[Primary reconstruction of the anterior sublingual sulcus with a nasolabial flap after the resection of a malignant neoplasm]. / Ricostruzione primaria della pelvi sublinguale anteriore con lembo nasogenieno dopo resezione di neoplasia maligna.

ABSTRACT

The reconstruction of the loss of substance from the oral floor following demolitive cancer surgery aims to guarantee adequate tongue movement and the consequent preservation of phonatory and swallowing functions, as well as the possibility of using prosthetic rehabilitation. Large defects are resolved using musculocutaneous or free vascularised flaps, whereas smaller defects may be closed by first intention using alveolo-lingual suture. There are a number of drawbacks to this method: occurrence of fistulas immediately after surgery and secondary ankyloglossia. It is then necessary to resort to a second operation using dermoepidermic graft and plastic surgery of the oral floor to liberate the tongue. These problems may be resolved using a nasolabial flap. The flap can be prepared using either an upper or lower peduncle, it is relatively simple to perform and does not significantly prolong operating times. The contemporary dissection of the neck with ligature of the facial artery does not in our experience significantly influence flap vascularisation. The main drawback is the limited size of the flap (on average it is 6-7 cm long with a maximum width of 3-4 cm at the base. The upper edge is equally placed 7-10 mm from the medial side). The flap must be sufficiently thick to ensure an adequate blood supply to subcutaneous tissue, but the dissection plane must be sufficiently near the surface to preserve the facial nerve. It is important to prepare the graft bed so as to avoid creating tension after suture.(ABSTRACT TRUNCATED AT 250 WORDS)