The Islanded Nasolabial Flap: A Versatile and Reliable Flap for Reconstruction in Cancers of the Oral Cavity

Abstract

On the Indian subcontinent, oral cancer represents a significant health burden. Local flaps offer a viable alternative to free flaps in specific reconstructive scenarios where free flaps may not be feasible. The islanded nasolabial flap, based on the facial artery, proves to be a robust and versatile option for single-stage reconstructions of oral cavity defects. In this study, we share our experience employing the islanded nasolabial flap at a high-volume cancer center in Central India for reconstructing buccal mucosa and tongue defects. This prospective observational study focused on approximately 76 patients diagnosed with squamous cell carcinoma of the oral cavity (specifically, the anterior 2/3rd of the tongue and buccal mucosa) at our cancer hospital between August 2021 and January 2023. Initially, 76 patients were included; however, four patients were subsequently excluded due to inadvertent facial vein injury during neck dissection caused by level IB node invasion. Consequently, 72 patients underwent islanded nasolabial flap reconstruction and were monitored for postoperative complications and functional outcomes. Our study's patients fell within the age range of 24 to 81 years, with the majority between 40 and 50 years old. Most of our patients had carcinoma affecting the anterior two-thirds of the tongue (61.11%), followed by carcinoma of the buccal mucosa (38.88%). Surgical site infection occurred in four patients (5.55%) at the donor site, and one patient (1.38%) experienced flap necrosis after tongue carcinoma surgery. However, the majority of our patients (93.05%) experienced no postoperative complications. Speech intelligibility was good for all patients (100%) with buccal mucosa cancer. A significant portion of patients (78.57%) could tolerate a normal diet, while 21.42% required a soft diet. Among patients with tongue carcinoma, 56.81% had good speech intelligibility, and 43.18% had acceptable speech intelligibility. Regarding swallowing capacity assessment, 65.90% of patients tolerated a normal diet, and 34.09% could manage a soft diet. None of our patients had poor speech intelligibility, and none depended on a liquid diet or tube feeding. This study underscores the versatility of the islanded nasolabial flap in oral cancer resection reconstruction. The islanded nasolabial flap proves to be a straightforward, effective, and reliable technique with a low incidence of complications and exceptional functional outcomes, establishing it as a valuable reconstructive option for small-to-medium-sized oral defects. This is particularly noteworthy for high-volume centers and regions with limited resources.