EXTENDED NASOLABIAL FLAPS IN MANAGEMENT OF ANTERIOR BUCCAL MUCOSAL DEFECTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENJie ¹ ,  JIANGCanhua ¹ , CHENLichun ² , LINing ¹ , RENHui ¹ , WULimeng ¹ , JIANXinchun ¹

1. Department of Oral Maxillofacial Surgery, Central South University, Changsha Hunan, 410008, P. R. China;
2. Department of Operation Room, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P. R. China;

Corresponding author：

JIANGCanhua, Email: canhua-j@sohu.com

Keywords：

Extended nasolabial flap; Anterior cheek; Mucosal defect; Wound repair

DOI：

10.7507/1002-1892.20150126

Video：

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Objective To investigate the feasibility of the extended nasolabial flap in repairing small or medium anterior buccal mucosal defects. Methods Between March 2013 and April 2014, 10 patients with anterior buccal mucosal defects were treated with extended nasolabial flaps. There were 8 males and 2 females with the average age of 47.2 years (range, 39-62 years). The left side was involved in 4 cases and the right side in 6 cases. The pathological types included 3 cases of oral leukoplakia (OLK), 3 cases of OLK with malignant changes, 1 case of malignant oral lichen planus, and 3 cases of papilloma. The clinical course ranged from 2 to 15 months (mean, 7.1 months). The resection was restricted to the mucosa and little buccinators without cheek penetration, and the defects ranged from 2.5 to 4.0 cm in width and 3.5 to 5.5 cm in length. The distance between defect and the corner of the mouth was 0.5 to 1.5 cm. A falcate flap was designed along the nasolabial fold with a pedicle lateral beside the corner of the mouth. The flap was lifted in the plane of the superficial muscular aponeurotic system from both terminal points to the region of the central pedicle. Then the flap was transposed intraorally through a transbuccal tunnel to cover the mucosal defect while the extra-oral incision was closed directly. Results All flaps completely survived and all wounds healed primarily. All patients were followed up 6 to 18 months (mean, 10.4 months). All patients regained symmetrical appearances and normal mouth commissure only with linear scars hidden in the nasolabial folds. The mouth opening was 2.7 to 3.5 cm (mean, 3.1 cm) at last follow-up. The intraoral flaps healed perfectly with thin and flat outlooks. No cheek biting or fish-mouth deformity was observed. Conclusion The extended nasolabial flap can be used to repair small or medium anterior buccal mucosal defects because it has the advantages of reliable blood supply, flexibility in design, simplicity in harvesting, and hidden donor site scars.

Citation： CHENJie, JIANGCanhua, CHENLichun, LINing, RENHui, WULimeng, JIANXinchun. EXTENDED NASOLABIAL FLAPS IN MANAGEMENT OF ANTERIOR BUCCAL MUCOSAL DEFECTS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(5): 582-585. doi: 10.7507/1002-1892.20150126 Copy

1.	Kuehnemund M, Bootz F. Reconstruction of the cheek. Facial Plast Surg, 2011, 27(3):284-289.
2.	陈誉华. 含真皮下血管网真皮蒂鼻唇沟皮瓣修复鼻唇部缺损. 中国修复重建外科杂志, 2011, 25(12):1459-1461.
3.	胡小华, 黄桂林, 张霓霓, 等. 鼻唇沟岛状皮瓣在口底组织缺损修复重建中的应用. 中国修复重建外科杂志, 2014, 28(6):710-713.
4.	Duzgun S, Unlu E, Bali Y. A new facial artery free-style perforator flap and conchal cartilage graft for one-step reconstruction of the alar defects. J Craniofac Surg, 2013, 24(6):2053-2055.
5.	Borle RM, Nimonkar PV, Rajan R. Extended nasolabial flaps in the management of oral submucous fibrosis. Br J Oral Maxillofac Surg, 2009, 47(5):382-385.
6.	刘汉前, 俞辉明, 刘家武. 颏下岛状皮瓣修复早期口腔鳞状细胞癌术后缺损. 中国修复重建外科杂志, 2013, 27(9):1098-1101.
7.	Riml S, Larcher L, Grohmann M, et al. Defect closure in the paranasal region:an enduring challenge. Int J Dermatol, 2014, 53(3):362-368.
8.	姚柏松, 周晓志, 白清华, 等. 鼻唇沟皮瓣在修复口腔颌面部组织缺损中的应用(附12例报告). 口腔颌面外科杂志, 2001, 11(增刊):31-32.
9.	Hynes B, Boyd JB. The nasolabial flap. Axial or random? Arch Otolaryngol Head Neck Surg, 1988, 114(12):1389-1391.
10.	Agarwal M, Gupta DK, Tiwari AD. Extended nasolabial flaps in the management of oral submucous fibrosis. J Maxillofac Oral Surg, 2011, 10(3):216-219.
11.	Bande CR, Datarkar A, Khare N. Extended nasolabial flap compared with the platysma myocutaneous muscle flap for reconstruction of intraoral defects after release of oral submucous fibrosis:a comparative study. Br J Oral Maxillofac Surg, 2013, 51(1):37-40.
12.	Ibrahim AM, Rabie AN, Borud L, et al. Common patterns of reconstruction for Mohs defects in the head and neck. J Craniofac Surg, 2014, 25(1):87-92.
13.	Levender MM, Ratner D. Reconstructing complex central facial defects involving multiple cosmetic subunits. Facial Plast Surg, 2013, 29(5):394-401.
14.	Kavarana NM, Bhathena HM. Surgery for severe trismus in submucous fibrosis. Br J Plast Surg, 1987, 40(4):407-409.
15.	Rai A, Datarkar A, Rai M. Is buccal fat pad a better option than nasolabial flap for reconstruction of intraoral defects after surgical release of fibrous bands in patients with oral submucous fibrosis? A pilot study:a protocol for the management of oral submucous fibrosis. J Craniomaxillofac Surg, 2014, 42(5):e111-116.
16.	Ye W, Song Y, Ying B, et al. Use of the buccal fat pad in the immediate reconstruction of palatal defects related to cancer surgery with postoperative radiation therapy. J Oral Maxillofac Surg, 2014, 72(12):2613-2620.
17.	徐新江, 蒋斌, 韩靓. 不同面动脉供血皮瓣重建颊黏膜缺损疗效观察. 中华实用诊断与治疗杂志, 2014, 28(7):697-698.
18.	Wollina U. Reconstructive surgery in advanced perioral non-melanoma skin cancer. Results in elderly patients. J Dermatol Case Rep, 2014, 8(4):103-107.

1. Kuehnemund M, Bootz F. Reconstruction of the cheek. Facial Plast Surg, 2011, 27(3):284-289.
2. 陈誉华. 含真皮下血管网真皮蒂鼻唇沟皮瓣修复鼻唇部缺损. 中国修复重建外科杂志, 2011, 25(12):1459-1461.
3. 胡小华, 黄桂林, 张霓霓, 等. 鼻唇沟岛状皮瓣在口底组织缺损修复重建中的应用. 中国修复重建外科杂志, 2014, 28(6):710-713.
4. Duzgun S, Unlu E, Bali Y. A new facial artery free-style perforator flap and conchal cartilage graft for one-step reconstruction of the alar defects. J Craniofac Surg, 2013, 24(6):2053-2055.
5. Borle RM, Nimonkar PV, Rajan R. Extended nasolabial flaps in the management of oral submucous fibrosis. Br J Oral Maxillofac Surg, 2009, 47(5):382-385.
6. 刘汉前, 俞辉明, 刘家武. 颏下岛状皮瓣修复早期口腔鳞状细胞癌术后缺损. 中国修复重建外科杂志, 2013, 27(9):1098-1101.
7. Riml S, Larcher L, Grohmann M, et al. Defect closure in the paranasal region:an enduring challenge. Int J Dermatol, 2014, 53(3):362-368.
8. 姚柏松, 周晓志, 白清华, 等. 鼻唇沟皮瓣在修复口腔颌面部组织缺损中的应用(附12例报告). 口腔颌面外科杂志, 2001, 11(增刊):31-32.
9. Hynes B, Boyd JB. The nasolabial flap. Axial or random? Arch Otolaryngol Head Neck Surg, 1988, 114(12):1389-1391.
10. Agarwal M, Gupta DK, Tiwari AD. Extended nasolabial flaps in the management of oral submucous fibrosis. J Maxillofac Oral Surg, 2011, 10(3):216-219.
11. Bande CR, Datarkar A, Khare N. Extended nasolabial flap compared with the platysma myocutaneous muscle flap for reconstruction of intraoral defects after release of oral submucous fibrosis:a comparative study. Br J Oral Maxillofac Surg, 2013, 51(1):37-40.
12. Ibrahim AM, Rabie AN, Borud L, et al. Common patterns of reconstruction for Mohs defects in the head and neck. J Craniofac Surg, 2014, 25(1):87-92.
13. Levender MM, Ratner D. Reconstructing complex central facial defects involving multiple cosmetic subunits. Facial Plast Surg, 2013, 29(5):394-401.
14. Kavarana NM, Bhathena HM. Surgery for severe trismus in submucous fibrosis. Br J Plast Surg, 1987, 40(4):407-409.
15. Rai A, Datarkar A, Rai M. Is buccal fat pad a better option than nasolabial flap for reconstruction of intraoral defects after surgical release of fibrous bands in patients with oral submucous fibrosis? A pilot study:a protocol for the management of oral submucous fibrosis. J Craniomaxillofac Surg, 2014, 42(5):e111-116.
16. Ye W, Song Y, Ying B, et al. Use of the buccal fat pad in the immediate reconstruction of palatal defects related to cancer surgery with postoperative radiation therapy. J Oral Maxillofac Surg, 2014, 72(12):2613-2620.
17. 徐新江, 蒋斌, 韩靓. 不同面动脉供血皮瓣重建颊黏膜缺损疗效观察. 中华实用诊断与治疗杂志, 2014, 28(7):697-698.
18. Wollina U. Reconstructive surgery in advanced perioral non-melanoma skin cancer. Results in elderly patients. J Dermatol Case Rep, 2014, 8(4):103-107.

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EXTENDED NASOLABIAL FLAPS IN MANAGEMENT OF ANTERIOR BUCCAL MUCOSAL DEFECTS

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