Nasal Reconstruction with an Elongated Right Paramedian Flap after Maxillectomy for Basal Cell Carcinoma

Background: An extensive basal cell carcinoma that reached the maxillary sinus was removed. In the first reconstructive stage, we closed the primary defect on the sinus with a rotation-transposition flap. The distal portion of the flap necrosed, producing a defect in the nasolabial fold that left the sinus open and caused upward retraction of the upper lip. Objective: The defect of the nasolabial fold had to be corrected and the sinus closed; in a later stage, the retractile scar that appeared on the upper lip also needed correction. Methods: We used a delayed, elongated, right paramedian flap to correct the defect on the nasolabial fold and to close the sinus. We then corrected the retractile scar on the upper lip with a V-Y advancement flap. Results: The defect was closed without complications and the V-Y flap worked in returning the upper lip to its anatomic position. Conclusion: The midforehead flap is best for the reconstruction of the tip and the alar areas of the nose, including the near nasolabial fold. The V-Y advancement flap is an easy flap that allows one to correct retractions around the facial orifices. In dermatologie surgery, the final results must be as esthetic as possible.