Nasolabial Flaps to Anterior Floor of Mouth

I. A. McGREGOR

D. SOUTAR

The functional integrity of the anterior floor of the mouth is probably more important in maintaining tongue mobility and consequent normality of articulation and deglutition and control and disposal of saliva than any other part of the oral cavity. Even minor loss of tongue mobility results in a serious disturbance of function. As a result, small defects of this area that elsewhere in the mouth might be suitably managed by direct suture require a formal reconstruction.

For the small defect, a suitably matching small flap reconstruction is required, and it is in this situation that the nasolabial flap provides a simple, safe, and effective method of reconstruction. The reconstruction involves the raising of an inferiorly based nasolabial flap on one side (1) or, much more frequently, both sides (2), depending on the site and size of the intraoral defect. The flap or flaps are tunneled through the cheek and brought into the mouth. There the single flap is sutured to the defect or, in the case of bilateral flaps, inter-digitated and sutured to the defect. Division of the pedicle and insetting are carried out 3 weeks later.

INDICATIONS

Defects of the anterior floor of the mouth that are most suitable for a bilateral nasolabial flap reconstruction often involve the floor itself and part of the ventral aspect of the tongue. Frequently, it is found that one flap covers the defect of the floor while the other covers the defect of the tongue, the combined flaps forming a rectangle. The method works best in the edentulous mouth where the loss of the teeth and the alveolar resorption that follows leave a shallow floor of the mouth.

Certain virtues of the technique are obvious: the good cosmetic result on the face because of the scar line in the nasolabial fold and the fact that most adults can spare tissue in the nasolabial site. Less obvious, but possibly more important, is the direction of any pull of the bridge segment. This is upward and laterally and has the effect of holding the tongue up and preventing it from sinking down into the mouth during healing. This plays a significant role in maintaining tongue mobility.

Nearly all the defects in the anterior floor that are potential candidates for the method require bilateral flaps, and it is this technique that will be described.

FLAP DESIGN AND DIMENSIONS

Inferiorly based nasolabial flaps are outlined on each cheek and raised with sufficient subcutaneous tissue to ensure a good blood supply, although remaining superficial to the facial muscles. The base of the flap should be maintained at just above the level of the angle of the mouth (Fig. 182.1). It is desirable to place the base of the flap at this point because just below this level several branches from the facial artery and inferior labial artery pass into the nasolabial skin and subcutaneous tissue (3). The flap relies on the subcutaneous and dermal vascular system, augmented by these vessels in the base of the flap. Placing the base of the flap at this level also ensures that the flaps enter the oral cavity from well above the “sump” area and so minimize any tendency to fistula formation.

Only gold members can continue reading. Log In or Register to continue