Bilateral Nasolabial Tunnel Flaps for Single-stage Oral Commissure Reconstruction

Nasolabial flaps are a reliable option for oral commissure reconstruction due to their robust vascularity and minimal donor site morbidity. However, conventional methods that involve folding of the flap into the oral cavity usually lead to bulky commissures and restricted mouth opening. Here, we report a case of bilateral oral commissure defects in an older patient with suspected verrucous carcinoma. Bilateral inferiorly pedicled nasolabial tunnel flaps were used for reconstruction after tumor resection. The flaps were transferred intraorally via subcutaneous tunnels to preserve oral function and prevent microstomia, and their thinned distal portions were used to restore the commissures. This approach enabled a single-stage reconstruction without the need for secondary flap division. The patient experienced favorable long-term outcomes, including preserved mouth opening, stable denture use, and no tumor recurrence. Only minimal lip incompetence was observed, without leakage of saliva or food. This case highlights the effectiveness of nasolabial tunnel flaps for simultaneous bilateral commissure reconstruction, providing reliable single-stage repair with functional and aesthetic benefits while minimizing the risks of bulkiness, restricted mouth opening, and microstomia.