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A unique melolabial flap in the surgical management of oral submucous fibrosis—“the sea gull flap”—an experience with 85 cases

2009; Elsevier BV; Volume: 38; Issue: 5 Linguagem: Inglês

10.1016/j.ijom.2009.03.400

1399-0020

David P. Tauro,

Reconstructive Surgery and Microvascular Techniques

Melolabial tissues with various modifications have been extensively used for reconstructive purposes in the orofacial region. The nasolabial flap has been widely employed as a versatile reconstructive option for small to moderate sized defects of the oral and perioral regions. Considerable confusion does exist with regard to the pattern of its blood supply and is generally misconstrued as an axial pattern flap based on the facial artery. It has been used as a superiorly or inferiorly based flap making it a two-staged surgical procedure particularly when used for intraoral reconstruction. A variety of surgical modalities used in the past have not proved to be convincingly useful in the successful management of oral sub mucous fibrosis (OSMF). Although nasolabial flaps have been used, there is a paucity of literature with regard to their use in the management of OSMF. One hundred and seventy flaps were performed in 85 patients with bilateral sub mucous fibrosis based on a central subcutaneous pedicle over the last ten years and followed up for a mean period of 66 months. All the flaps healed without any evidence of necrosis, infection or dehiscence with an excellent aesthetic and functional outcome and significant patient satisfaction. The flaps remained viable in all the cases with good healing and adaptation to the recipient site. The sea gull nasolabial flap offers outstanding features, providing supple soft tissue lining and adequate flexibility to the cheek thus facilitating excellent mouth opening on a long term basis. The ease of harvest and negligible aesthetic morbidity makes it a viable option for use in bilateral OSMF. This paper deals with a novel modification of the flap for use in the management of sub mucous fibrosis as a single stage procedure. The anatomic basis of the flap, the factors governing the technique and the logistics of its use in OSMF are discussed.