The use of the nasolabial flap to cover the microvascular iliac crest graft in segmental mandibulectomies

Introduction: There have been many techniques described to reconstruct segmental mandibulectomies. The free iliac crest flap provides an excellent bone height to place immediate dental implants. The drawback is the excessive amount of soft tissues associated to this flap. The use of nasolabial flaps offers the chance to cover the free iliac crest avoiding the bulky effect of its soft tissues.

Case report: We present a 45 years old male patient who suffered from a primary gingiva squamous cell carcinoma affecting the mandibular body. A segmental mandibulectomy associating a bilateral neck dissection was performed. A free iliac crest flap with immediate dental implants and a nasolabial flap were used in the reconstruction.

Discussion: Segmental mandibular defects can be reconstructed using different techniques: plate and soft tissue coverage, non-vascularized grafts, transport distraction or free flaps. Microvascular reconstruction, after oncological resections, remains the gold standard reconstructive procedure. The iliac crest is a good alternative to the fibula in defects up to 10 cm in length and offers enough bone height to place immediate dental implants. When the excision involves soft tissues we may associate the internal oblique muscle for big defects or the nasolabial flaps for medium or smaller resections.

Conclusions: The nasolabial flap is another option to help reconstructing segmental mandibulectomies. It can provide the necessary soft tissue coverage for the free iliac crest flap when there is a medium or small defect.

Conflict of interest: None declared.

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Feb 5, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on The use of the nasolabial flap to cover the microvascular iliac crest graft in segmental mandibulectomies
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