Various surgical modalities have been used in the surgical management of oral submucous fibrosis with variable results. We propose a new protocol for the management of oral submucous. Nasolabial flap definition of nasolabial flap by medical. Our aim was to define the role of the inferiorly based nasolabial flap for lip reconstruction in such cases with moderate to large size defects. Efficacy of nasolabial flap in reconstruction of fibrotomy. An example of an interpolation flap is a forehead flap used in nasal reconstruction. There are many techniques available for reducing the prominence of nasolabial folds.
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. Avoid these flaps in men to prevent transfer of hairbearing skin to the nose. This article describes the successful use of pedicled nasolabial. 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 flap was designed by marking the nasolabial fold and a curved line from. Although you may not be familiar with the term nasolabial folds, you know them by their more common name laugh lines. The nasolabial flap is a simple flap used for reconstructing small intraoral defects created after the excision of malignant tumors. The nasolabial flap can be superiorly or inferiorly based, but the author has found the superiorly based flap more useful because it has a more versatile arc of rotation and the donor site scar is less noticeable. O r nasolabial island flap in the management of oral. Our data suggest that scar contracture is the predominant cause of the trapdoor effect in nasolabial flaps. Nasolabial flap alternative uses for a classic but. Reconstruction of nasal ala with nasolabial perforator. In this prospective study, we treated 20 patients of oral submucous.
Pdf inferiorly based nasolabial flap as a backup flap a. Nasolabial flap reconstruction in oral cancer world. In 22 cases, the excision was combined with neck dissection and facial artery ligation. The nasolabial flap can also be used as an interpolation flap in either a single or a staged technique. The flap receives its blood supply from the angular artery a branch of the facial ar. The nasolabial flap may be raised as an axial flap, a random flap, or as an island flap. Reconstruction of the nasal defects by nasolabial flaps 68 3. This technically easy and maximally effective procedure has. Flap turned in to reconstruct the defect figure 11. The authors are alone responsible for the content and writing of the paper. She is shown preop left, after the nasolabial flap middle, and 3 months after the resection of the nasolabial flap right. Care of the flap during surgery should include, not grasping the skin with forceps but instead using skin hooks attached to the underlying fibrous tissue to move the flap in positionsee advancement flap. In 8 of these patients, the facial artery was carefully dissected and preserved while doing.
This common saying is especially true for the nasolabial folds. Pdf a 56yearold woman with a recurrent depressed scar of the commissure, treated with a nasolabial island flap, is presented. Sushruta, an indian surgeon in 600 bc described a soft tissue flap very similar to what we know today as nasolabial flap. In the inferior region of the flap, around the upper lip and towards the commissure, the medial incision. Nasolabial flap for tongue reconstruction pjmhs online. This technique allows the reconstruction of alar and perialar defects. Using four key technical concepts, a surgeon can execute a nasolabial flap for tip reconstruction with superior results. Expanded uses for the nasolabial flap article pdf available in seminars in plastic surgery 272. Superiorly based nasolabial flap for nose reconstruction. Pdf expanded uses for the nasolabial flap researchgate. The nasolabial flap 1 is a regional flap that can be easily used to repair the columellar area.
Nasolabial medical definition merriamwebster medical. Deepening of these creases is one of the signs of aging in the midface. Reconstruction of the nasal defects by nasolabial flaps. Pdf the use of a nasolabial island flap in vestibulo. The flap was elevated in the subcutaneous plane and was turned over upward and medially like a page of a book. 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.
Pdf the place of nasolabial flap in orofacial reconstruction. Results a total number of 40 patients 24 females and 16 males were included fig. This flap is also useful for small defects involving the columella and infratip lobule and for women with short foreheads. Fiftyseven years later, esser 1921 described the use of the inferiorly based nasolabial flap to close palatal fistulae esser, 1921. Cameron editorial comment the versatility and usefulness of the nasolabial flap are well known.
Nasolabial flap nlf cover is one of the oldest techniques to replace orofacial soft tissue defects. A modification of the nasolabial flap islanded pedicled nasolabial flap. Nasolabial perforator flap for onestage reconstruction of nasal. Pdf the nasolabial flap is an excellent choice for use in reconstruction of the nasal alar subunit due to its inherent properties that match skin. A new twist to the nasolabial flap for reconstruction of. The use of nasolabial flap nlf to reconstruct orofacial soft tissue defects is one of the oldest. Arterial anatomy of the nasolabial flap keio university. Nasolabial flap is a very useful and simple alternative to other pedicled flaps and. The nasolabial flap was described 170 years ago and still remains one of the most frequently used methods in facial reconstruction. Reconstruction of the lip defects following wide excision of the squamous cell cancer is challenging for the surgeon. The nasolabial flap is one of the most ancient techniques used in orofacial surgery. All the cases were treated by nasolabial flap for nasal defects 32 cases were partial. 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 flap was designed along the nasolabial fold and was deepithelialized in the proximal onethird portion with a no.
A retrospective analysis of 26 cases of oral cancer treated with primary excision and nasolabial flap reconstruction was carried out. Conversely, softening these lines through various interventions results in a rejuvenated appearance. Unsubscribe from dr shashidhar k mch surgical oncology. It provides thin, local tissue for coverage of small defects. Use of nasolabial flap in the management of oral submucous. Nasolabial definition of nasolabial by medical dictionary.
Versatility and reliability of islanded pedicled nasolabial flap in. These are the lines we all have that run from the side of the nose to the corner of the mouth. The nasolabial flap is a very reliable flap to restore the function of oral cavity. Reconstruction of alarperialar defects with a combined. Nasolabial and extended nasolabial flaps for reconstruction in oral. If you are bothered by your nasolabial folds, and wonder what to do to improve the area, it is important to know that the nasolabial folds commonly appear to deepen that is in part from the decent of the cheek fat, which leaves hollows on the upper inner cheeks, as seen in your photo. For mild to moderately severe trapdoor deformities, multiple, small zplasties about the periphery of the nasolabial flap are indicated. The nasolabial flap is an axial flap but may be utilized as a random flap 4. The bilateral inferiorly based nasolabial flap has utility in the reconstruction of the anterior defects of the floor of the mouth. Patients and methods fortyseven consecutive patients 46 men and 1 woman aged between 18 and 44 years of age, were. The twostage nasolabial flap for subunit reconstruction. The base of the pedicle either can be incorporated into the reconstruction or divided at a second stage, depending on the.
Nasolabial flap, ala reconstruction, skin tumors structive surgeon 4,5,6. A nasolabial flap was designed, raised and turned in to reconstruct the defect figures 911. 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. Expanded uses for the nasolabial flap pubmed central pmc. Replacement of the soft tissue loss after traumatic injuries or surgical excision requires soft tissue flaps. Nasolabial and cheek skin flaps plastic surgery key. Pdf on sep 3, 2012, sailesh kumar mukul and others published inferiorly based nasolabial flap as a backup flap. The inferiorly based flap is designed with the superior medial border of the flap running in the nasolabial fold and widening to incorporate the desired width of the flap laterally along the cheek. The nasolabial flap is an excellent alternative in these situations and will provide the patient with an exceptional result. Inferiorly based nasolabial flap is a reliable, economical option for the management of oral submucous fibrosis borle et al, 2009.
Nasolabial flap inset into the defect and donor site and lipsplit closed figure 12 illustrates a penrose drain left in. However, since reconstruction with such flaps produces a flat ala, this method is. Pdf reconstruction of the columella and the tip of the. In cases of carcinoma, the skin lesions were excised with an adequate margin. Defect in the alar area had been frequently covered with vy pattern nasolabial advancement flap or a rotationadvancement flap from the groove of the nasal sidewall. Nasolabial flap reconstruction in oral cancer article pdf available in world journal of surgical oncology 101. Defect in the anterior face, nose and upper lip, floor of the mouth oaf 48. Case report reversed vascular nasolabial flap pedicled. Revisit of nasolabial flap in the reconstruction of defects involving. Nasolabial skin flaps to the cheek plastic surgery key. What are my options for improving nasolabial folds. The use of nasolabial flap nlf to reconstruct orofacial soft tissue. The shape of the flap was generally consistent with aesthetic subunit of the defect.
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