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BACKGROUND: Human facial bites are uncommon and usually cause a wound that presents major challenges for the reconstructive surgeon. PURPOSE: The purpose of this study is to present the advantages and disadvantages of using a superiorly based interpolated nasolabial flap for reconstruction of a nasal tip defect. METHODS: We present a case of serious injury of the nasal tip as a result of a human bite. Early maxillofacial surgical intervention resulted in restoration of the facial anatomy and function of the structures involved. RESULTS AND CONCLUSION: We present a serious mutilating injury of the tip of the nose in a young patient as a result of a human bite. These injuries can be rather destructive and cause a facial defect which may have a significant adverse psychological impact on the patient. Because of the proximity and the skin colour match of the melolabial fold to the nose, nasolabial flaps are a very attractive and reliable reconstructive choice for nasal tip defects. The relative advantages over other reconstructive options and the limitations of an interpolated superiorly based nasolabial flap are discussed. The elaborated use of a nasolabial peninsular pedicled skin flap may deliver a very satisfactory outcome from a functional and cosmetic point of view.

To evaluate the application of extended nasolabial flap versus buccal fat pad graft in the surgical management of oral submucous fibrosis.This prospective study was carried out in the Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai.A total of 8 patients (6 men and 2 women) with age range from 21 to 65 years were selected for study. These 8 patients were randomly divided into two groups of four namely group 1 and group 2. In group 1 patients, reconstruction was planned with extended nasolabial flaps and in group 2 patients, reconstruction was planned with buccal fat pad graft respectively.PairedThe mean preoperative mouth opening in group 1 was 8.5 mm and in group 2 was 11.75 mm. The mean increase in group 1 after one year of postoperative period was 21.50 mm and in group 2 was 24.75 mm.In the present study, buccal fat pad graft proved to give better results as the interposition material as it has good patient acceptance, rapid epithelization, minimal donor site morbidity and minimal intra and postoperative complications.

This article represents the use of inferiorly based nasolabial flap in reconstruction of various intraoral and extraoral defects.Nasolabial flaps were performed in 40 patients, for reconstruction of buccal mucosa, gingivobuccal sulcus, commissure, lower lip, floor of mouth, upper lip and lower alveolar defects.The most common defect site in the oral cavity was the buccal mucosa. Partial flap necrosis occurred in five patients. Out of 40 cases of carcinoma of lip, commissure and floor of the mouth, all the patients had good speech after complete healing of the wound. None of the patients who had lip or commissure reconstruction developed drooling of saliva due to lip incompetence.The inferiorly based nasolabial flap provides reliable coverage of intermediate-sized oral cavity defects when used alone. Minimal donor morbidity is associated with its use. It is especially useful in elderly patients with facial skin laxity and where esthetics is not a major concern.

There are different treatment modalities mentioned in the literature for the management of oral sub mucous fibrosis (OSMF) [1, 2]. We at our centre follow a specific protocol for the management of OSMF, i.e. release of fibrous bands, bilateral coronoidectomy, extraction of all the third molars (maxillary and mandibular) and reconstruction of defect with extended nasolabial flap [3]. Post operative physiotherapy is the key in achieving the adequate mouth opening. Initially wooden spatulas and then Heister’s jaw opener were used for the purpose of passive and active physiotherapy simultaneously. But these are useful in the patients who are dentulous with acceptable periodontal status. We at our centre came across two cases of oral sub mucous fibrosis who were edentulous and it was difficult to perform post operative physiotherapy by conventional means. The conventional jaw opener are metallic which can traumatise the edentulous ridge with poor post operative patient compliance for physiotherapy. In such patients we recommend use of modified Heister’s jaw opener (RAI Modification, Fig. 1) for post operative physiotherapy. Fig. 1 Modified Heister’s jaw opener In such patients a denture base with soft resin liner is prepared. Slots are made over the base plate (Fig. 2) for the placement of Heister’s jaw opener which avoid trauma to the alveolar mucosa. The modified instrument is safe and very economical to use. Patient can himself use the instrument for post operative physiotherapy (Fig. 3). Fig. 2 Denture base with slots for Heister’s Jaw opener Fig. 3 Patient with Jaw opener