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Introduction: Conventional nasolabial flap has been widely used for reconstruction for head and neck defects. Recent decades witnessed modification of this flap like islanded version based on subcutaneous pedicle or facial artery and vein. The later modification obviated a need for pedicle division, secondary procedures and facilitates reach of the flap to distant sites. Especially, the islanded nasolabial flap pedicled on facial artery and vein can have a long pedicle to conveniently reach the tongue, floor of mouth when the flap is routed through retromandibular area. Methods: A retrospective analysis was done on 14 patients analyzing the functional outcome like deglutition, speech, and aesthetic outcome of flap donor area, recruiting patients in which islanded nasolabial flap was done based on facial vessels for early stages of cancer tongue and lip. Results: In our series of 14 operated cases, all flaps survived. All the flaps were islanded over the skeletonized facial artery and vein. Tip necrosis occurred in one case. The donor site was closed primarily in all cases. The average speech scoring was grade five, Vancouver scar score of the flap donor area was 2.5 and intelligible speech was difficult in only three cases in follow up. Conclusion: We found this flap useful for reconstruction of small to moderate size defects of oral malignancy following excision with acceptable aesthetic and functional outcome in most of the patients. [ABSTRACT FROM AUTHOR]

Introduction: Early retromolar trigone (RMT) lesions are difficult to access and free tissue transfer is often an overkill for such small lesions. The aim was to devise a novel surgical approach that would aid the resection without raising a cheek flap and simultaneously provide a local reconstructive option for small lesions in the RMT. Methodology: This study was to demonstrate the outcomes of the "trans-facial" approach used to simultaneously access and reconstruct small RMT tumors through an islanded nasolabial flap. Patients with histologically proven squamous cell carcinoma of RMT requiring surgery were included from January 2021 to September 2022. Case selection was done based on the location of the disease and its size (cT1/T2). All needed bone and soft tissue resection via per oral trans-facial approach, along with an ipsilateral neck dissection. The technique is described along with their post-operative and pathologic outcomes. Results: Out of the eight patients included in this study, six underwent a bi-alveolar marginal resection and reconstructed using the trans-facial approach. No major complications were noted in the post-operative period. 50% were pT1 tumors and 75% were pN0 status. One patient had a close margin; while, the others had adequate resection margins. All patients were followed up for a median of 18 months with a locoregionally controlled status. Conclusion: The trans-facial approach can be a suitable option with a reasonable oncologic outcome to address small RMT lesions. [ABSTRACT FROM AUTHOR]

Myopericytoma is defined as a rare benign myxoid tumour that is usually found in distal extremities. However, it may rarely affect the oral cavity. Few cases of oral myopericytoma were reported in the literature. A 56‐year‐old female patient presented with a mouth floor lesion. A wedge biopsy performed from the lesion revealed an atypical round cell proliferation, which may be plasmablastic lymphoma or plasmacytoma. Post‐contrast neck MRI described a well‐defined lobulated lesion at the right sublingual region measuring 14 × 21 mm. Transoral wide local excision of the ulcer was performed, and reconstruction of the defect was done using an inferiorly‐based nasolabial flap. Microscopic examination of the excised swelling revealed a tumour proliferation formed of bland‐looking spindle cells alternating with fibroblasts and intervening vascular spaces. No detected mitosis or necrosis in the examined material. IHC staining of the tumour cells was positive for Caldesmon and alpha smooth muscle actin, while Ki67 was positive in 3% of cellularity. Desmin, ALK, B‐catenin, ERG, CD31, and CD138 showed a negative reaction. This led to the diagnosis of bland spindle cell proliferation suggestive of oral myopericytoma with free all surgical margins. Myoepricytoma is a rare benign tumour that rarely affects the oral cavity. Surgical excision is the mainstay of treatment. Local flaps constitute a good choice for the reconstruction of the resection defect. [ABSTRACT FROM AUTHOR]

Background: Carcinoma of the floor of the mouth (FOM) can be difficult to treat surgically. Reconstruction is often necessary to close defects and restore function. In countries with limited resources, the pedicled pectoralis major myocutaneous (PMMC) flap can be considered as an alternative for FOM reconstruction, especially in the era of microvascular techniques. Methods: In this study, we assess the effectiveness of using the PMMC flap to treat defects caused by carcinomas in the floor of the mouth (FOM). We have analyzed 28 patients and examined the surgical techniques, postoperative results, and complications related to the use of the PMMC flap. We have compared this approach to other reconstruction methods, with a focus on restoring function and ensuring patient satisfaction. Results: In our research, we studied 28 patients who had the floor of mouth cancer. Out of them, 15 patients underwent PMMC flap reconstruction. The reconstruction results were encouraging as patients reported high satisfaction levels with improved speech and swallowing abilities. Although some complications were observed, such as two cases of orocutaneous fistula formation and one case of partial flap necrosis, the functional outcomes of PMMC flap reconstruction were better than other flap reconstructions. Conclusions: In modern times, reconstructive surgery has advanced significantly, and the PMMC flap has proven its enduring worth. Although it may not always be the first choice, this time-tested technique has emerged as a viable option in the armamentarium for FOM carcinoma reconstruction. By balancing tradition and innovation, surgeons are able to offer optimal outcomes, functional restoration, and patient satisfaction in this challenging clinical scenario. Therefore, the PMMC flap deserves consideration as a valuable adjunct in the modern era of microvascular reconstruction for floor-of-mouth carcinoma. Further research and case studies are necessary to refine its indications and techniques in contemporary practice. Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Introduction: A prospective study was conducted to find out an effective alternative in the form of non-vascularized abdominal dermal fat graft (ADFG) and to compare its efficacy with the vascularised nasolabial flap (NLF) for the treatment of oral submucous fibrosis (OSMF). Method: Comparative study comprising of 30 patients with Grade 3 and 4A OSMF, randomly divided into 2 groups: Group A (ADFG) and Group B (NLF). They were evaluated for mouth opening (MO), graft uptake, time taken for mucosalization, pain, intercommissure distance (ICD), scar, duration of surgery (DOS), patient satisfaction and thickness of masseter muscle on ultrasonography. Findings.: At 6 months, MO improved by 22.4 and 36.2 mm in Group A and Group B, respectively. There was statistically significant difference (p < 0.05) seen for the values between the groups for all the parameters except for ICD and VAS score, which was statistically insignificant (p > 0.05). Intraoral hair growth, facial scar, orocutaneous fistula and commissure tear was seen in Group B. Complete necrosis of graft followed by recurrence was seen in three cases in Group A. Conclusion: NLF holds better as compared to ADFG in the management of OSMF. However, the cornerstone of success remains habit cessation and aggressive physiotherapy. The limitations of the study are small sample size and short duration of follow-up. [ABSTRACT FROM AUTHOR]

Objectives: Reconstruction of large lower lip defects remains challenging in terms of aesthetics, function and safety. The aim of this study is to explore a modified nasolabial flap to repair large lower lip defects. Methods: The full‐thickness nasolabial facial artery flap was used for reconstruction of defects in lip squamous cell carcinoma (LSCC) patients after tumor ablation. The postoperative recovery of patients was obtained through clinical review and follow‐up in the first and sixth month. Results: There were four LSCC patients who received tumor ablation at the Beijing Stomatological Hospital of Capital Medical University from November 2022 to March 2023, were included in our study. All patients did not suffer from postoperative infection, orocutaneous fistula, flap necrosis, and flap loss. One patient had the trapdoor deformity. These patients achieved better lip closure function. One patient developed cervical lymph node metastasis 2 months after surgery. Conclusions: The modified nasolabial flap could achieve good outcomes in terms of aesthetics, function, and safety. It provided a supplementary strategy for the using of nasolabial flap in larger defects of lower lip. [ABSTRACT FROM AUTHOR]

Objectives: Following primary surgery for unilateral cleft lip palate (UCLP), cleft lip nasal deformities (CLNDs) (nasal asymmetry, collapsed nasal alae, and a widened alar base) are generally inevitable and often require secondary rhinoplasty. However, reconstructing a cleft nose with an alar tissue deficiency remains challenging for rhinoplasty surgeons. Methods: The manifestations of common deformities are described herein, and a secondary rhinoplasty technique for unilateral CLNDs using a nasolabial flap (NLF) has been proposed for patients with alar tissue deficiency. Secondary rhinoplasties were performed in 12 patients with unilateral CLNDs between 2020 and 2021 using a NLF. Photogrammetric measurements were performed preoperatively and postoperatively. A total of 12 flaps were successfully transferred. Ten patients were followed up for >1 year. Results: Significant postoperative decreases in nasal alar width were measured in both the base view (p < 0.050) and the frontal view (p < 0.050). Despite the additional facial scars that occurred in some cases, all patients were satisfied with the aesthetic effects. Conclusions: The NLF achieved satisfactory results in secondary rhinoplasty of unilateral CLND for patients with nasal tissue deficiencies in whom the surgeon weighed the potential benefits over postoperative scarring. Level of Evidence: 4 Laryngoscope, 134:1648–1655, 2024 [ABSTRACT FROM AUTHOR]

Purpose : Oral submucous fibrosis (OSMF) is a chronic, potentially malignant condition affecting any part of the oral cavity and is prevalent in Southeast Asia and the Indian subcontinent. The aim of this study is to compare the efficacy of buccal fat pad flap with the nasolabial flap in the management of OSMF. Methods: We systematically compared two commonly used constructive techniques in the management of OSMF: the buccal pad of fat flap and the nasolabial flap. We performed a comprehensive search in four databases for all articles published between 1982 and November 2021. We assessed the risk of bias using the Cochrane Handbook and Newcastle–Ottawa Scale. We used the mean difference (MD) for pooling the data with 95% confidence intervals (CIs) and evaluated the heterogeneity between pooled studies using χ2 and I2 tests. Results: Out of 917 studies, six were included in this review. The meta-analysis significantly favored conventional nasolabial flap over buccal fat pad flap in improving the maximal mouth opening (MD, − 2.52; 95% CI, − 4.44 to − 0.60; P = 0.01; I2 = 0%) after OSMF reconstructive surgery. Conversely, when it comes to esthetic outcomes, these studies favored buccal fat pad flap. Conclusion: Our meta-analysis found that nasolabial flap was better than buccal fat pad flap in terms of mouth opening restoration after OSMF reconstructive surgery. Also, the included studies found better results, favoring nasolabial flap over buccal fat pad flap in terms of oral commissural width restoration. Also, these studies reported better outcomes in terms of esthetics, favoring buccal fat pad flap. Further studies with larger sample sizes and different populations/races are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Basal cell carcinoma (BCC) is the most common skin cancer with more than 80% occurring on the face occurring mainly due to exposure to ultraviolet rays in the elderly due to cumulative exposure of the UV rays during their lifetime. Though various treatment modalities are available for the treatment of basal cell carcinomas, wide local excision is the standard line of management. However, reconstruction of facial BCC poses a challenge to the reconstructive surgeon. Over a 4-year-old period from 2017 to 2021, a total of 30 patients of head and neck basal cell carcinoma were surgically excised in our institution. We have explored all modes of reconstruction from small to large BCC defects in terms of cosmesis, form and function. Four patients underwent primary closure, 8 patients underwent skin grafting, 13 patients underwent closure by local and advancement flaps and 5 patients with large defects underwent free flap reconstruction. No flap loss was reported. None reported any functional deficit. To achieve adequate aesthetic surgical outcomes after reconstruction, knowledge of facial aesthetic regions is of utmost importance. The size and location of the defect and the presence of vital structures adjacent to the defect should be assessed to determine the kind of reconstruction that should be carried out without adversely affecting adjacent structures. For greater patient satisfaction, the method of reconstruction should be tailor made, where donor tissue resembles native tissue with good contour and texture match, suture line scars are camouflaged, and complications are nil. [ABSTRACT FROM AUTHOR]

Moderately advanced (stage III) and advanced (stage IV a & b) OSMF requires surgical intervention for management A number of options are available for reconstruction of post OSMF oral cavity defects. In our study we retrospectively compared buccal fat pad, nasolabial flap and platysma flap for reconstruction of the buccal mucosal defects. Patient records were obtained from the medical records section of the Institute and divided into three groups; group A (buccal fat pad), group B (nasolabial group) and group C (platysma flap). Maximal mouth opening and intercommisural distance were the primary outcomes. Kruskal Wallis test was used to test the mean difference between three groups. Mann–Whitney test was used for intergroup comparisons. Wilcoxon signed rank test was used to evaluate the mean difference in outcomes at each follow up interval. A p value of < 0.05 was considered as statistically significant at 95% confidence interval. After 1 year follow up patients in platysma group had significantly better mouth opening (39.84 ± 1.65 mm) compared to both buccal fat pad (36.69 ± 3.41 mm) and nasolabial groups (37.94 ± 0.43 mm). Inter commisural distance was significantly better in patients reconstructed with platysma flap (59.21 ± 0.99 mm) compared to both buccal fat pad (54.11 ± 1 mm) and nasolabial flap (56.84 ± 1.48 mm). Platysma flap lead to significantly better maximal mouth opening compared to both nasolabial and buccal fat pad. Both buccal fat pad and nasolabial lead to comparable mouth opening. Inter commissural distance is maximum with platysma flap followed by nasolabial flap and buccal fat pad. [ABSTRACT FROM AUTHOR]

Abstract Background Sebaceous carcinoma is an uncommon non-melanoma skin cancer. Extraocular sites are extremely rare, with only a few cases reported in the medical literature. This article reviews the diagnostic challenges and treatment of a case of sebaceous carcinoma of nasal ala. Case presentation A 75-year-old female presented with a slow-growing right nasal alar mass for the last 1.5 years. It was nodular in appearance and covered with crusts and concretions. An incisional biopsy confirmed the diagnosis of sebaceous carcinoma. The patient underwent a wide local excision of the mass followed by nasolabial flap reconstruction. Conclusions Sebaceous Carcinoma should be included in the differential diagnosis of an elderly patient with nasal growth to avoid delaying treatment.

To assess the efficacy of different flaps along with active physiotherapy for comprehensive management of OSMF. A total of 33 patients of oral submucous fibrosis were admitted and surgically treated. All patients were diagnosed with bilateral oral submucous fibrosis of buccal mucosa. All the patients had advanced oral sub mucous fibrosis with interincisal distance less than 20 mm. Eleven patients were treated with buccal pad of fat, eleven with nasolabial flap and eleven patients were treated with temporo-parietal fascia flap. Physiotherapy was started from the 5th postoperative day and the patients were followed regularly for one year to measure maximum interincisal distance. There was a significant corelation between post-operative mouth opening and regular physiotherapy, exercise and quitting of the habit irrespective of type of reconstruction flap used. On the basis of the result obtained from this study, significant improvement in mouth opening was seen in patients who performed aggressive physiotherapy irrespective of the flap used. Thus we conclude along with the surgical treatment, post-operative physiotherapy and cessation of habit are of equal importance for good prognosis in OSMF patients. [ABSTRACT FROM AUTHOR]

An inferiorly based nasolabial flap (NLF) is a versatile flap for various oral cavity defects. However, it generally necessitates a second stage procedure to release the base at 3 weeks following the initial surgery. Reconstruction for oral cavity defects can be done with the inferiorly based nasolabial flap as a single-stage procedure. In this retrospective clinical audit, we analyzed patients who underwent an inferiorly based NLF reconstruction for oral cavity defect from January 2016 to September 2021. We analyzed the various defects for which this flap was used along with the associated complications and the safety of performing this flap in terms of its flap-related complications and the histopathological features such as margins. Forty-four patients underwent this inferiorly based single-stage NLF. The median age of the patients in the cohort was 56 years, with the majority being men (n = 38, 86.4%). Buccal mucosa and lip were the most common sites of the primary. Twenty-nine patients were per primam and 15 were recurrent cancers. Most had T1 (n = 14, 31.8%) and T2 (n = 19, 43.2%) cancers. The median closest margin was 6 mm and the base was 7 mm. There were no flap losses; however, 6 patients had minor wound breakdown for which secondary suturing was needed. Single-stage NLF is a safe flap that could be considered in select patients for appropriate oral cavity defects. [ABSTRACT FROM AUTHOR]

Background: Sebaceous carcinoma is an uncommon non-melanoma skin cancer. Extraocular sites are extremely rare, with only a few cases reported in the medical literature. This article reviews the diagnostic challenges and treatment of a case of sebaceous carcinoma of nasal ala. Case presentation: A 75-year-old female presented with a slow-growing right nasal alar mass for the last 1.5 years. It was nodular in appearance and covered with crusts and concretions. An incisional biopsy confirmed the diagnosis of sebaceous carcinoma. The patient underwent a wide local excision of the mass followed by nasolabial flap reconstruction. Conclusions: Sebaceous Carcinoma should be included in the differential diagnosis of an elderly patient with nasal growth to avoid delaying treatment. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the outcomes of the nasolabial flap in the management of oral submucous fibrosis (OSMF). The descriptive case series included 75 patients diagnosed with OSMF who underwent surgical intervention under general anesthesia. Preoperative mouth opening measurements were compared with postoperative measurements taken after 2 months. Regarding mouth opening, out of the 75 patients, 4 (5.3%) had unsatisfactory results after treatment, while 22 (29.3%) experienced satisfactory outcomes. The majority of patients, 49 (65.3%), achieved normal mouth opening (more than 30 mm) following the Nasolabial flap procedure. This indicates that the Nasolabial flap yielded favorable results in terms of restoring normal mouth opening and benefiting the patients. Based on the findings of this study, the Nasolabial flap was determined to be a viable surgical option for managing oral submucous fibrosis due to its ease of operation, reliable flap vascularity, and low post-operative complication rate. The only drawback identified was the presence of a surgical scar, which can be addressed through secondary correction procedures. [ABSTRACT FROM AUTHOR]

Objective: To share our experience with nasal reconstruction and to give a standardized algorithm for nasal reconstruction. Study Design: Descriptive cross sectional. Setting: Burns and Plastic Surgery Center, Peshawar. Period: January 2019 to December 2022. Material & Methods: Data was obtained from patient records after approval from IREB. Patients with multiple co-morbidities and small defects (<1.5cm) were excluded from this study. Defects were classified based on anatomic areas of radix, dorsum, sidewall, alar and lower third nasal defects. Cases were cross tabulated regarding site for the reconstructive options to generate the treatment algorithm. Results: A total of 51 cases were included in the study including 30 (58.8%) male patients. Mean age of patients was 48.12+21.89SD. Skin malignancies were the most common (n=35, 68.6%). Nasal ala was the most common site reconstructed in our study (25.5%) followed by nasal dorsum and sidewalls. Medium size (41.2%) was the most common. In 64.8% (n=33) cases, forehead based flaps were used to reconstruct the nasal defects (Table-I). In 5.9% cases we observed flap congestion. In 19 (37.25%) cases, patients presented with additional soft tissue defects which needed reconstruction (Table-II). Reconstructive options are presented as an algorithm based on the defect site (Figure-1). Conclusion: In this study we shared our experience with the readers regarding reconstruction of the nasal detects. We have formulated an algorithm for reconstruction of these defects that will simplify reconstruction in such cases. [ABSTRACT FROM AUTHOR]

After an extensive tumor resection, a defect of the floor of the mouth is a significant reconstructive challenge. The main goal is to preserve the mobility of the tongue, which allows the restauration of mastication, deglutition, and articulation. Today, a standard method for reconstruction of floor of the mouth defects is free microvascular flaps, especially radial forearm free flap. Despite that, a potential problem is the high perioperative risk and high complication rate associated with the patient’s age and comorbidities. Current literature suggests that a local nasolabial flap is a reliable treatment option for reconstruction of this type of defect, with a low complication rate and excellent functional and aesthetic results. The aim of this case presentation is to show the use of a local nasolabial flap for reconstruction of the floor of the mouth and to determine the criteria for this type of reconstruction. We present a patient who underwent resection of a floor of the mouth tumor. Due to the patient’s age, medical condition, and comorbidities, the defect was reconstructed with a local nasolabial flap. There were no postoperative complications. Articulation, mastication, and deglutition were satisfactorily rehabilitated. Follow-up showed no signs of recurrent disease twelve months postoperatively. To conclude, a local nasolabial flap is still an important reconstructive choice for oral cavity defects, especially for elderly patients with multiple comorbidities who have a higher risk of perioperative complications.

Introduction: The lips just like any other part of the body could be affected ny myriads of diseases including infection and neoplasm. Surgical management of lip cancer is often challenging in both reconstructive options and outcomes. Aims: This study aimed to assess the pattern of presentation and management of lip cancer in Usmanu Danfodiyo University Teaching Hospital Sokoto. Materials and Methods: This was a retrospective study of cases of lip cancer managed at the Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital Sokoto, northern Nigeria, over 9 years. Data collected included patients' demographics, lip involved, treatment given, and the treatment outcomes data were analyzed using IBM SPSS version 25. Results: Of the 47 cases in the study, 31 (66.0%) were male and 16 (34.0%) were female and the majority of them were aged over 50 years. The range was 43–76 years with a mean of ± standard deviation of 55.06 ± 8.9. There were no statistically significant differences in either age or gender. The lower lip was involved in 41 (87.2%), whereas the upper lip was involved in 6 (12.8%) cases. Squamous cell carcinoma (SCC) constituted the majority at 42 (89.4%), which were mostly well differentiated. Of the 6 cases of the lower lip, 4 cases were basal cell carcinoma, 1 case was SCC, and the remaining 1 case was sebaceous carcinoma. A total of 38 (80.9%) patients were surgically treated, and the remaining 9 (19.1%), were referred to the oncology department. Of the various options available in the literature for lip reconstruction after tumor excision, nasolabial flap 17 (44.7%) was the most frequently used in our cases, and the outcome of all the surgeries was found satisfactory. Conclusion: Lip cancer is a relatively common cancer in the orofacial region, and the majority is SCC. All the cases of basal cell carcinoma occur in the upper lip. Several options are available for the reconstruction of the lip defect after resection, with the nasolabial flap being a versatile option.

Introduction: The lips just like any other part of the body could be affected ny myriads of diseases including infection and neoplasm. Surgical management of lip cancer is often challenging in both reconstructive options and outcomes. Aims: This study aimed to assess the pattern of presentation and management of lip cancer in Usmanu Danfodiyo University Teaching Hospital Sokoto. Materials and Methods: This was a retrospective study of cases of lip cancer managed at the Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital Sokoto, northern Nigeria, over 9 years. Data collected included patients' demographics, lip involved, treatment given, and the treatment outcomes data were analyzed using IBM SPSS version 25. Results: Of the 47 cases in the study, 31 (66.0%) were male and 16 (34.0%) were female and the majority of them were aged over 50 years. The range was 43-76 years with a mean of ± standard deviation of 55.06 ± 8.9. There were no statistically significant differences in either age or gender. The lower lip was involved in 41 (87.2%), whereas the upper lip was involved in 6 (12.8%) cases. Squamous cell carcinoma (SCC) constituted the majority at 42 (89.4%), which were mostly well differentiated. Of the 6 cases of the lower lip, 4 cases were basal cell carcinoma, 1 case was SCC, and the remaining 1 case was sebaceous carcinoma. A total of 38 (80.9%) patients were surgically treated, and the remaining 9 (19.1%), were referred to the oncology department. Of the various options available in the literature for lip reconstruction after tumor excision, nasolabial flap 17 (44.7%) was the most frequently used in our cases, and the outcome of all the surgeries was found satisfactory. Conclusion: Lip cancer is a relatively common cancer in the orofacial region, and the majority is SCC. All the cases of basal cell carcinoma occur in the upper lip. Several options are available for the reconstruction of the lip defect after resection, with the nasolabial flap being a versatile option. [ABSTRACT FROM AUTHOR]

Aim: Reconstruction of the surgical defects of the external nose has been challenging and largely considered to be the domain of plastic reconstructive surgeons. The present study aims to share our experience in reconstructing such defects. Materials and methods: A retrospective analysis of 11 patients who underwent external nasal reconstruction secondary to surgical defect at our otolaryngology department in a tertiary care hospital from 2017 to 2019 was done. All the patients underwent surgical excision of a part of the external nasal dorsum followed by reconstruction by our team of otolaryngology surgeons using local random pattern/ axial flaps. The patients were followed up postoperatively for a period ranging from 3 months (for benign pathologies) to 2 years (malignant pathologies). Results: The flaps were taken up in all the patients. Minor complications like postoperative infection were seen in 2 cases, resulting in wound dehiscence in one that required resuturing that was uneventful. The appearance was bulky in all the patients, although the patients were satisfied with the overall cosmetic appearance. The average hospital stay was 2 to 4 days. Conclusion: Reconstruction of external nasal surgical defects is a challenging task. Thorough knowledge of relevant anatomy, proper planning, and availability of abundant vascularized donor tissue in the near vicinity of the defect makes this challenge acceptable with good outcomes even in the hands of otolaryngologists. [ABSTRACT FROM AUTHOR]

Background: Reconstruction of facial defects is often challenging and is dependent on numerous factors including size of the defect, availability of donor site, any existing scar, patient's consent, prognosis, etc. There are various reconstruction modalities highlighted in the literature with their inherent merits and demerits. Considering the versatility of nasolabial flap, we present a case series of different facial defects where nasolabial flap has been used successfully for reconstruction. Case Reports: Three patients with different disease process in three different areas of face were reported. All underwent wide local excision and reconstruction with nasolabial flap. The result obtained was esthetically pleasing with minimal donor site morbidity. Conclusion: Nasolabial flap is a versatile flap and can be effectively used for reconstruction of small to moderate facial defects over any other flaps. [ABSTRACT FROM AUTHOR]

Background: Different studies performed on nasal subunit reconstruction by either the nasolabial flap or the paramedian forehead flap have reported contradictory outcomes and complications, claiming one flap or the other as superior. This inconsistency has led to a gap in existing literature regarding the preferable flap for nasal reconstruction. Our aim was to statistically evaluate and compare these two flaps for nasal reconstruction, in terms of subunit preference, complications, and outcomes, using data from previous studies. Methods: This systematic review is reported using PRISMA protocol and was registered with the International prospective register of systematic reviews. The literature search was done using "paramedian forehead flap", "nasolabial flap", "melolabial flap", "nasal reconstruction". Data regarding demography of study and population, subunit reconstructed, complications, and aesthetic outcomes were extracted. Meta-analysis was performed using MetaXL and summary of findings using GRADEpro GDT. Results: Thirty-eight studies were included, and data from 2036 followed-up patients were extracted for the review. Meta-analysis was done on data from nine studies. Difference in alar reconstruction by forehead versus nasolabial flap is statistically significant [pooled odds ratio (OR) 0.3; 95% CI 0.01, 0.92; p = 0.72; I2 = 0%, n = 6 studies], while for dorsum and columella reconstruction the difference is not statistically significant. Risk of alar notching is marginally more in forehead flap, however difference in incidence of partial/complete flap necrosis, alar notching and hematoma/bleeding among the flaps is not statistically significant. Conclusion: Alar reconstruction is preferred by nasolabial flap. Complications are similar in both groups. Comparison of aesthetic outcome needs further exploration. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Early-stage oral cancers are usually treated with surgical resection and in most of cases the resulting defects are too large to be primarily reconstructed. There are many modalities of reconstruction as nasolabial flap, buccal bad of fat, polyglycolic acid sheets. Objective: This work aimed to evaluate the reconstruction of oral mucosal defects using either polyglycolic acid (PGA) sheet or nasolabial flap. Material and Methods: 51 patients of them 26 were reconstructed using (PGA) sheet, and 25 using nasolabial flap retrospectively. The tumors' location, perioperative situation, postoperative aesthetic and functional results were assessed. Results: There was no significant difference between the 2 groups regarding the early start of oral feeding or hospitalization time. While, the PGA group had significant shorter operative time. In cases with exposed bone surface, the PGA sheet was more feasible for reconstruction. There was no significant difference between the 2 groups in speech intelligibility in lingual cases. In buccal reconstruction the PGA sheets were more suitable for larger defects. Conclusion: The optimal choice of nasolabial flap or PGA sheet depends on tumor location, mucosal defect size, the general condition of the patient and tolerability for surgery. [ABSTRACT FROM AUTHOR]

Introduction: Lip reconstruction aims at maintaining the function and aesthetics of the facial subunits. Sensation in the reconstructed lip helps in bolus formation, tactile discrimination, and thermal sensation. In this study, we aim to describe random pattern nasolabial flap for lip reconstruction using various functional parameters. Methodology: This is a retrospective study of 22 patients with carcinoma lip who underwent surgical resection and reconstruction with sensate nasolabial flap. Several clinicopathological parameters were studied. Outcome parameters like oral competence, tactile sensation, thermal sensitivity of reconstructed lip and speech outcomes were evaluated. Result: A functional outcome with 2–4 mm of two‐point discrimination was obtained in 19 patients. All patients had intelligible speech. A mean sulcus depth of 19.59 mm was achieved. One patient had partial flap loss owing to wound infection. Conclusion: Random pattern senate nasolabial flap offers a good functional outcome by maintaining the tactile and thermal sensitivity. [ABSTRACT FROM AUTHOR]

To find out the usefulness of the infolding technique of nasolabial flap to reconstruct full-thickness defects of the lower lip. It is a retrospective analysis of 5 surgically operated cases. The infolding nasolabial flaps were utilized for the full thickness defect over the lower lip in carcinoma of the oral cavity from January 2018 to July 2019. The patients were followed up for a minimum period of 12 months, and the outcomes were evaluated. The mean age of the patients was 39.72 ± 7.58 years (range 30–52 years). The infolding nasolabial flap has used each case for the reconstruction of the lower lip. The average length and breadth of the flaps were 65 mm (range 60–75 mm) and 35 mm (range 30–40 mm), respectively. One patient presented with partial necrosis of the flap its tip. The functional and cosmetic outcomes were found satisfactory till 12 months of follow-up, and none of the patients had a recurrence of the disease. Infolding of the nasolabial flap can be a good surgical technique for the reconstruction of the full-thickness defect of the lower lip, ensuring satisfactory functional and cosmetic outcomes without causing major intraoperative/postoperative complications in patients with carcinoma of the lower lip. [ABSTRACT FROM AUTHOR]

Nasolabial flap is very versatile flap for the lesion of basal cell carcinoma of nose. It is preferred choice for the closure of surgical defect of nose after removing the lesion of basal cell carcinoma. This flap has very good vascularity and scar is almost invisible. The objective of this study to evaluate the suitability of nasolabial flap for the basal cell carcinoma, the survival of the flap, cosmetic appearance of the patient after the surgery and patient satisfaction. This is the case study of ten cases of basal cell carcinoma of the nose. The skin lesion was at the nasal tip, dorsum and the side of the dorsum. All the surgeries were performed by the same and first author of the article at the department of Otorhinolaryngology Sir T General Hospital Bhavnagar Gujarat. The patient age ranged from 5th to 6th decades of life. All the patients were from the coastal region of Saurashtra Gujarat. All the surgery was performed as single stage surgery. The defatting of the flap was done in all cases to match with the texture of skin of nose. The biopsy was performed in all the cases before the surgery to confirm our clinical diagnosis. The underlying cartilage was removed in all the cases to prevent the recurrence and was sent separately for the frozen and histopathology examination. The nasolabial flap survived in all the ten cases. The color and the texture of the flap matched perfectly with the adjoining skin color of nose. The scar mark of the cheek side malar flap was almost invisible. There was no trap-door deformity observed and there was good aesthetic outcome. The nasolabial flap is very reliable and versatile flap for the basal cell carcinoma sugary of nose. It can reach to almost to the all area of nose including tip of the nose. Its single stage surgery with very good aesthetic results. [ABSTRACT FROM AUTHOR]

Nasolabial flaps are one of the oldest methods of reconstruction. This study aims to observe the viability of a random-pattern subcutaneous nasolabial flap. Inpatients of carcinoma of oral cavity and nose undergoing excision with primary reconstruction from January 2014 to December 2019 were observed and followed-up. Their data including site of primary and post-operative complication was recorded. A total of 38 patients underwent reconstruction using nasolabial flap. Most cases were of buccal mucosa carcinoma (68.4%). Facial vessels were ligated in all except 7 cases and, only 1 (2.6%) showed total, and 3 (7.9%) showed partial flap necrosis. A subcutaneous nasolabial flap is simple, viable and easy to harvest. It is a random-pattern flap therefore; facial vessel preservation may not be a compulsion. Flap raised subcutaneously is thinner and thus inset is easy and bulk associated discomfort is avoided. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the functional efficacy of two different grafting techniques following the fibrotomy among subjects with oral submucous fibrosis (OSMF). Design: Forty consecutively treated OSMF subjects between 20 and 40 years who had grades 3 and 4a OSMF and mouth opening < 15 mm were included in the present study. All the subjects were randomly divided into two groups. In Group I, all the subjects received a buccal pad of fat sandwiched with a nasolabial flap following fibrotomy. In contrast, Group II subjects received a buccal pad of fat combined with a collagen graft. The effect of two different surgical protocols on mouth opening was evaluated clinically before the surgery (T0) and 1 month (T1), 6 months (T2), and 12 months (T3) after the surgery. Results: In Group I subjects, the mouth opening increased significantly (P < 0.001) from 10.90 ± 1.971 mm at T0 to 34.25 ± 3.127 mm at T1, but reduced marginally to 32.15 ± 3.422 mm at T2, and 31.30 ± 3.358 mm at T3. In Group II, the mouth opening increased significantly (P < 0.001) from 10.85 ± 1.725 mm at T0 to 28.90 ± 3.059 mm, 29.10 ± 2.808 mm, and 28.20 ± 2.285 mm at T1, T2, and T3, respectively. At the end of 12 months of follow-up, the mean value improvement in the mouth opening (T0–T3) was 20.4 ± 3.5 mm and 17.3 ± 2.9 mm in Groups I and II, respectively, and the difference was statistically significant (P = 0.006). Conclusion: The buccal pad of fat sandwiched with a nasolabial flap for the reconstruction following fibrotomy had a slightly better beneficial effect on the postoperative mouth opening among OSMF subjects. [ABSTRACT FROM AUTHOR]

Background: The nose is the most critical aesthetic element of the face and even the smallest loss of substance can create a deformity of concern. The forehead flap has been the workhorse for nasal reconstruction for centuries but requires multiple surgical steps and leads to prominent donor-site scarring. The nasolabial flap allows a single-step reconstruction with a donor-site scar concealed in the nasolabial crease but is conventionally designated for small defects involving the ala. Methods: The authors analysed all surgical records of patients undergone nasal reconstruction by nasolabial flap between May 2005 and December 2021 by the Plastic Surgery Unit of a major regional hospital in Lombardy. Defects were classified according to Burget's subunit principle and the 3-component approach. Reconstruction features and finesses were reported and analysed. Results: In the 16-year period under analysis, 378 patients with nasal defects of various aetiologies received nose reconstruction by nasolabial flap. All nasal subunits were involved; 20 patients had multisubunit defects. In all the cases the reconstruction with nasolabial flap, alone or combined with other solutions, was intended to be one-stage. Conclusions: The authors present several tips and tricks about preoperative planning and design, choice of the pedicle, flap harvesting and sculpting with preservation/restoration of grooves and convexities, conjoining multiple flaps, downsizing extensive defects by a rhinoplasty-like framework reduction. With a careful planning and refined technique, the range of application of the nasolabial flap can include defects involving any nasal subunit and larger and/or multisubunit defects., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2023 The Author(s).)

The nasolabial flap is one of the most ancient techniques used in orofacial surgery. 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.

Subtotal reconstruction of the lower lip after excision of the tumor is always a challenge for surgeons. It is because of the difficulty in regaining the function of the lip, including the oral competency and restoring the aesthetic subunit. A 46-year-old patient presented with an ulceroproliferative growth involving 70% of the lower lip, including the right commissure. After the confirmation to be a malignancy, patient underwent excision of the tumour and reconstruction of the lower lip using the left Karapandzic flap and right nasolabial flap. The patient was on regular follow-up in the postoperative period to assess the surgical outcomes. The combined use of Karapandzic flap and the nasolabial flap can be reliably used for subtotal reconstruction of the lower lip in advanced oral cavity malignancy, involving one of the commissures. Later can ensure good postoperative results in terms of aesthetic and functional lip reconstruction without any significant intraoperative or postoperative complications. [ABSTRACT FROM AUTHOR]

Purpose: The involvement of temporalis muscle fibers by oral submucous fibrosis (OSMF) and the procedure of coronoidectomy and temporalis myotomy in the surgical treatment protocol for the disease is a controversy. The primary objective of this study is to evaluate the histopathological changes in temporalis muscle fibers in patients undergoing surgical treatment for OSMF and to authenticate the importance of temporalis myotomy and coronoidectomy in surgical treatment protocol. Method: A 3-year prospective study was conducted to assess the histopathological changes in temporalis muscle in surgically treated OSMF cases. The predictor variables were drawn from demographic characteristics (age and gender) etiology, and mouth opening. The outcome variables were histopathological assessment of temporalis muscle fibers for parameters suggestive of degenerative changes and fibrosis changes at cellular level. Results: Out of 56 patients, 30 patients were had surgical intervention. Twenty-eight (93.3%) were male and 2 (6.6%) were female with a ratio of 14:1. Histopathological examination of temporalis muscle fibers revealed hyalinization of muscle fibers in 80% of the patients followed by loss of striation (73.33%), fragmentation (60%), nucleus internalization (33.33%), infiltration of macrophages and other inflammatory cells (20.67%), multiple nuclei (20%), and swollen muscle fibers (6.67%). Mean preoperative mouth opening was 12.4 and post-operatively 41.3 mm on 1-year follow-up and this was stable on further follow-up. Conclusion: The results of this study suggest involvement of temporalis muscle with disease itself and the justification for coronoidectomy and temporalis myotomy in the surgical protocol was established. [ABSTRACT FROM AUTHOR]

Background: Oral submucous fibrosis (OSMF) is a chronic disease of insidious onset predominant in the Asian subcontinent. It is a progressive condition resulting in forced closure of mouth and inability to take solid oral feeds. Having a multifactorial etiology, it is a well-known premalignant condition. Measures such as forcing the mouth open and releasing the fibrotic bands have resulted in aggravated fibrosis and disability. Aim: The aim was to evaluate the outcomes of bilateral inferiorly based nasolabial flaps in the management of severe trismus in patients with submucous fibrosis. Materials and Methods: The study included patients with progressive trismus presenting to the department of plastic surgery who underwent release and cover with nasolabial flap during the period from August 2014 to July 2018 (4 years). A total of eight patients were studied for their offending agents, the progression of the disease, the preoperative and postflap transfer, and inter-incisal distance, and this was followed up for a period of 1 year. Patients were studied for their improvement in mouth opening, flap status, and donor-site scar acceptability. Results: A total of eight patients of submucous fibrosis with severe trismus were treated with nasolabial flaps and followed for an average of 1 year from 2014 to 2018. The mean preoperative inter-incisal opening of 2 mm was treated by the bilateral release of mucosal fibrous bands and covered with tunneled facial artery-based nasolabial flaps. All patients received postoperative mouth-opening physiotherapy. Their inter-incisal opening improved from a mean of 2 mm to a mean of 30.8 mm. Conclusion: Bilateral pedicled nasolabial flaps can be successfully used for long-term relief of severe trismus in OSMF. Our study showed easy elevation of bilateral flaps, adequate postoperative mouth opening, with no recurrence of disease, and no flap contracture. This small-sized flap gives good coverage of the buccal mucosa without flap redundancy and cosmetically acceptable donor site.

Background: The lip has functional and aesthetic importance. Lip defects occur due to the variety of etiology and the choice of their reconstruction has profound effect on functions and cosmesis. There are multiple options available for reconstruction according to defect size, but superiority of one method over another is still debated and hence the methods and their outcome were analyzed prospectively.Material and method: Twenty-one patients with all sizes and locations of defects in upper and lower lip with acquired etiology were included in the evaluation. Reconstruction was performed according to defect size, availability of local/regional and distant donor tissue, defect location, patients’ comorbid conditions and patients’ preference. Patients were assessed at 1 month and 6 months postoperatively. Observers’ and patients’ input were also taken into account for outcome.Results: Out of 21 patients, 5 free radial artery forearm flap reconstructions, 4 nasolabial flap reconstructions, 5 primary closures of defect, 4 Estlander flap reconstructions, 2 lip advancements, and one Karapandzic flap reconstruction were done. Free flap and nasolabial flap had hypoesthesia and incompetence if commissure is reconstructed and problem of bulk, restricted mobility and vermilion mismatch. Local and lip flaps were associated with decreased stoma size and some form of local scarring and asymmetry. However, all patients were satisfied with the functional and aesthetic outcome.Conclusion: Local flaps are better in terms of functional and aesthetic outcome but with some degree of microstomia which was well tolerated by most patients. Regional and distant flaps provide reconstruction where no other option is available and provide good functional support and acceptable cosmesis.

Repair and reconstruction of external nose defect is one of the challenging clinical problems in plastic surgery. Many different techniques and methods have been applied to the repair and reconstruction of external nasal defects with different location, scope and level of nasal defects, but the principles of subunit repair and layered reconstruction should be followed in the repair and reconstruction surgery. The external nose is not only an aesthetic organ, but also a functional organ. As taking into account of both the appearance and the nasal ventilation function, a personalized treatment should be planned in combination with the actual situation of the external nose defect in the repair process. This article comments on Research progress in the repair of external nasal defect. [ABSTRACT FROM AUTHOR]

Facial artery is a branch of the external carotid system extending from the upper neck to the nasion. Various flaps are described in the literature based on the facial artery and vein in the neck and face to reconstruct the head-and-neck cancer defects, either superiorly based or inferiorly based. This article summarizes the flaps and their variations based on the facial arteriovenous system. The flap harvest techniques, the indications, advantages and the limitations of the nasolabial flap, facial artery myomucosal flap, and submental flap are described, with appropriate case demonstrations. Variations of the flaps are also discussed.

Reconstruction of full-thickness eyelid defects is done to provide a mobile lid with corneal protection, having good aesthetic quality, and acceptable donor site morbidity. Various flap procedures have been described and used for the lower eyelid reconstruction; however, the nasolabial flap is rarely employed. It is a random pattern cutaneous flap with redundant blood supply from the perforating branches of the facial and angular arteries and can be used as an inferiorly or superiorly based flap. Here, we aim to present the clinical results of using the superiorly based nasolabial island flap for reconstruction of anterior lamella and turnover/hinge flap of infraorbital skin and palpebral conjunctiva with support of conchal cartilage for reconstruction of posterior lamella for lower eyelid defect. To our best knowledge, this reconstructive combination of flaps has not been described previously for total and full-thickness posttraumatic defect of lower eyelid.

Background Nasal-defect reconstruction is a challenging subject, nasolabial flaps are common methods for nasal reconstruction. Different modalities of nasolabial flaps were identified as V–Y advancement, superiorly or inferiorly based, freestyle perforator based, interpolated flap, and propeller types are commonly used. Objective The objective of the study is to evaluate the different modalities of nasolabial flaps in nasal-defect reconstruction and review of literature about nasal reconstructions with nasolabial flaps defining the advantages and disadvantages for each subunit. Patients and methods The study included 40 patients presented with nasal defects admitted to Benha University Hospital in the period from December 2018 to December 2020. Patients were reconstructed with different nasolabial flap types. Results In total, 40 patients whose nasal defects were reconstructed with nasolabial flaps were included in this study. The most frequent lesion was basal-cell carcinoma (73.3%). The most frequent flap type was superiorly based flap (60.0%), followed by inferiorly based flap (23.3%), and freestyle perforator nasolabial island flap was the least frequent one (16.7). All patients (100.0%) reported good functional outcomes such as normal breathing and no airway obstruction. About half of the patients reported excellent outcomes (53.3%). Partial wound dehiscence in three (7.5%) patients and alar distortion in two (5%) patients. Conclusion V–Y-advancement flap and freestyle perforator-based flap may be preferred for sidewall-and dorsum-defect reconstruction. Two‑stage interpolation type gives the best results for tip-region defects. Propeller and transposition (superior or inferior based) type flaps may be the choice for treatment in alar-region defects. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To describe our clinical experience with, and functional outcomes of the nasolabial flap for reconstruction of orofacial defects. Methods: Design: Retrospective Case Series Setting: Tertiary National University Hospital Participants: Records of 11 patients on whom a nasolabial flap was performed for reconstruction of head and neck defects between January 2013 and December 2018 were analyzed. Results: All patients underwent wide excision with or without frozen section, with or without neck dissection, and nasolabial flap closure was performed by a single surgeon. There were no major complications. In two cases, the nasolabial flap was used as an adjunct for Abbé and deltopectoral flap reconstruction. One had poor oral competence due to the bulk of the deltopectoral flap. Acceptable aesthetics and functional outcomes were achieved. Conclusion: The nasolabial flap is a viable alternative for reconstruction of orofacial defects following head and neck surgeries. Additional cases can help validate our initial experience

Introduction: Nose is the most noticeable feature in the facial profile. Any deformity of nose causes social embarrassment and ridicule. Isolated nasal alar hypoplasia/cleft or traumatic loss is a rare anomaly which requires reconstruction. Congenital deficiency of soft triangle of nose and part of ala is not paid attention to in early childhood. Hence, most of these individuals present in late childhood, adolescence or adulthood. We report ten such cases and their reconstruction using two stage ipsilateral interpolated nasolabial flap. Material and Methods: Demographic data including age, sex, associated co-morbidities, previous surgeries or history of trauma were documented. Patients were in age group of 10-25 years. The mean size of defect was 1.5 X 1.6 cm. Inferiorly based skin flap raised from ala was turned down and used as inner lining. Conchal cartilage graft was placed for support in the first stage itself. Nasolabial flap was raised by subcutaneous dissection and insetting done to create outer cover. Second stage for pedicle detachement was done after 3 weeks. Results: Post operative period was uneventful in all cases. Minimal cosmetic morbidity was noted. Scar was well concealed in the nasolabial crease and colour match was also acceptable with good patient satisfaction at 6-12 months. Conclusion: Nasal alar hypoplasia/cleft, congenital or traumatic, is a rare entity which needs to be recognised and reconstructed. According to the size of the defect, it can be reconstructed with composite cartilage graft or local flaps. Interpolated nasolabial flap with cartilage graft is a good option with minimal scar and excellent patient satisfaction.

Osteo-odonto-keratoprosthesis (OOKP) is a procedure that is beneficial to patients with end-stage ocular disease, which is not amenable to corneal transplantation. It involves the harvest of tooth lamina and implantation of lamina cortex into the eye. The oroantral fistula (OAF) is one of the most disastrous complications of this procedure. The complication of an OAF during the harvest of a molar for an OOKP procedure can be prevented by applying a sound surgical technique. However, in case an OAF develops, it can be managed by a variety of options depending on the dimensions of the defect. In this report, we present the use of a nasolabial flap along with an upper sulcus flap for coverage of an OAF after undergoing an OOKP procedure. Measures to avoid this disastrous complication have also been discussed.

Abstract The novelty of this procedure is the reconstruction of a maxillary palatal defect with two pedicled flaps: a pedicled buccal fat pad and a nasolabial flap. This use of combination flaps makes the surgery simple, short, and useful for a wide defect.The novelty of this procedure is the reconstruction of a maxillary palatal defect with two pedicled flaps: a pedicled buccal fat pad and a nasolabial flap. This use of combination flaps makes the surgery simple, short, and useful for a wide defect.