Unilateral one stage nasolabial flap for reconstruction of the lips

Abstract

Background: Nasolabial flap (NLF) is one of the oldest described soft tissue flaps. Despite the great advances in maxillofacial reconstruction it still has a stable location in the reconstructive ladder of the face and oral cavity. Reconstruction of the lips, which are important structures that connect the oral cavity to the facial skin, with this flap is the interest of the surgeons.

Patients and methods: Experience of the authors for reconstruction of the upper lip philtrum, correction of lower lip contracture and subtotal reconstruction of the lower lip with emphasis on simultaneous correction of the red lip (volume and color) is explained in five cases.

Results: Satisfactory functional and aesthetic results were obtained. Iatrogenic epidermoid cyst occurred in one patient.

Conclusion: One stage reconstruction of lateral lower lip defects with/without commissural involvement in full or partial thickness defects is possible by NLF. Supplementary flaps are needed when the vermilion needs simultaneous reconstruction.

Keywords: Lip reconstruction; Nasolabial flap; Philtrum.

Fig. 1

a Deformed philtrum in bilateral adult cleft lip patient. b Superiorly based subcutaneous NLF with inclusion of hair bearing skin. c Final results immediately after operation. d 2 years follow up

Fig. 2

a Downward slanting of lower lip. b Superiorly based subcutaneous NLF. c Deepithelialization at flap base. d Postoperative results immediately after operation. e Results 1 year later note inconspicuous skin scar

Fig. 3

a Verrocous carcinoma of lower lip extends from left commissure to midline. b Inferiorly based musculocutaneous NLF concomitant with vermilion advancement flap. c Results 1 month after operation

Fig. 4

a Basal cell carcinoma of labial skin. b Inferiorly based musculotaneous NLF for reconstruction. c Hinged buccal mucosal flap for vermilion reconstruction. d Results of reconstruction 2 months postoperation

Fig. 5

a Lower lip skin defect resulted from human bite. b Part of NLF that interfers with red lip vermilion was removed. c Mucosal advancement flap based on orbicularis oris muscle. d Schematic picture. e Result immediately after operation. f Deepithelialized distal part of NLF for advancement below skin edges

Fig. 6

Schematic picture of NLF for reconstruction of the lips. Rotation and transposition flaps in left and tunnelized NLF in right side of the picture are illustrated. Pivotal point (asterisk) for rotation and transposition NLF is superior to the oral commissure and in tunnelized NLF lateral to the nasal ala

Fig. 7

Arterialized NLF with inclusion of facial artery in flap

Fig. 8

a Bulging at the base of NLF 3 years after surgery. b Excised lesion. c Keratin filled cystic cavity compatible with epidermoid cyst (H-E X × 100)