ABSTRACT: Nasolabial flap is a versatile flap well suited for single stage reconstruction. Redundant skin

extends from the medial canthus of the eye to the inferior margin of the mandible. The flap consist of skin

subcutaneous tissue and underlying musculature the flap can be used unilaterally or bilaterally for reconstruction

of alveolus, nose, floor of the mouth, buccal mucosa, palate and also in the case of bilateral oral submucous

fibrosis.

ANATOMY : Nasolabial flap is a myocutaneous flap

pedicled on facial artery. The subdermal plexus is supplied by

feeder vessel from the branches of facial artery facial artery

has four main branches in the face , the inferior labial artery,

the superior labial artery ala and lateral nasal artery and

terminates as angular artery [1]

Figure 1 and 2: Anatomy of nasolabial region

Figure 3: Types of nasolabial flap

The flap can be used unilaterally or bilaterally in the form of

superiorly, inferiorly or centrally based pedicled flap [3]. It is

commonly designed lateral to the nasolabial fold with the

medial limit of the flap 2-3 mm lateral to the nasaolabial fold

[4].

CASE 1: A 45 year old male patient presented with the chief

complaint of restricted mouth opening and gives a history of

NASOLABIAL FLAP FOR RECONSTRUCTION

OF INTRA ORAL DEFECTS

Journal of Dental Sciences

University

University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 112

University J Dent Scie 2018; Vol. 4, Issue 2

CaseReport

Key words:

Nasolabial flap, intraoral

defects, reconstruction,

oral submucous fibrosis,

intraoral reconstruction

Conflict of interest: Nil

No conflicts of interest : Nil

1Dr. Madumati Singh., BDS, MDS, FIMSA, MFDS, RCPS (Glasgow)Professor and Head of Department.2Dr. Irene Ann Shibu. Post Graduate Trainee.1,2Department of Oral and Maxillofacial SurgeryRajarajeswari Dental College And Hospital, Kumbalgodu, Mysore Road, Bangalore - 560074.Affiliated to Rajiv Gandhi University Of Health Sciences, Bangalore

pan chewing for more than 25 years. On examination the

mouth opening was 9 mm and fibrous band were palpable

intraorally. The patient was diagnosed with stage III oral sub

mucous fibrosis and was primarily treated with excision of the

fibrotic band and the secondary defects were covered with

buccal fat pad on one side and collagen membrane on the

other. On follow up there was no improvement in the mouth

opening and hence a second surgery was planned. Bilateral

fiberectomy and coronoidectomy was performed and

reconstruction of the defect was done with bilateral nasalabial

flap.

Figure 4: A. Pre-operative interincisal mouth opening; B.

Fiberectomy and closure with collagen membrane on the left

side and buccal pad of fat on the right side; C. Second surgery

– nasolabial flap harvest; D. Closure and Immediate post

operative mouth opening.

CASE 2: A 54 Year female patient presented with pain and ill

fitting denture in the upper anterior region. The patient gives

history of extraction following which the denture was placed

and cemented to the adjacent tooth. On examination the

denture and the teeth were mobile and there was tenderness

around. The denture was removed under local anaesthesia

underlying which an ulceroproliferative lesion was observed.

Incisional biopsy was performed and was diagnosed as wel

differentiated squamous cell carcinoma. The patient was

treated with wide excision and reconstruction of the defect

was done by using nasolabial flap in the antertior maxillary

region.

Figure 5: A. Squamous cell carcinoma of the anterior maxilla;

B. Resected mass; C. Flap harvest; D. Closure of the intraoral

defect.

CASE3: A 39 year old female patient reported to the

department with a non healing ulcer in the left anterior tooth

region from two months . Patient gives a history betel nut

chewing for more than 20 years. Incisional biopsy was

performed and was diagnosed as squamous cell carcinoma

histopathologically. The patient was treated with wide

excision of the lesion and supra-omohyoid neck dissection.

Reconstruction of the anterior mandibular defect was done

with nasolabial flap.

Figure 6:A. Squamous cell carcinoma of the lower anterior

alveolus ; B. Flap harvest; C. Closure

CASE 4: A 30 year old female patient reported with reduced

mouth opening since two months and gives a history of betel

nut chewing since 14 years. On Examination, the mouth

opening was less than 5 mm and fibrous bands were palpable

University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 113

University J Dent Scie 2018; Vol. 4, Issue 2

A B

C

bilaterally over the buccal mucosa. The patient was diagnosed

with stage III Oral Sub mucous Fibrosis. Surgery was planned

under General anaesthesia, bilateral fiberectomy and

coronoidectomy was performed along with reconstruction

using nasolabial flap.

Figure 7: A.preoperattive; B.ultrasonitc Doppler markitngs;

C. Flap harvest; D.closure

DISCUSSION: Sushrutha Samihita in 600 AD, first

described nasolabial flap for correction of cutaneous defects

[5][6]. Dieffenbach used superiorly based nasolabial flap for

nasal ala reconstruction in 1830 [7][8]. Inferiorly based

nasolabial flap was used for reconstruction of floor of mouth.

Lip, tongue, buccal mucosa, upper and lower alveolus,

maxilla and oro-nasal defect [9].

Nasolabial flap is highly versatile because blood vessels in

subdermal layer travel in axial direction, so the length/width

ratio can reach near that of the true axial pattern flap [10]. It is

not necessary to include facial artery in the flap design for flap

survival but facial artery preservation at the same side with

nasolabial flap will increase the flap reliability. Axial pattern

nasolabial flaps are thick flaps, more reliable and have a good

pedicle length [11]. They can be orthograde or reverse flow

based on facial and angular artery respectively. Nasolabial

flap can be used in different thickness. It can be thinned at the

level of dermis and epidermis when a thin pliable flap is

required or can be used as a full thickness flap for through and

through defects [12].

Eliminating nasolabial fold is common if fold is included in

the flap. Periosteal suspension suture and minimum eversion

of the skin during closure of donor site is advised to prevent a

fat cheek formation [13]. In medial canthal region, if distance

between apex of the flap and medial canthus is not followed,

medial lower eyelid ectropion may result.

Inherent limitation of nasolabial flap is the presence of hair in

the intraoral reconstruction in the case of male patients [14].

There is also an elevated or bulging deformity of tissue within

the semicircular confines of a U-, C-, or V- shaped scar which

can occur in both inferiorly and superiorly based flaps [15].

The posoperative extra

oral scar is hidden in the nasolabial fold in older patients with

prominent nasolabial fold and laxity of skin compared to

younger patients [16][17].

CONCLUSION: Nasolabial flap is a well organised flap

which can be used for reconstruction of intraoral defects. The

flap is pedicled on the facial artery and hence a single stage

closure with a small pedicle can be achieved if the proximal

portion is de-epithelised. The nasolabial region has excellent

blood supply and ensures the viability and prevents flap

breakdown and fistula formation [18]. An abundant blood

supply allows for a length to breadth ratio of 3:1. The flap is

good for small to intermediate intraoral defects.

The bulk provided by the facial musculature helps to

reconstruct large defects. The flap is good for small to

intermediate intraoral defects. The flap does not impair

speech and it has minimum donor site mobility [19]. The

patient compliance is not very good as far as the facial

aesthetics is concerned. It is a simple flap and is one of the

least time consuming flap with promising post operative

results.

REFERENCES:

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management of severe trismus in oral submucous

fibrosis. Indian J. Dent. Res. 27: 492-497

CORRESPONDING AUTHOR :

Dr. Irene Ann Shibu

Rajarajeshwari Dental College and Hospital,

#14, Ramohall Cross, Mysore Road, Kumbalgodu,

Bangalore - 560074

E-mail : annshibu@gmail.com,

+917259523800 (not to be prtinted)

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