Levator anguli oris muscle based flaps for nasal reconstruction following resection of nasal skin tumours

Abstract

Backgroundsurgical excision remains the best tool for management of skin tumors affecting nasal skin, however many surgical techniques have been used for reconstruction of the nasal defects caused by excisional surgery. The aim of this work is the evaluation of the feasibility and outcome of levator anguli oris muscle based flaps.MethodsNinety patients of malignant nasal skin tumours were included in this study. Age was ranged from four to 78 years. For small unilateral defects affecting only one side ala nasi, levator anguli oris myocautaneous (LAOMC) flap was used in 45 patients. For unilateral compound loss of skin and mucus membrane, levator anguli oris myocautaneous mucosal (LAOMCM) flap was used in 23 patients. Very large defects; bilateral either LAOMC or LAOMCM flaps combined with forehead glabellar flaps were used to reconstruct the defect in 22 patients.ResultsWound dehiscence was the commonest complication. Minor complications, in the form of haematoma and minor flap loss were managed conservatively. Partial flap loss was encountered in 6 patients with relatively larger tumours or diabetic co-morbidity, three of whom were required operative re-intervention in the form of debridement and flap refashioning, while total flap loss was not occurred at all.ConclusionsImmediate nasal reconstruction for nasal skin and mucosal tumours with levator anguli oris muscle based flaps (LAOMC, LAOMCM) is feasible and spares the patient the psychic trauma due to organ loss.

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“…In addition, the scars from flaps should always be placed within the normal depressions and elevations of the nose. 59 Together, this technique is known as the subunit principle and is especially important in reconstruction of convex surfaces of the nose. For defects involving nasal cartilage, restoration of the nasal framework is crucial to maintaining nasal projection and definition.…”

“…The flap permits reconstruction of both the mucosal surface and nasal skin, which maximizes aesthetic appearance with minimal donor-site scarring. 59…”

“…Very large cutaneous defects that encompass more than one nasal subunit are most often reconstructed using the paramedian forehead flap. 59 Advantages of this flap are a single donor site for skin and bone that can close primarily with minimal donor-site morbidity and good color match for facial skin. 66 Figure 2 illustrates the use of a paramedian forehead flap for a large nasal defect.…”

“…The flap permits reconstruction of both the mucosal surface and nasal skin, which maximizes aesthetic appearance with minimal donor-site scarring. 59 The smallest subunit of the nose is the soft triangle, which bridges the tip and ala of the nose, and is often the most difficult to reconstruct. Soft triangle defects that involve only skin with intact lining can be reconstructed using composite grafts or nasolabial flaps with cartilage grafts.…”