Nasal Vestibular Chondromucosal Flap

EDITORIAL COMMENT

The editors feel that correction of the retruded columella could be accomplished by shortening the nose as the author did, but it also could be achieved by judicious placement of cartilaginous grafts to the columella. In correcting notching of the alar rim, the described procedure is indicated when a shortage of nasal lining but an adequate amount of external nasal skin are present.

The chondromucosal flap for correction of columellar retraction after septal resection was first described in 1963 (1). This flap has several donor areas and great versatility, and it is available for unilateral or bilateral use (2, 3).

INDICATIONS

When the columella is retracted, the nasal tip is depressed from lack of anterior septal support, and the lateral side walls are relatively long, then lateral chondromucosal flaps, including portions of the lower lateral alar cartilage, are available (Fig. 68.1A). When there is a hanging columella that is exaggerated by retracted lateral side walls or even collapse of the alar margins and nasal obstruction, reverse chondromucosal flaps are available (Fig. 68.2A).

These flaps are also available for a unilateral deformity and can even be taken from one lateral vestibule and slid subcutaneously over the septum to supply the opposite side. (The temporary fistula can be closed after several weeks.)

During reconstruction of a columella or side wall, the chondromucosal flaps can be used to provide lining and support. These flaps also can be quite helpful in conjunction with a nasolabial skin covering flap.

ANATOMY

This is a compound flap containing lining and cartilage. The vascular dependability of this flap is remarkable, considering the hazardous width-to-length ratio. This is probably due to

the fact that the flap is backed by cartilage, which acts as a splint to prevent collapse or kinking of the vessels within it.

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