Reconstruction of columella and nasal vestibuli by bilateral nasolabial flaps – A case report

Abstract

Introduction and importance The nose is a common location for non-melanoma skin cancers. Resection of such cancers can result in large, multilayer defects that are challenging to reconstruct. The surgical approach is determined by multiple factors and the main goal is to obtain a satisfactory functional and aesthetic result. We present a case of reconstruction of the nasal vestibuli and columella by two transnasal nasolabial flaps. Presentation of case A 66-year-old male underwent resection of a large squamous cell carcinoma in the right nasal vestibulum that extended through the columella into the left vestibulum. The resection resulted in a multilayer defect including the floor and roof of the right vestibulum, the entire columella, part of the septum cartilage and floor of the left vestibulum. The defect was reconstructed in two stages by bilateral nasolabial flaps, that were brought into the nasal cavity through incisions on the side of the nose and were used to line the vestibuli and sutured to each other medially to form the neocolumella. No complications or surgical site infections were observed. Clinical discussion Transnasal nasolabial flaps can be used for larger columellar defects. The length of the flaps in our case provided enough tissue to reconstruct the columella as well as the entire vestibular linings. Conclusion We describe a successful reconstruction of the nasal vestibuli and columella with two transnasal nasolabial flaps, which provided an acceptable aesthetic and functional result.

Columella Reconstruction Using a Bilateral Nasolabial Flap: A Case Report

“…Sometimes, it could be necessary to harvest costal cartilage, at the price of additional comorbidity [ 1 ]. Nevertheless, in our case, as in the one previously described by Krogerus et al [ 11 ], that was not necessary, as we obtained good support for the tip and adequate nostril patency and air passage. A cartilaginous graft should be taken into consideration in patients with better general health conditions; however, the solution used in our patient is feasible, guarantees a reasonable aesthetic and functional result, and can be considered in patients who are elderly or have compromised health.…”

“…The reconstruction technique of the columella using nasolabial flaps was first described by Da Silva in 1964, when he described a case of columellar reconstruction using a single naso-labial flap lined with a skin graft [ 8 ]. The use of bilateral nasolabial flaps was reported in 1982 by Nicolai [ 9 ] and in 1986 by Yanai et al [ 10 ], and more recently by Krogerus et al in 2022 [ 11 ] and Faenza et al in 2024 [ 12 ]. As shown in our patient and in the few reported cases, this type of reconstruction is safe and guarantees good functional and aesthetic results, with reduced operating and healing times.…”