The Upper Buccal Musculomucosal Flap for Nasal Lining and Columellar Defect Reconstruction

Abstract

Restoring the nasal lining is a great challenge in the reconstruction of nasal defects. In this series, the authors present our experience in using the upper buccal musculomucosal (UBMM) flap for the reconstruction of full thickness columellar or nasal lining defects. Ten patients who underwent UBMM flap reconstruction of columellar or nasal lining defects, with or without composite grafting, were identified between December of 2014 and February of 2017. The records were retrospectively reviewed to determine the demographics, nasal deformity etiology, surgical technique, complications, flap survival rate and duration of follow-up. Of these ten patients, three were men, and seven were women; the average age was 48.1 years (range, 34-66 years). Four patients underwent bilateral UBMM flaps, and 6 patients underwent unilateral UBMM flap reconstruction. All of the donor sites were closed without complications, except for one small granuloma that occurred 8 months later. Of the total 14 flaps, 7 healed well, 6 healed well after minimal debridement in the clinic, and one failed and was replaced with a contralateral UBMM flap. The average follow-up time was 20.1 months (range, 8-38 months). All patients had satisfactory aesthetic and functional outcomes. Due to the limited availability of healthy local tissue for nasal lining reconstruction after multiple surgeries, the UBMM flap serves as an applicable choice to restore columellar or nasal lining defects, with minimal donor site morbidity and no visible external scarring.

Stair-Step Incision for Composite Grafts in Nasal Reconstruction

“…[2][3][4][5][6][7][8][9][10][11] On the other hand, mucosal flaps from the oral cavity, turbinate flaps, skin grafts, composite grafts, or vascularized free flaps can be used as reconstructive materials on the mucosal side. [19][20][21][22][23][24][25] There are many options for this procedure, but in some cases, a deformity of the landmark nasal rim or alar may be present, while tissue deficiency may not be large enough to perform a free tissue graft. In other cases, the individual units may be present and may not need to be replaced, or the patient may not be eligible for major surgery.…”

“…On the skin side, reconstructive materials include skin grafts, local skin flaps, nasolabial flaps, frontonasal flaps, composite grafts, free radial flaps, and more recently, free vascular auricular flaps 2–11 . On the other hand, mucosal flaps from the oral cavity, turbinate flaps, skin grafts, composite grafts, or vascularized free flaps can be used as reconstructive materials on the mucosal side 19–25 …”

Buccal Myomucosal Flap for Reconstruction of Red Lip Defects Close to Mouth Angle

“…Since then, surgeons’ interest in this flap has been increased. Many studies have demonstrated that buccal myomucosal flap is a versatile flap that can be utilized to repair a variety of small and moderate-sized head and neck defects, such as cleft palate, oroantral fistula, oropharyngeal stenosis, nasal lining and columellar defects, and glossectomy defects after tumor resection 23–27…”

“…Many studies have demonstrated that buccal myomucosal flap is a versatile flap that can be utilized to repair a variety of small and moderate-sized head and neck defects, such as cleft palate, oroantral fistula, oropharyngeal stenosis, nasal lining and columellar defects, and glossectomy defects after tumor resection. [23][24][25][26][27] As proposed here, the buccal myomucosal flap for red lip reconstruction has several advantages. Anatomically, it has a welldescribed and constant blood supply sourced by the buccal or facial artery, which makes it a dependable flap that leads to soft tissue survival.…”