Columella reconstruction using double nasolabial flap and costal cartilage: A case report

Abstract

Total loss of columella causes significant aesthetic and functional deformities due to its important functions which provides assistance and extension to the nose pointer. Noma is described as one of the developed sources of total columellar loss, and is also contagious, with the ability to intensely damage facial tissues and immediate structures. However, the condition is predominantly suffered in Africa, with an estimation of 20 instances per 100,000 individuals. Furthermore, the reformation of a columellar disorder offers a complex process, due to the structural features of the location. A 24-year-old female patient with total columellar loss caused by Noma. We performed a two stage reconstruction. First, we used double nasolabial flaps to create a new columella. Second, we inserted costal cartilage and dermofat graft to support it. The double nasolabial flap demonstrated 100% survival. Both nasal airway and the final appearance showed functionally and cosmetically remarkable results. The nasolabial angle projected better than the preoperative measurement. The patient was satisfied. The patient was followed up until a year after surgery. The double nasolabial flaps combined with costal cartilage graft is one of the best surgical options to obtain astonishing columellar reconstruction.

Double mesolabial flap for repair of large nasal tip wound involving multiple nasal subunits

“…There are no conflicts of interest or funding supports to declare. Julia Montero-Menárguez MD 1 Víctor Onecha-Vallejo MD…”

Noma, a neglected disease: prevention is better than cure

“…The most commonly used classification systems for noma surgical programs are the Montandon system which focuses classification on the area of the face implicated [48], the WHO noma classification system which classifies noma according to distinct stages of clinical progression [3] and the nose, outer lining, inner lining, trismus, upper lip, lower lip, particularities (NOITULP) grading tool which classifies noma cases based on the percentage loss of each anatomical unit [49]. Appropriate reconstructive surgery is performed to repair defects and restore esthetic form and function, utilizing local, regional, pedicled, and free flaps along with surgery of the craniofacial skeleton [23,24,28,29,33,48,[50][51][52][53]. Surgical plans are formulated from a multidisciplinary group, with special consideration for airway management, postoperative care settings, and physical therapy needs.…”

“…The focus of recent literature on noma (2019–2021) includes noma's distribution and risk factors [17–19], treatment [20–34], knowledge and beliefs about the disease [14,35–37] along with reviews of the literature and viewpoints [38–41]. Recent literature (2019–2021) has shown that noma cases are being reported from an increasingly diverse set of geographical locations outside of Africa including China [22,28], India [23], Vietnam, [24] and Indonesia [33] (Fig. 3).…”

“…Despite significant progress in scientific methods since these ancient reports, the literature on noma has predominantly been comprised of low level evidence such as case reports [10]. The focus of recent literature on noma (2019-2021) includes noma's distribution and risk factors [17][18][19], treatment [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34], knowledge and beliefs about the disease [14,[35][36][37] along with reviews of the literature and viewpoints [38][39][40][41]. Recent literature (2019-2021) has shown that noma cases are being reported from an increasingly diverse set of geographical locations outside of Africa including China [22,28], India [23], Vietnam, [24] and Indonesia [33] (Fig.…”

A Unique Case of Modifying an Old Extended Spreader Costal Graft into a Supportive Structure in a Nasal Alar Reconstructive Surgery – A Case Report

“…Many methods have been used for nasal reconstruction, for instance, dermal regeneration (intergra), skin grafts, and different kinds of skin flaps (frontal flap, frontonasal flap, nasolabial flap) 1 . The nasolabial flap is one of the most commonly used methods for facial reconstruction surgeries 2 , with almost 100% survivability 3 . However, standard nasolabial flaps have some drawbacks, including a lack of proper curvature and difficulties to aesthetically blend with surrounding structures, especially in alar rim reconstructive surgeries 4 .…”