Repair of Nostril Stenosis Using a Triple Flap Combination: Boomerang, Nasolabial, and Vestibular Rotation Flaps

Abstract

Tissue losses within the nose due to various reasons result in the loss of normal anatomy and function. The external nasal valve area is one of the most important functional components of the nose. The columella, lobule, nostril, and alar region are among the components forming the external nasal valve area. Deformities of the nostrils are among the most frequently observed features that interfere with the functional anatomy of the nose. Malformations of the nostrils often emerge subsequent to cleft lip repairs. Stenoses are a common type of pathology among nostril deformities. In cases where a stenosis has formed, breathing problems and developmental anomalies may occur. In the patient with nostril stenosis presented in this report, there was a serious alar collapse and contracture subsequent to a cleft lip repair. In order to repair the nostril stenosis, a "boomerang flap" was chosen. This boomerang flap was used in combination with a nasolabial flap, a vestibular rotation flap, and a conchal cartilage graft to achieve a satisfactory repair.

Current treatment of nasal vestibular stenosis with CO2-laser surgery; prolonged vestibular stenting versus intraoperative mitomycin application. A case series of 3 patients

“…The principal step for relief of nasal vestibular stenosis is surgical excision. Various strategies such as different types of grafts and skin flaps are propagated for relief of nasal vestibular stenosis [2,5,[7][8][9][10]. However, the use of CO 2 -laser surgery for relief of nasal vestibular stenosis has never been described before in the literature.…”

“…Main complaints are nasal obstruction and aesthetic discomfort. Though it can be caused in children by trauma, Behcet's disease and infections such as smallpox, the main cause however remains iatrogenic injury such as cauterization for epistaxis, septoplasty and cleft lip surgery [1][2][3][4][5]9]. In adult patients are also cases of nasal vestibular stenosis reported due to endoscopic sinus surgery, inferior turbinate cauterization, nasal tubes (e.g.…”

“…In adult patients are also cases of nasal vestibular stenosis reported due to endoscopic sinus surgery, inferior turbinate cauterization, nasal tubes (e.g. nasogastric), rhinoplasty, skin resurfacing and prolonged nasal packing [1][2][3][4][5][6][7][8][9]. Long term nasal vestibular stenosis leads to histological changes of the nasal mucosa and vestibular skin such as loss of cellular integrity and cilia necessary for humidification, warming and filtering of inspired air [1].…”

“…In the literature, several strategies are advocated such as the use of split-and full-thickness skin grafts, chondrocutaneous grafts and local flaps [2,5,[7][8][9][10]. However, the use of CO 2 -laser surgery for correction of nasal vestibular stenosis has not been described before.…”

Nasal Reconstruction in Children

“…How to involve a "boomerang flap" for reconstruction was described by Bozkurt et al It was used in combination with a nasolabial flap, a vestibular rotation flap, and a conchal cartilage graft to achieve a satisfying repair. 49 Blandini et al recommend a stable correction by using a "piercing" flap taken from the labial vestibule transferred to the nasal floor. 50 In case of surgical treatment of vestibular stenosis, the use of a custom-made vestibular device such as thinly walled stents with increasing diameter and intermediate sponge packing with an expanding effect may help prevent restenosis.…”