Anatomical and Ultrasonographic Analyses of the Levator Labii Superioris Alaeque Nasi Muscle at the Level of the Nasal Ala / Análisis Anatómico y Ecográfico del Músculo Elevador Nasolabial a Nivel del Ala Nasal

SUMMARY: We aimed to determine the width of the levator labii superioris alaeque nasi muscle (LLSAN) at the level of the nasal ala through cadaveric dissections and ultrasonography (US), to provide essential anatomical information for use during both invasive and noninvasive procedures in the nasal ala region. The LLSAN was investigated in the 40 hemifaces of 20 Korean cadavers, comprising 10 males and 10 females with a mean age of 73.6 years. The LLSAN width of the 40 specimens at the level of the midpoint of the nasal ala was 5.02±2.35 mm (mean±standard deviation), and ranged from 1.45 mm to 10.11 mm. The LLSAN widths were 5.96±2.36 mm and 3.93±1.89 mm in males and females, respectively, with ranges of 2.40-10.11 mm and 1.45-6.96 mm, respectively. The LLSAN widths on the left and right sides were 4.77±2.72 mm and 5.26±1.99 mm, respectively. The proportions of the LLSAN fibers inserting into the nasal ala and upper lip were similar in 13 specimens (32.5 %), while more fibers inserted into the nasal ala in 11 specimens (27.5 %) and more fibers inserted fibers of the LLSAN into the upper lip in 16 specimens (40 %). When clinicians need to target or avoid the LLSAN, the present width and range data can be helpful for ensuring the efficacy and safely of both invasive and noninvasive procedures. In addition, the possibility of asymmetry in the width of the LLSAN in the nasal ala region should be confirmed by US before performing such procedures.

Nuestro objetivo fue determinar el ancho del músculo elevador nasolabial (MENL) a nivel del ala nasal mediante disecciones cadavéricas y ecografía, para proporcionar información anatómica esencial, para su uso durante procedimientos invasivos y no invasivos, en la región del ala nasal. El MENL se estudió en 40 hemicaras de 20 cadáveres coreanos (10 hombres y 10 mujeres) con una edad media de 73,6 años. El ancho de MENL de las 40 muestras a nivel del punto medio del ala nasal fue de 5,02 ± 2,35 mm (media ± desviación estándar) y osciló entre 1,45 mm y 10,11 mm. Los anchos de MENL fueron 5,96 ± 2,36 mm y 3,93 ± 1,89 mm en hombres y mujeres, respectivamente, con rangos de 2,40 a 10,11 mm y 1,45 a 6,96 mm, respec- tivamente. Los anchos de MENL en los lados izquierdo y derecho fueron 4,77 ± 2,72 mm y 5,26 ± 1,99 mm, respectivamente. Las proporciones de fibras de MENL que se insertaban en el ala nasal y en el labio superior fueron similares en 13 muestras (32,5 %), mientras que se insertaron más fibras en el ala nasal en 11 muestras (27,5 %) y además, se insertaron fibras de MENL en el labio superior en 16 ejemplares (40 %). Cuando los médicos necesitan apuntar o evitar el MENL, los datos actuales de ancho y rango pueden ser útiles para garantizar la eficacia y seguridad de los procedimientos, tanto invasivos como no invasivos. Además, la ecografía puede ser utilizada para confirmar una posible asimetría en el ancho del MENL en la región del ala nasal antes de realizar los procedimientos.

Application of tunneled subcutaneous pedicle flaps in repair of nasal alar defects / 中华皮肤科杂志

Objective:To investigate clinical efficacy of tunneled subcutaneous pedicle flaps in the repair of ipsilateral nasal alar defects.Methods:A total of 20 patients with nasal alar defects after excision of basal cell carcinoma, which were repaired with ipsilateral tunneled subcutaneous pedicle flaps, were retrospectively collected from January 2018 to January 2020. There were 11 male patients and 9 female patients, with an average age of 60.6 years (range, 48 - 76 years) . According to clinical manifestations, the basal cell carcinoma lesions could be classified into 3 types: nodular-ulcerative type (13 cases) , superficial type (4 cases) and pigmented type (3 cases) , and the skin lesions varied from 0.4 cm × 0.5 cm to 0.9 cm × 1.1 cm in size. All the patients received extended surgical resection of basal cell carcinoma, and nasal alar defects were repaired with tunneled subcutaneous pedicle flaps, with the size of flaps ranging from 0.7 cm × 0.8 cm to 1.2 cm × 1.4 cm.Results:All flaps survived successfully, the nasal alar defects were completely repaired, and all wounds healed primarily. During the postoperative follow-up of 6 - 24 months, neither recurrence of tumors nor obvious scar hyperplasia occurred on the nasal ala, and nasal morphology and appearance were favorable.Conclusion:The tunneled subcutaneous pedicle flap can be used for the repair of ipsilateral nasal alar defects following excision of tumors or other lesions, resulting in favorable therapeutic outcomes and aesthetic appearance.

The application of nasolabial fold flap in the nasal ala subtotal defect after nasal ala tumor operation / 中国医师进修杂志

Objective:To explore the effect of nasolabial fold flap in the treatment of nasal ala subtotal defect nasal afte ala tumor operation.Methods:The clinical data of 7 nasal ala subtotal defect patients underwent nasal ala basal cell carcinoma operation in the First People′s Hospital of Lianyungang City from February 2018 to September 2020 were retrospectively analyzed.Results:Seven patients with nasal ala subtotal defect were successfully repaired with nasolabial fold flap. The patients were followed up for 19 to 52 months, the flaps survived, the color was good, the contour was not bloated, the nasal ventilation was not affected, and good results were achieved.Conclusions:The nasolabial fold flap repair of the nasal ala subtotal defect after nasal ala tumor operation has the advantages of simple method, rich materials, no need for vascular anastomosis, no need for secondary surgery, accurate effect and so on, which is suitable for clinical promotion in clinical.

Clinical efficacy of composite subcutaneous pedicled flaps in repairing full-thickness nasal alar defects of 11 patients: a clinical observation / 中华皮肤科杂志

Objective:To investigate clinical efficacy of composite subcutaneous pedicled flaps in repairing full-thickness nasal alar defects.Methods:Clinical data were collected from 11 patients with basal cell carcinoma of nasal ala in Department of Dermatologic Surgery, the Third People′s Hospital of Hangzhou from August 2019 to September 2020, and analyzed retrospectively. There were 6 females and 5 males, aged 70 years in average (range, 56-87 years) . After tumor resection, full-thickness nasal alar defects were formed, a flap was designed along the inner side of the cheek and turned by 180 degrees to repair the nasal mucosal lining; then, a subcutaneous pedicled flap was designed along the ipsilateral nasolabial fold to repair the outer secondary defects and postoperative defects.Results:The mean diameter of postoperative defects was 1.8 cm (range, 1.5-2.5 cm) , and the mean diameter of the nasal lining was 0.9 cm (range, 0.6-1.5 cm) . Seven days after the operation, stitches were removed, wounds healed without complications, and all flaps survived with a satisfactory appearance. The follow-up period ranged from 1 to 13 months (average, 6 months). After scar maturation, all patients were satisfied with the aesthetic outcome. No tumor recurrence was observed during the follow-up period.Conclusion:The composite subcutaneous pedicled flap is safe and effective for the repair of full-thickness nasal alar defects, and has advantages of a well-hidden donor site, good color match, and stage-I operation for reconstruction.

Detail repair technique for alar deformity after the first stage reconstruction of alar defect / 中华整形外科杂志

Objective@#To sum up the repair techniques of secondary alar deformity after the first phase reconstruction of alar defect.@*Methods@#From January 2010 to December 2017, 17 patients with secondary alar deformity were included. Secondary alar deformities after the first stage reconstruction of alar defect included the abnormalities of alar groove line, absence of alar-cheek groove and the notch of alar rim. Z-plasty, V-Y advanced flaps, local skin flap and other technologies were introduced to repair details.@*Results@#Infection was found in one case of the reconstruction of the alar-cheek groove and the wound was healed by treatment. There was no necrosis occurred in other flap. The shape of the alar was satisfactory and the anterior nostril was not narrow. Patients were followed up for 1 month to 1 year. The average follow-up time was 5 months. No recurrence of nasal alar tumor was found. The patients were satisfied with the appearance.@*Conclusions@#The symmetrical and satisfactory nasal shape can be obtained with local flaps such as Z-plasty, V-Y advancement of flaps for secondary alar deformities.

Auricular Composite Tissue Flap for Repairing Nasal Ala Defect / 昆明医科大学学报

Objective To discuss the effects of repairing nasal ala defects by free transplantation of autogenous auricle composite tissue flap. Methods 50 cases with nasal ala defects were repaired by free auricular composite tissue flap transplantation from Janu 2003 to May 2013. The defects size was 0.5cm x 0.7cm~1.3cm x 1.5cm. According to the size of the defects, full thick wedge-shaped auricle composite tissue flap were cut off, then inserted into the nasal ala defects area and fixed stablely, the donor sites were sutured directly avoiding ear cartilage. Salvianolate and hyperbaric oxygen were used in postoperative treatment for 5-7 days. Results 48 cases achieved good results, 2 cases had partial necrosis of composite tissue flap after operation, also achieved good results after reoperation. Over 3 months~5 years follow-up, all cases had satisfactory results. The volume of auricle composite tissue flap reduced less than 10%. Surgical incisions had a linear scar, good color matching, nostril symmetry. All patients were satisfied with the overall appearance. Conclusions Autogenous auricle composite tissue flap free transplantation for repairing middle and small size of nasal ala defects can recover ala formation and structure very well, nasal appearance can be improved greatly with nostril symmetry. There is no hypertrophic scar in donor sites. This method is simple and easy,and is also a good method for repairing nasal ala defects.

The Full-thickness Forehead Skin Graft for a Nasal Ala Defect / 대한피부과학회지

Skin cancers require excision and reconstruction for achieving optimal functional and cosmetic results. There are numerous reconstructive options, which include primary repair, secondary intention healing, a local flap and a skin graft. Generally, a full-thickness skin graft is not considered applicable for reconstructing a nasal defect because a local flap is thought to be a superior alternative to a skin graft due to the unique nature of the lower third of the skin, which is often thick and fixed to the adjacent structures. But a defect on a lower third of the nose that includes the nasal ala can be well reconstructed by a skin graft in some cases. The donor site options include the preauricular, postauricular and supraclavicular areas etc. But in some cases, the forehead skin is a good match with the nasal ala area. We herein report the case of a 69-year-old female with a nasal ala defect that was induced by excision of basal cell carcinoma. The patient was reconstructed with a full-thickness skin graft using the redundant skin of the forehead.

Hinged Turnover Flap for Reconstruction of Nasal Ala Defect / 대한피부과학회지

Surgical remedy of nasal ala present a challenge to the reconstructive surgeon. As ala have anatomic complexity and a paired structure, reconstruction must be precise and aesthetically acceptable. The reconstruction of full-thickness ala defects often require staged surgical procedures, and they can introduce operational risks and consume extraordinary time and cost. However, a hinged turnover flap can offer a one-stage repair of full-thickness ala defects. With this procedure, satisfactory ala reconstruction was achieved in one step, and good aesthetic and functional results were obtained.