Nasal Flap Research Articles

Buccal rotation flap and nasal septal chondromucosal flap: a one-stage reconstruction for full-thickness lower eyelid defect

Objective To describe an ideal technique to repair full-thickness lower lid marginal defects in a one-stage procedure. Methods The buccal rotation flap and the nasal septal chondromucosal flap were used in one-stage operation to repair full-thickness lower eyelid defect. Results Eleven patients including 6 male patients and 5 female patients underwent lower eyelid reconstruction since January 2000.The age ranged from 29 to 64 years with average 43. Seven patients with full-thickness lower eyelid defect were caused by basal cell carcinoma excision, while four patients were caused by trauma. All the fullthickness lower eyelid defects were reconstructed by using the buccal rotation flap and the nasal septal chondromucosal flap in one-stage operation. All the flaps survived completely after operation. There were no other complications excepting that two patients developed to mild lower eyelid retration after six months. Conclusion The technique consisting of the buccal rotation flap and the nasal septal chondromucosal flap is a simple and useful alternative procedure to close full-thickness defects in the lower eyelid. Key words: Buccal rotation flap; Composite chondromucosal flap; Total lower eyelid defect

Distally Based Dorsal Nasal Flap in Nasal Ala Reconstruction

The nasal dorsum is a good skin flap donor site for alar reconstructions because of its qualities: appropriate color, texture, and thickness. An anatomic vascular study on cadaver and the clinical use of the dorsal nasal skin flap, inferiorly based on the nasal septal branches, is reported. Vascular anatomy of the nasal dorsum was demonstrated in five fresh-frozen latex-injected heads. Fourteen patients were operated of reconstruction of the nasal ala using an inferiorly based dorsal nasal flap. Nasal septal branches, from the superior labial arteries, give vascular supply to the nasal tip. Connections of these arteries with lateral nasal branches (facial system) and dorsal nasal arteries (ophthalmic system) form a consistent vascular network in the dorsal nasal superficial muscular aponeurotic system and allow to safely raise cutaneous flaps distally based. No total or partial loss of the flaps was observed in clinical use. The donor site was sutured directly in 13 patients and with a skin graft in one. The inferiorly based dorsal nasal flap provides very good cosmetic and functional results and could be considered an additional adequate surgical option for nasal ala reconstruction, especially when skin from the nasolabial fold, upper lip, and cheek is not available. The authors have indicated no significant interest with commercial supporters.

Commentary about the hemi nasal flap

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Effect of mitomycin C on success rate in dacryocystorhinostomy with silicone tube intubation and improper flaps

To assess the effect of mitomycin C on surgical success rate of dacryocystorhinostomy and silicone intubation in patients with improper flaps. The study was a randomized clinical trial. The patients with indication for dacryocystorhinostomy surgery with silicone intubation (inappropriate lacrimal sac or nasal mucosal flaps during surgery and/or history of dacryocystitis in the past 3 months) were randomly assigned to application of mitomycin C (0.02%) on surgical flaps (group A) or a control group without mitomycin C application (group B). Main outcome measures were subjective symptomatic improvement and result of irrigation test at last follow-up visit. The study enrolled 88 patients (88 eyes); there were 42 patients in group A and 46 patients in group B. There was an average follow-up of 10 months (range 6-15 months) following surgery. Significant improvement (no tearing with patent lacrimal system in irrigation) was observed in 31 patients (73.8%) in group A and 32 patients (69.6%) in group B. There was no statistically significant difference in no improvement (no change in tearing state and obstruction in irrigation test), relative improvement (decreased tearing and passage of fluid with force in irrigation test), and significant improvement rate between the 2 groups of study (p>0.05). Application of mitomycin C on surgical flaps during dacryocystorhinostomy surgery with silicone intubation in patients with improper flaps has no proven beneficial effect on success rate of surgery.

Posterior Pedicle Lateral Nasal Wall Flap: A New Reconstructive Technique for Large Defects of the Skull Base

Posterior Pedicle Lateral Nasal Wall Flap: A New Reconstructive Technique for Large Defects of the Skull Base

Correction of complete bilateral cleft lip by using post nasal septal arterie's flap

Objective To develop a new method for correction of the deformity of the complete bilateral cleft lip with short pre-lip. Methods Two specimens with the complete bilateral cleft lip was chosen to investigate the arterial supply to the pre-lip. The arteries were observed by radiography when the specimen was infused with lead oxide. 16 patients with the complete bilateral cleft lip and shortage in the length of pre-lip were enrolled in this study. Taking advantage of the unique character of arterial supply of complete bilateral cleft lip, those with short pre-lip were corrected. Photos of them were taken when preand post-operation for further measurement. And more than 1 year following-up was conducted to judge if the results were good enough or not. 30 babies were chosen as a control group to confirm the results of surgury objectively. Results Post nasal septal arteries were found to supply the pre-lip of the bilateral complete cleft lip. Appearance of 16 patients was good after surgery or 1 years later. There was no statistical significant difference between the patients and control group in the measurement data but nasal-lip angle. Conclusion It is an effective way to correct deformity of the bilateral cleft lip with short pre-lip by taking advantage of post nasal septal arterie's flap. Key words: Bilateral compelet cleft lip with short pre-lip; Surgical correction; Post nasal septal arteries; Short pre-lip

Endoscopic inferior meatal antrostomy

An inferior maxillary sinus antrostomy is useful for several reasons. In patients with open medial antrostomies who are having persistent infections a secondary cilial dysfunction may be present. An inferior antrostomy provides an alternate pathway of drainage allowing the cilia to become functional. It also helps for polyp disease, thick secretions, large retention cysts, maxillary related choanal polyps or fungal disease removal. It gives better exposure to the floor and anterior maxillary sinus. The use of an medial based nasal flap which can be elevated prior to the antrostomy enhances healing if a larger permanent window is desired. The window can be made small, if temporary, or large, if permanent, as is necessary.

Dorsal Nasal Flap for Reconstruction of Full-Thickness Defects of the Nose

J. Michael Wentzell, MD, has indicated no significant interest with commercial supporters.

Nasobasicranial surgical reconstruction with nasal septum periost flap in nasal endoscope.

目的探讨鼻内镜下鼻中隔软骨瓣转位重建鼻颅底缺损的可能性。方法对30具成人湿性尸头标本进行解剖学测量，对5具冰冻保存的成人新鲜尸头标本进行鼻内镜下重建鼻颅底缺损的模拟手术实验。结果鼻中隔软骨瓣上边长38.17—49.95mm，平均（x±s，以下同）为（44.19±5.82）mm，鼻中隔软骨瓣下边长50.85～63.16mm，平均为（56.83±6.65）mm，鼻中隔软骨上下径长23.52～31.74mm，平均为（27.93±3.48）mm，鼻中隔软骨前后径长16.55～24.83mm，平均为（20.83±2.12）mm。模拟手术显示以鼻中隔软骨瓣重建鼻颅底缺损的操作可行。结论鼻颅底缺损在长（27.22±4.91）mm、宽（13.03±3.44）mm的范围时，可在鼻内镜下应用鼻中隔软骨瓣转位进行修复。

Island composite nasal flap for nasal dorsum skin defects

Skin defects on the nasal dorsum remain a challenge for the plastic surgeon. There are few local nasal flap options for the repair of proximally positioned nasal skin defects. During a 3-year period, 22 patients were treated after excision of skin cancer in the proximal two-thirds of the nose. Nine patients (41%) were female and 13 (59%) were male, with an average age of 69 years. All patients were operated on under local anesthesia. The average follow-up was 25 months. In all patients, after tumor ablation, the skin defect was closed with an island composite nasal skin flap. Pathohistologic analysis confirmed that the margins of the removed tumor were free of malignant cells. Six patients (27.3%) had squamous cell and 16 (72.7%) had basal cell carcinoma. There was no total or partial flap loss. None of the patients has suffered from recurrence of the tumor. The island composite nasal flap is a reliable technique for the closure of proximal nasal skin defects. Complications in the elevation of the island composite flap were rare, and the final result was acceptable.

Midface Reconstruction With Various Flaps Based on the Angular Artery

Although several methods can be used to perform midface reconstruction, difficulties exist in selecting the appropriate method because of anatomic and functional complexities, donor site morbidities, and poor esthetic results. The purpose of this study was to develop an alternative reconstructive method for the midface using various flaps based on the angular artery. We investigated the relation between the angular artery and its surrounding structures through cadaveric studies and then applied the findings clinically. As a result, we were able to perform reconstruction with a retroangular flap for defects of the lower half of the nose and the lower eyelid. In addition, defects of the upper half of the nose and the medial canthal area were reconstructed by use of island composite nasal flaps. The angular artery was reliable as a pedicle whether it was used in an antegrade or retrograde manner. All the wounds were successfully closed, with the exception of minor complications such as partial skin necrosis and flap bulkiness. The esthetic outcomes for the donor and recipient sites were acceptable. The angular artery has diverse relations with its surrounding structures according to its course of travel, and if the surgeon has a precise understanding of its anatomic location, we believe that retroangular flaps and island composite nasal flaps may prove useful for the treatment of midface defects.

Morphology and Morphometry of the Olfactory Rosette of a Teleostean Fish: <i>Catla catla</i> (Ham.)

The morphological structure and morphology of the olfactory organs in a freshwater, aquatic breathing fish, Catla catla (Ham.) has been described. It consists of two nasal openings on each side of the head, the anterior and posterior nasal opening with a prominent nasal flap in between. A pair of olfactory rosettes is lodged in the depression called olfactory pits or olfactory chambers. The olfactory rosettes are oval, cup shaped structures. Each rosette bears a series of olfactory lamellae on each side of the median raphe. A single lamella is a flat, bifid tongue like structure. Measurements of the dimension of olfactory rosettes have been made and the data were analysed with respect to body weight using logarithmic transformations, Y = awb. The total number of lamellae in the olfactory rosette increased with increase in body weight. With unit increase in body weight, the total number of lamellae increased by a power (b) of 0.2603, while the total surface area of lamellae increased by power of (b) 0.636. Both the parameters showed highly significant correlation coefficient i.e. r = 0.9894; P < 0.001 and r = 0.95218; P < 0.001 respectively.Key words: Catla catla, Olfactory organ, Morphology, Morphometricsdoi: 10.3126/on.v6i1.1652Our Nature (2008)6:30-37

Nasal Reconstruction After Severe Facial Burns Using a Local Turndown Flap

Reconstruction of the nose after severe burn injury is a challenging problem. There are usually associated facial burns, which limits the availability of local flaps. Reconstruction with unburned distant tissue is often not appropriate because of the resulting mismatch in color and texture. Successful nasal reconstruction can be accomplished in this group of challenging patients using a simple, inferiorly based flap from the nasal dorsum with subsequent skin grafting to the resulting defect. We have used an inferiorly based nasal turndown flap to reconstruct severe nasal deformities after burn injury in 28 patients. The flap tissue consists of the dorsal surface of the nose, which is usually made up of skin graft and scar. The flap base is the scar transition zone between the dorsum of the nose and the lining mucosa. This is turned over to provide nasal length, projection, and to stimulate alar lobules. The resulting defect on the dorsum of the nose is then skin grafted. If further length or refinement is required, the procedure may be repeated. The records of all patients who underwent this procedure were reviewed for demographics, age at burn, percentage of total body surface area burned (%TBSA), availability of the forehead, number of procedures, and complications. Twenty-eight patients underwent nasal reconstruction in our series using this local turndown flap. Most of these patients had severe burns, with an average %TBSA of 46%. The procedure was initially applied to patients with devastating injuries and %TBSA of 80%-95%, with extremely limited donor sites. As the success of the procedure was established, less severely burned patients were included in the series, thereby lowering the mean %TBSA. All patients had partial or complete destruction of their forehead donor site. All patients presented for multiple hospitalizations, with an average of 17 hospital admissions. Using this local turndown flap, adequate nasal length and projection could be achieved. There were few complications. All of the flaps survived, although there were 2 cases of necrosis of the distal edge of the flaps (0.7%). This resulted in decreased length and projection but this problem was successfully addressed with additional staged procedures. Contraction of local scar tissue created bulk and support, eliminating the need for distant tissue transfer or cartilage grafting. Twelve of the 28 patients required repeat turndown flaps to achieve sufficient nasal length and projection. These results were durable over a follow-up period of up to several decades. A simple, multistaged dorsal nasal flap can be used to reconstruct severe nasal deformities after facial burn injury. This can obviate the need for distant tissue transfer. Even in patients with subtotal nasal amputation and complete absence of cartilaginous support, the opportunistic use of scar tissue can restore nasal tip projection and alar lobule architecture without cartilage grafting. The resulting nasal reconstruction blends well into the surrounding facial appearance. This simple technique has been remarkably successful in this selected group of patients with challenging nasal deformities.

Endoscopic management of congenital meningo-encephalocele with nasal flaps

The objective of this paper is to present a case of a 2-year-old girl diagnosed with a meningo-encephalocele after episodes of meningitis, and treated with a transnasal endoscopic approach using nasal septal flaps pediculated at the sphenopalatine artery. Endoscopic repair is a viable and minimally invasive alternative to traditional craniotomy, however technical difficulties encountered as well as questions that remain unanswered are discussed.

The surgical repair of half-nose

Absence of half-nose is an extremely rare congenital malformation, which has a devastating impact on the patient and the family. A review of indexed English-language literature found 91 cases of half-nose, including 50 patients with proboscis lateralis. Pathogenesis is not clear, and the reported cases have sporadically occurred. Many aspects must be considered when reconstructing a congenital half-nose, such as timing of surgery, type of tissue to be used and the need to reconstruct nasal airway. The aim of this article is to present personal experience in seven cases of half-nose reconstruction, in order to review the literature regarding to this rare entity, highlighting aspects of incidence, pathogenesis and surgical treatment. Nasal reconstruction was performed at ages of 5-7 years to minimise psychological trauma. Forehead skin demonstrated to be an excellent donor site to re-surface the nose. For the inner lining, contralateral cutaneous nasal flap was our preference. Concerning the nasal framework reconstruction, alar contour was restored using a cartilage graft from the lower portion of ear tragus and concha.

Nasal Reconstruction Based on Subunit Principle Combined With Turn-Over Island Nasal Skin Flap for Nasal Lining Restoration

The reconstructive plan of full-thickness nasal defects should include recreation of internal nasal lining, skeletal and cartilaginous support and external cover. We performed nasal reconstruction combined with turn-over island nasal skin flap for nasal lining reconstruction in 12 patients who underwent full-thickness resection of nasal area because of skin cancer. The flap filled the nasal lining defect of the alar area and provided a good support for skeletal reconstruction. The external skin coverage, which was enlarged according to the subunit principle, was restored by the forehead skin flap at the same operation. Enlarging the nasal defect according to the subunit principle and using the residual skin as a turn-over skin island flap for nasal lining, combined with forehead skin flap for external coverage, provides an excellent nasal reconstruction in a single operation.

Nasal Reconstruction: An Overview and Nuances

Nasal reconstruction continues to be a formidable challenge for most plastic surgeons. This article provides an overview of nasal reconstruction with brief descriptions of subtle nuances involving certain techniques that the authors believe help their overall outcomes. The major aspects of nasal reconstruction are included: lining, support, skin coverage, local nasal flaps, nasolabial flap, and paramedian forehead flap. The controversy of the subunit reconstruction versus defect-only reconstruction is briefly discussed. The authors believe that strictly adhering to one principle or another limits one's options, and the patient will benefit more if one is able to apply a variety of options for each individualized defect. A different approach to full-thickness skin grafting is also briefly discussed as the authors propose its utility in lower third reconstruction. In general, the surgeon should approach each patient as a distinct individual with a unique defect and thus tailor each reconstruction to fit the patient's needs and expectations. Postoperative care, including dermabrasion, skin care, and counseling, cannot be understated.

Representation of multiple variant forms in spoken word recognition: Friends, not enemies.

Prior research [Ranbom and Connine (2007)] showed that alternative variant forms of a word are represented in the lexicon as a function of variant frequency. Two experiments investigated whether these multiple representations conspire or compete during spoken word recognition of nasal flap variants. In experiment 1, nasal flap productions of high (i.e., “counter”) and low (i.e., “enter”) variant frequency words, as well as a set of nonword controls (i.e., “penter”), were presented in a phoneme monitoring task (detection of a /t/ sound). The results showed “higher‐t” detection rates for words than for nonwords, and higher‐t detection for high than for low‐variant frequency words. Experiment 2 used truncated versions of the stimuli from experiment 1 and showed comparable t‐detection rates across all conditions. The results suggest that coactivated multiple representations of phonological variants conspire during spoken word recognition.

Initial Experience with Endoscopic Reconstruction Using the Pedicled Nasal Septal Flap

Initial Experience with Endoscopic Reconstruction Using the Pedicled Nasal Septal Flap

A revision of the western North Pacific swellsharks, genus Cephaloscyllium Gill 1862 (Chondrichthyes: Carcharhiniformes: Scyliorhinidae), including descriptions of two new species

The genus Cephaloscyllium Gill 1862 (Chondrichthyes, Carcharhiniformes, Scyliorhinidae) until recently had only two species recognized, C. isabellum [= C. umbratile (Jordan & Fowler 1903)] and C. fasciatum Chan 1966, from the western North Pacific (WNP), with one dubious species, C. formosanum, having been described by Teng in 1962. Recently, three additional species were described, C. circulopullum Yano et al. 2005, C. sarawakensis Yano et al. 2005, and C. parvum Inoue & Nakaya 2006 from this region. Here we present a revision of this genus for the WNP, including redescriptions of C. fasciatum and C. umbratile based on the holotypes, a re-examination of the recently described species, and descriptions of two new species from Taiwan. Cephaloscyllium umbratile can be distinguished from its congeners based on maximum size, length of first dorsal-fin base, anal–caudal space, and dorsal–caudal space. We conclude, based on a comparison of C. parvum and C. sarawakensis, that the former is a junior synonym of the latter species. The two new Taiwanese species can be separated from other WNP species by color pattern, shape of the anterior nasal flap, anal and dorsal-fin size, internarial width, and mouth size. Finally, we present a revised dichotomous key to the WNP Cephaloscyllium recognizing six contemporary taxa: C. circulopullum, C. fasciatum, C. sarawakensis, C. umbratile, C. pardelotum sp. nov. and C. maculatum sp. nov.