The Application of Nasolabial Propeller Flap in Trismus Release Patients After Facial Artery Ligation-Two Cases Report

Background: Most advanced oral submucous fibrosis (OSF) with previous modified radical neck dissection (mRND) require surgical reconstruction using flaps from various donor sites, including intraoral flaps (tongue flap, palatal flap, and buccal fat pad) and extraoral flaps such as nasolabial and temporalis muscle flaps. Aim and Objectives: We aimed to report our experience with two patients who underwent buccal soft tissue resurfacing after buccal submucous fibrosis release using a nasolabial propeller flap. Materials and Methods: Two male patients, both aged 61 years, presented to our plastic surgery group at different times with severe trismus due to submucous fibrosis after intra-oral cancer treatment along with ipsilateral facial artery ligation during modified radical neck dissection (mRND). The inter-incisor distance (IID) increased after trismus release in both patients, and nasolabial propeller flaps were applied for soft tissue resurfacing to prevent further fibrosis and to avoid the recurrence of trismus. Pre-operative head & neck vascular image studies were performed to confirm the vascularity of the nasolabial region, and the location of perforators at level II were mapped. Perforators near the mouth angle were preserved by making it the pivot point to ensure the blood supply of this flap. After harvesting the flap, a tunnel was created toward the mucosal defect after trismus release, and the flap was rotated to pass through the tunnel for resurfacing. Results: Nasolabial propeller flaps were harvested in two patients who underwent ipsilateral facial artery ligation. Both flaps totally survived, and no recurrence of trismus had occurred in either patient at one-year follow-up visit. We found this flap to be reliable even for these two patients who needed ipsilateral facial artery ligation due to previous neck dissection. Conclusions: The nasolabial propeller flap is a reliable local flap for soft tissue resurfacing after trismus release in patients who received previous facial artery ligation. The success is due to the maintenance of flap vascularity from the minor pedicles. By identifying and preserving the perforators, the nasolabial propeller flap supports satisfactory outcomes of reconstruction in patients with OSF who underwent ipsilateral facial artery ligation after previous mRND.

關鍵字

oral submucous fibrosis ； ipsilateral facial artery ligation ； nasolabial propeller flap ； trismus release

並列摘要

背景：大多數晚期口腔黏膜下纖維化與先前改良式根治性頸部淋巴廓清術需要使用來自不同供體部位的皮瓣進行手術重建，包括口內皮瓣（舌皮瓣、腭皮瓣和頰脂肪墊）和口外皮瓣，如鼻唇溝和顳肌肌肉瓣。目的及目標：我們的目標是通過使用鼻唇溝螺旋槳皮瓣在頰黏膜下纖維化釋放術後重建頰側軟組織。即使對於接受同側顏面動脈結紮或頸部廓清術的患者，這種皮瓣也是可靠的。材料和方法：我們的兩名患者在進行口腔內癌治療以及同側面動脈結紮後，由於黏膜下纖維化而出現嚴重的牙關緊閉。釋放手術後切牙間距離增加。我們接著用鼻唇螺旋槳皮瓣進行軟組織表面置換，以防止纖維化和復發。術前可以進行頭頸部血管影像學檢查，以確定鼻唇區域是否存在血管分佈及它們的位置。我們應該保留靠近嘴角的穿通動脈，作為其中樞軸點以確保皮瓣的血液供應。取得皮瓣後，我們向粘膜缺損處創建一個隧道，然後旋轉皮瓣穿過隧道並完成重建。結果：我們在接受同側面動脈結紮的患者使用鼻唇溝螺旋槳皮瓣修補頰黏膜下纖維化釋放術後的缺損。手術後追蹤一年，皮瓣存活而且牙關緊閉沒有復發。結論：鼻唇溝螺旋槳皮瓣是一種可靠的局部皮瓣，可用於先前接受過面動脈結紮術的患者在牙關緊閉釋放術後進行軟組織重建。通過識別和保存穿通動脈，鼻唇螺旋槳皮瓣可以帶來滿意的效果。

並列關鍵字

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