One half to two thirds of lower lip defects larger than one half of the lip cannot be closed primarily without undue wound tension. The split orbicularis myomucosal flap for lower lip reconstruction. Reconstruction of both upper and lower lips sciencedirect. Reconstruction of the lip commissure with upper and lower lip fullthickness defects using submental and nasolabial flaps. The split orbicularis myomucosal flap for lower lip. Lower lip reconstruction strategies patient had a lesion covering 90% of the lower lip that was reconstructed using the websterbernard technique and a tongue flap figure 7, table 1. Surgical technique the split orbicularis myomucosal flap.
The modified estlander flap is based more medially to the initially proposed flap and seeks to avoid lip commissure deformations. Appearance 3 years following lip reconstruction, a frontal, b adequate opening of oral aperture. As the portal of entry for the gastrointestinal system, the mouth and lips take part in the cephalic phase of digestion. The hexagonal lip aesthetic subunit can be divided into upper and lower divisions.
This would be a more reliable option when the neck starts swelling compared to the previous option. There is a wide array of reconstructive options for both the upper and lower lip. Address for correspondencechi mao, md, department of oral and. This pdf is available for free download from a site hosted by. Care should be taken when planning this flap in patients who have had previous facial surgery and previous neck dissections as previous incisions and facial artery ligation can alter the reliability of the cutaneous circulation. Reconstruction of lateral lower lip defects with transverse lip advancement flap. Defect of 30% of the upper or lower lip can be closeddefect of 30% of the upper or lower lip can be closed primarily great elasticity of. Functional and cosmetic considerations must be included in any lip or chin reconstruction. Prelamination can combine reliable functional muscle. Strategies for closure involve borrowing tissue eitherfrom theopposite lip or from the cheek. The face can be divided into adjacent topographic areas of characteristic skin quality col. Reconstruction of the lower lip, dermatologic surgery 10. Reconstruction of small and mediumsized defects of the lower lip karen h.
Seven years ago, the patient underwent mohs surgery for the same diagnosis on the lower lip. However, squamous cell carcinoma involving near total upper and lower lip and oral commissure is rarely seen in the english literature. The use of submental island flap for total lower lip reconstruction. This is more so when the resection is total and a complete lip has to be constructed. Direct primary closure feasible for lower lip reconstruction. Identify, prevent, and treat complications of cheek reconstruction. Patients underwent assessments at 2, 4, 6, 12, and 18 months postoperatively. Pribaz function the lips play an important role in both human physiology and culture. Any reconstruction of the lips must include both functional and cosmetic considerations. The method is based on the principle introduced by stein and modified by estlander, abbe, kazanjian, and converse, and seems to be especially valid. Reconstruction of small and mediumsized defects of the. Larrabee, jr, md procedure selection for surgical reconstruction of lip defects depends on the location and extent of the defect.
Squamous cell carcinomas located on the lower lip represent 2030% of all oral cancers, and present good. In those patients who have had cancerous lesions, lip reconstruction should be a part of the complete management of their treatment. Total reconstruction of the upper lip using bilateral. D fibula inset with soft tissue platform for lip reconstruction. Lip reconstruction poses a particular challenge to the plastic surgeon in that the lips are the dynamic center of the lower third of the face. However, the lower lip contains the orbicularis oris muscle, which plays an important role in oral sphincter function, which is essential for speech, facial expression, and eating. It is important to be familiar with local flaps, especially tongue flap which has a good blood supply. Reconstruction of the lower lip using karapandzic and gilles flaps.
Lower lip reconstruction is more significant, because oral competence depends greatly on a functional lower lip having good muscular function, adequate height and sensation. Upper lip reconstruction special considerations include presence of central structures cupids bow, philtrum in men, facial hair aids in hiding scars in men, nonhairbearing flaps brought into hearbearing areas can be noticeable the upper lip is less important in oral competence more lower lip tissue can be borrowed. Hence, reconstruction of new lip tissue with nonlip tissue is necessary, such as the websterbernard, 810 mcgregor, 11 nakajima12, and free flap. Even small abnormalities can be apparent because of the prominent location on the face. Giles fa gillies fan flap for lower lip reconstruction. Pdf lip reconstruction poses a particular challenge to the plastic surgeon in that the. Reconstruction of the lower lip reconstruction of the lower lip cook, jonathan lambert 20010801 00. The upper fibers of the middle portion merge with the orbicularis oris fibers of the lower lip, while the lower fibers of the middle portion merge with the orbicularis fibers of the upper lip. Lip reconstruction list of high impact articles ppts. Hence, reconstruction of new lip tissue with non lip tissue is necessary, such as the websterbernard, 810 mcgregor, 11 nakajima12, and free flap. Lip defects can be classified according to thickness of the defect ie, skin or mucosa only, fullthickness and overall size of the defect. Cancers of the lower lip are most common and most often caused by sun exposure. Tissue borrowing from the op posing lip was first described by sabattini in 1838,7andis.
Simultaneous reconstruction of the upper and lower lips has been inconclusive and presents a challenge to the surgeon. This leaves scars but is a good option if the natural tissue of the upper lip is truly damaged or missing. The reconstruction of fullthickness defects of the lower lip can be challenging because the integrity of mucosal, muscular, and cutaneous layers must be reestablished, and in this setting. Reconstruction of acquired lip deformities evan matros julian j. Total lower lip reconstruction using free neurotendinofasciocutaneous anterolateral thigh composite flap. Functional lower lip reconstruction with a forearm flap. There were concomitant chin and mandible defects in three and four patients. Among the reconstruction techniques described for the lower lip, the. Individual patient factors, such as previous operations, underlying comorbidities, compliance, and mechanisms for the wound defect, may affect choices of reconstruction. In 1845, dieffenbach12 was the first to suggest lower lip reconstruction using bilateral medial advancement flaps of the cheeks.
The lips are the main feature of the lower third of the face. We present a case of lip reconstruction following a total resection of the upper lip. Median cleft of the lower lip and mandible this is caused by the failure of the mandibular. Lip reconstruction may be required after trauma or surgical excision. Its potential disadvantages include notching of the central lip incision and effacement of the gingivobuccal sulcus.
The most common type of lip surgery is lip augmentationsometimes referred to as lip enhancement surgery. While there are beautiful flap designs for reconstruction, the lip. Lip reconstruction connecticut stanislawmdstanislawmd. As a result of the relatively lower incidence of cancer, the reconstructive techniques for defects of the upper lip are fewer than lower lip. The aesthetic or functional abnormalities that prompted revision surgery and. The patient is a 61 year old man with a shave biopsy proven squamous cell carcinoma scc of the lower lip. Various plans of lip reconstruction with switched flaps the patient was returned to the operating room where the flaps were separated and wider excision was obtained from the lower lip. Sakai 1 and sadove 2 reported reconstruction of the lower lip and chin with a. Reconstruction of both upper and lower lips 171 excised in the nasolabial and lateral mental regions. The middle portion of the buccinator travels to the angle of the mouth and then decussates.
The flap designs for the second stage reconstruction are outlined. Gordon buck, during the civil war, was the first surgeon in the englishspeaking world to describe a crosslip reconstruction. Basal cell cancers typically occur on the upper lip whereas squamous cell cancers occur on the lower lip. Direct primary closure without undermining is a reliable method of reconstructing vermilionectomy defects of the lower lip, according to research published online. A case report yuxing guo, md 1 chi mao, md1 1department of oral and maxillofacial surgery, peking university school and hospital of stomatology, beijing, china facial plast surg 2016. The use of submental island flap for total lower lip. Aesthetically, facial units should be reconstructed with adequate tissue match in terms of colour and texture, aiming at symmetry as well as preservation of the apparent. Vermilion defects the vermillion is the most prominent feature. Reconstruction of the lower lip involved the rotation of a lateral area of the upper lip to the commissure. A radial forearm flap has been thought to be ideal for reconstruction of the lower lip. Lips are also common sites for occurrence of skin cancers. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal. It also is an adynamic reconstruction, and when used in the lower lip. Calhoun, md, facs the lower lip is a sheet of skin, muscle, and mucosa, attached to surrounding tissue at the sides and bottom, with a free upper border.
Prelamination can combine reliable functional muscle transfers with thin pliable. Advanced squamous cell carcinoma involving both upper and. Using tongue as a donor, it is expected to gain a high rate of success. These flaps of skin are added to the injured lip to restore it. For example, the lower lip can be a beginning point and the collarbones the endpoint.
Oral mucosa was stitched to skin to create a vermilion. Lips serve a vital role in cosmetic beauty of the face and are an important. Lip reconstruction can generate a considerable challenge to the plastic surgeon because of their role in aesthetic balance. Lip reconstruction poses a particular challenge to the plastic surgeon in that the lips are the.
A 71yearold male has presented with an ulcerating lip nodule in the middle one third of the lower lip, measuring about 1. Reconstruction of skin cancer defect by sam naficy, md, seattle plastic surgeon. The tumor was removed in two surgical stages, and the wound that resulted from tumor removal measured 2. The muscles must be carefully repaired to avoid numbness in the lip. Squamous cell carcinoma is one of the most common malignant tumors of the skin and oral mucosa. The most common reason for creation of a lip defect is to remove a lip cancer. The sphincteric action of the orbicularis oris closes the oral stoma. The total lip defects resulted from tumor resection n6, trauma n3, and noma n1. Reconstruction of acquired lip deformities plastic. Lip reconstruction is a challenging surgery but can produce good results in the right hands. Although, tobacco use has also been implicated in their formation. If there is a deep wound or hole in the lip, mucosa, or mucus membranes can also be used to fill in the area. Patient reports that over the past 6 years the lesion has increased in size, has bled at intervals, and was not healing.
The planning and choice of operative methods depended on the quality of the surrounding tissue and the patients age, sex, occupation, and general health. Aesthetic upper lip reconstruction with vermilion submucosalpedicle crosslip flap mutsumi okazaki, md, tsuyoshi hisatomi, md,1 shunji sarukawa, md2 tokyo, japan the localized cutaneous amyloidosis occurring on the upper lip of a 48yearold man was surgically treated andaestheticallyreconstructed with. Outcomes following vy advancement flap reconstruction of. Lip reconstruction surgery in these cases typically uses skin grafts. T2 n0 squamous cell carcinoma subtotal lower lip defect reconstructed with a karapandzic flap. But there are other types of lip procedures as well. A method for reconstruction of the lower lip following larger subtotal excision is described. Their role in aesthetic balance, facial expression, speech, and deglutination is not replicated by any other. A second surgery is necessary to reconstruct the commissure angle. Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. General considerationsgeneral considerations for upper lip reconstruction, lower lip can be used, butfor upper lip reconstruction, lower lip can be used, but vice versa is avoided. Any patient who has suffered trauma to their lips, for example a dog bite or laceration, must be treated immediately. Methods all patients presenting to the senior author y.
In patients with almost a total defect of the lower lip, we used the websterbernard flap, which involved the medial advancement of the cheek tissue to create a new lower lip. Lip reconstruction is the process of maintaining oral competence, sufficient oral access and preservation of sensation after severe injury, burn or in case of lip cancer. Becoming familiar with the principles of a few flaps is important because the actual defect size is not often known until immediately prior to reconstruction. During this period, one patient who underwent reconstruction with a myomucosal flap and. Reconstruction of the lip commissure with upper and lower. Technique for the reconstruction of oral commissure ijsrp. Defect of 30% of the upper or lower lip can be closeddefect of 30% of the upper or lower lip can be closed primarily great elasticity of lips. Reconstruction of oncologic defects of the eyelid, lips and ear. The lips are considered the beginning of the oral cavity and are the most common site of oral cancer. Transverse facial cleft this extends from the mouth to the ear. Lip reconstruction and aesthetics are the main focus of reconstructive, cleft and aesthetic surgeons.
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