Labial Mucosal Flaps for Reconstruction of The Columella

EDITORIAL COMMENT

The use of mucosal flaps to reconstruct the columella has two obvious disadvantages: (1) the lack of color match, and (2) the tendency of the mucosa to dry and crust. Both disadvantages are partly corrected by resurfacing of the mucosa with a skin graft.

A flap or flaps from the labial mucosa can be pulled through the lip at the proposed columella base and inserted into the nasal tip for reconstruction of the columella. This is a procedure that has been used on a number of occasions by the author.

INDICATIONS

Mucosal flaps may be used to supply bulk from the base of the lip up to the tip of the nose to form the columella. However, this gives a pink mucosal appearance that generally is secondarily grafted with a full-thickness graft from the back of the ear to give the desired skin color and texture.

The mucosal flap is an undesirable first choice unless there is no tissue available in the immediate area to use as a direct flap. This would be the case when there has been extensive surgery in the nasolabial areas for malignancy or injury or when there has been extensive radiation to the cheeks. However, in such instances, the mucosal flaps themselves may have a precarious blood supply.

ANATOMY

The anatomic basis of the labial mucosal flap that extends outward in the cheek and is based farther laterally would be the superior labial artery. The superior labial vein would complete the circulatory exchange. For bilateral labial flaps taken on the medial aspect of the lip, the circulation is more precarious and would depend on branches of the superior labial artery and a septal branch, unless this had been interrupted. The superior labial artery anastomoses with its counterpart on the opposite side, with the lateral nasal branches of the facial artery, and with the septal branch of the sphenopalatine artery. If the septum has not been resected with the columella for malignancy or has not been injured by trauma, the sphenopalatine artery may be used to give some additional circulation into this flap.

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