For the lower lip, defects of up to of the lip may be closed primarily. 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. The goals of lip reconstruction therefore should be to restore the complex function and form of this anatomical unit. Since the early nineteenth century, several techniques have been described for lower lip reconstruction. Wounds adjacent to the philtrum that are closed primarily may shift the philtrum to the affected side. Extended karapandzic flap technique for reconstruction of lower. Cancers of the lower lip are most common and most often caused by sun exposure. Pelly and engpeng tan plastic surgery unit, the prince of wales hospital, randwick, sydney, australia summarymany well recognised and widely used methods of reconstruction of the lower lip. This is sewn to the skin below the red lip to make a new lower lip.
Functional and cosmetic considerations must be included in any lip or chin reconstruction. A composite flap from the lower lip supplied by the labiomental branch of the fa can be used to restore combined defects of the upper lip and nose or partial defects of the lower lip. The nasolabial crease separates the upper and lower lips from the cheeks and the labiomental crease separates the lower lip from the chin. Lower lip carcinoma reconstruction using abbe estlander flap. Individual patient factors, such as previous operations, underlying comorbidities, compliance, and mechanisms for the wound defect, may affect choices of reconstruction. Upper and lower lip soft tissue thicknesses differ in relation to age and sex. Lower lip li the point denoting the vermillion border of the lower lip in the. Reconstruction of large full thickness defect of the lower lip reconstruction of large full thickness defect of the lower lip 20011001 00. Lower lip reconstruction is more significant, because oral competence depends greatly on a functional lower lip having good muscular function, adequate height and sensation. During this period, one patient who underwent reconstruction with a myomucosal flap and. 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. One half to two thirds of lower lip defects larger than one half of the lip cannot be closed primarily without undue wound tension. One stage reconstruction of large lower lip carcinoma. All of the flaps described below can be used on the upper or lower lip.
After successfully completing the written examination, the candidate will register for the oral examination. The oral examination will contain a section of theory and practice and a. Functional lower lip reconstruction with a forearm flap combined with a free gracilis muscle transfer. Reconstruction of the lower lip, dermatologic surgery 10. The split orbicularis myomucosal flap for lower lip reconstruction. The patient noticed a small mass on the left side of the lower lip about 20 years ago. Jun 15, 2018 a number of surgical procedures for the repair of a unilateral cleft lip are well described, with a multitude of variations, including the lemesurier quadrilateral flap repair, randalltennison triangular flap repair, millard rotationadvancement repair, 14, 15 and skoog and kernahanbauer upper and lower lip zplasty repairs. Innovative insertion of the palmaris major tendon after lower lip reconstruction. Strategies for closure involve borrowing tissue eitherfrom theopposite lip or from the cheek. This technique has been modified and used in two patients.
The method is based on the principle introduced by stein and modified by estlander, abbe, kazanjian, and converse, and seems to be especially valid in cases of older patients with redundant upper lip tissue. The use of submental island flap for total lower lip reconstruction. To achieve complete closure of the mouth, the lips must have a sufficient and. Local flaps are useful for reconstructing sensate lips. Evaluation of bilateral mental nerve block as an alternative. Reconstruction of a lower lip deformity associated with leakage of saliva drooling and food spillage is challenging. The main objectives in lip reconstruction after tumoral mass resection are functionality and esthetics. For the reconstruction of defects of the lateral parts of the lower lip the abbe or estlander cross lip transposition flap may alternatively be employed depending on involvement of the commissure 21. Although, tobacco use has also been implicated in their formation. Implicit in this statement is the intent to reestablished both internal and external coverage, expressivity, masticatory function and aesthetic contour and quality. Cutaneous lower lip can be reconstructed with a variety of flaps from the chin and submandibular area. In the medical literature there are multiple reconstructive procedures for small and medium size defects of the lower lip, but only a few methods for larger defects involving the whole lower lip. The primary goals of cheek reconstruction include the restoration of native function, maximization of aesthetic outcome, and limitation of repair related morbidity. The muscles must be carefully repaired to avoid numbness in the lip.
Surgical technique the split orbicularis myomucosal flap. We report the case of an advanced squamous cell carcinoma involving both the upper lip, lower lip, left oral commissure and buccal area and simultaneous reconstruction with local flap coverage that, to the best of our knowledge, has never been reported. The use of submental island flap for total lower lip. Jan 18, 2012 the principle of lip defects involves reconstruction with the remaining or opposite lip but there are no existing studies that describe simultaneous reconstruction of both upper and lower lips. Lip chin cancer surgery skin cancer surgery treatment. We describe a case of squamous cell carcinoma of lower lip in a. The most common reason for creation of a lip defect is to remove a lip cancer. Risks of a vermilionectomy there are risks and complications with this procedure. Care should be taken when planning this flap in patients who have had previous. In many burn patients, performing one of these vermillion reconstruction options, such as an abbe flap, could worsen a patient already troubled by microstomia by further tightening the lower lip. With this modification, it is no longer necessary for the lateral margins of resection to extend beyond the commissure for technical purposes, and the shape of the resection does not have.
This is the lip reconstruction technique used when more than seventyfive percent of the lip is affected by the defect. Reconstruction for a large lower lip defect is surgically challenging, especially reconstruction with local flaps. So the partialthickness crosslip flap was elevated sparing the orbicularis oris muscle of the lower lip, and normal movement and expression were restored in both the upper and lower lips. All or part of the visible lower red lip will be removed. Vermillion reconstruction with anal verge transitional. The modified estlander flap is based more medially to the initially proposed flap and seeks to avoid lip commissure deformations. Pdf 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 find, read and cite all the research you. Evaluation of bilateral mental nerve block as an alternative to general anesthesia for resection of lower lip tumors abstract fulltext html xml download as pdf size. Lip reconstruction can generate a considerable challenge to the plastic surgeon because of their role in aesthetic balance, facial expression. Functional lower lip reconstruction with the modified. All lip defects were caused by resection of a squamous cell carcinoma that required repair by the plastic surgery team.
Summarya modification of the classic gillies fan flap as used in reconstructing full thickness defects of the lower lip is described. Defects that involve up to two thirds of the lips are reconstructed with local flaps, with tissue borrowed from the opposite lip, the remaining lip, or the adjacent cheek. Reconstruction of neartotal loss of the upper and lower lips. These flaps of skin are added to the injured lip to restore it. The defect involved the full thickness of the vermilion as well as adjacent cutaneous lip and measured 4. Advanced squamous cell carcinoma involving both upper and. Reports of simultaneous upper and lower lip reconstruction are rare.
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. You could not deserted going subsequent to books hoard or library or borrowing from your associates to entry them. Gordon buck, during the civil war, was the first surgeon in the englishspeaking world to describe a cross lip reconstruction. Because the chin is a very visible aesthetic unit, incisions should be planned where there is minimal chin distortion. Larger lower lip defects reconstruction can be done using an inferiorly based or bilateral inferiorly based melolabial flaps. Reconstruction of skin cancer defect by sam naficy, md, seattle plastic surgeon. In this case, the lip reconstruction involved reconstruction of both the cutaneous and mucosal layers of the lip. Address correspondence and reprint requests to minoru miyake, dds, phd, department of oral and maxillofacial surgery, faculty of medicine, kagawa university, 17501. Request pdf lip reconstruction the lips are the main feature of the lower third of the face. In large defects involving both upper and lower lips, it is difficult to achieve all the goals of lip reconstruction but we desired to achieve both an. Apr 10, 2020 upper lip reconstruction is more difficult than lower lip reconstruction because the upper lip has a central structure, the philtrum. Pdf 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 find, read and. Reconstruction of small lip can be achieved with lip advancement primary closure if located in the middle to lower lip, but this might require excising a standing cutaneous deformity of the red lip.
Cancers of the upper lip are less common but are more aggressive and more likely to. Address for correspondencechi mao, md, department of oral and. Lower lip reconstruction using the karapandzic technique. Lip defects can be classified according to thickness of the defect ie, skin or mucosa only, fullthickness and overall size of the defect. Address correspondence and reprint requests to minoru miyake, dds, phd, department of oral and maxillofacial surgery, faculty of medicine, kagawa university, 17501 ikenobe, miki. Upper and lower lip soft tissue thicknesses differ in. This is more so when the resection is total and a complete lip has to be constructed. Old age lower lip cancer defects reconstruction by abbe. In some cases, surgeons will attempt vermillion reconstruction with the use of a skin graft. Reconstruction of the lower lip involved the rotation of a lateral area of the upper lip to the commissure. First lip reconstruction was performed in 25 ad by a roman surgeon who made relaxing incisions in the cheek to close defect of the lower lip 1.
Here, we present a 52yearold male with a large t3 scc, which started years before this treatment and involved nearly all of his lower lip, oral commissure and upper lip. The mas gradually became larger until it causes both cosmetic and functional problems. Plastic and reconstructive surgery wiley online books. Reconstruction of total lower lip and chin defects using the. Choosing the repairing procedure for larger lower lip defects must take into account two aspects.
A second surgery is necessary to reconstruct the commissure angle. Modified gate flap for lower lip reconstruction springerlink. Aug 01, 2001 reconstruction of the lower lip cook, jonathan lambert 20010801 00. One stage reconstruction of large lower lip carcinoma, with. Oct 01, 2001 reconstruction of large full thickness defect of the lower lip 20011001 00. Oct 30, 2012 the nasolabial flap is a simple flap used for reconstructing small intraoral defects created after the excision of malignant tumors. However, they tend to result in tight lips due to a lack of tissue volume. Squamous cell carcinoma most frequently occurs in the mucosa of the lower lip.
No gold standard in the reconstruction of both upper and lower lips has been established. 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. Nov 07, 2016 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. Reconstruction of the lip commissure with upper and lower. Lip reconstruction connecticut stanislawmdstanislawmd. In addition, it can restore lip volume without any difficulties. One of the latest techniques advocated for total lower lip reconstruction is thegate flap described by fujimori in 1980 3.
Total reconstruction of the upper lip using bilateral. Even small abnormalities can be apparent because of the. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and. This wound will be closed by moving the inside of the lower lip. Jun 30, 2010 large lower lip defects karapandzic flap may be used in lesions up to 80% of lip, may cause microstomia bernardburows procedure provides new lip tissue, but sensation and competence problems can lead to drooling free flap may be needed in massive defects or those with insufficient lip or cheek tissue for reconstruction. Reconstructed lower lip 3 months postoperative i in modified fig. Any reconstruction of the lips must include both functional and cosmetic considerations. Lip cancer represents between 1215% of all oral cavity cancers. Patients underwent assessments at 2, 4, 6, 12, and 18 months postoperatively. The defect involved the full thickness of the vermilion as well as adjacent cutaneous lip and. One stage reconstruction of large lower lip carcinoma, with local flaps author. Giles fa gillies fan flap for lower lip reconstruction. Lip reconstruction may be required after trauma or surgical excision.
For the reconstruction of defects of the lateral parts of the lower lip the abbe or estlander crosslip transposition flap may alternatively be employed depending on involvement of the commissure 21. Outcomes following vy advancement flap reconstruction of. The repair is completed in two treatments, which are at least two weeks apart. Download file pdf local flaps in facial reconstruction 3e local flaps in facial reconstruction 3e getting the books local flaps in facial reconstruction 3e now is not type of challenging means. Modern surgical technics of lip reconstruction were developed in the mid1800s, and basics principles have not changed significantly since then 2, 3. 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. Tissue borrowing from the op posing lip was first described by sabattini in 1838,7andis.
During the last 12 years, 17 patients with scc of the lower lip t2, n0, m0 were treated by surgery and lip reconstruction was performed by staircase n 12 or modified staircase technique n 5. However, with time, the philtrum will tend to return to its midline position. Squamous cell carcinoma scc of the lower lip is a frequently diagnosed malignant pathology in the maxillofacial region. In this groundbreaking textbook, contemporary approaches are explained and demonstrated to allow trainee and experienced surgeons alike to understand and assimilate best practice. Large lower lip defects karapandzic flap may be used in lesions up to 80% of lip, may cause microstomia bernardburows procedure provides new lip tissue, but sensation and competence problems can lead to drooling free flap may be needed in massive defects or those with insufficient lip or cheek tissue for reconstruction. For the upper lip, defects of up to 14 25% of the lip may be closed primarily. Its potential disadvantages include notching of the central lip incision and effacement of the gingivobuccal sulcus. In the flap donor site, the two zplasties were additionally. If there is a deep wound or hole in the lip, mucosa, or mucus membranes can also be used to fill in the area. In 2017, he consulted us for resection of the lesion and correction of his lower lip. Small defects of the upper and lower lip can be closed primarily. Here, the authors report their use of this method for lip reconstruction in a 94yearold japanese female after the removal of a cancerous mass. Mar 27, 2015 plastic and reconstructive surgery continues to evolve as new techniques open up new possibilities for the surgeon. Lip reconstruction list of high impact articles ppts.
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. Reconstruction of the lip commissure with upper and lower lip fullthickness defects using submental and nasolabial flaps. A method for reconstruction of the lower lip following larger subtotal excision is described. The lips are considered the beginning of the oral cavity and are the most common site of oral cancer. Four patients undergoing labioplasty and lip reconstruction. 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. This is a perfect technique in cases where more than half of the lip is affected by the defect. Cancer of the lip is a relatively common malignancy of the head and neck region.
We present the case of an 81yearold male with a past medical history of squamous cell carcinoma of the maxilla. Reconstruction of medial lower lip defects after tumour. Squamous cell carcinoma scc is the most common malignancy of the lower lip, and depending on its size, can be infiltrative and destructive. The mental vy advancement flap is a useful reconstruction method for the cutaneous lower lip. Supplementary appendix this appendix has been provided by the authors to give readers additional information about their work. We present a case of lip reconstruction following a total resection of the upper lip. Reconstruction of the lower lip and chin with the composite radial forearmpalmaris longus. All but one patient were caucasian male, a single female was included. But there are other types of lip procedures as well.
Reconstruction of the lower lip journal of plastic, reconstructive. Nasolabial flap reconstruction in oral cancer world journal. Lip chin skin cancers can and do affect the lip and its surrounding structure. Fusuma sliding flap for lip reconstruction of lower lip.
Lip reconstruction after tumor ablation world journal of plastic. Reconstruction of total lower lip and chin defects using. Reconstruction of large full thickness defect of the lower lip. When reconstructing lip defects, it is important to consider not only the cosmetic appearance of the reconstruction but also the functional aspect of the lip. Luce et al concluded that general concepts for lower lip reconstruction are primary closured with vw or vy flap when defect size is less than one third lip. The tumor was removed in two surgical stages, and the wound that resulted from tumor removal measured 2.
Lip reconstruction surgery in these cases typically uses skin grafts. A retrospective analysis of 26 cases of oral cancer treated with primary excision and nasolabial flap reconstruction was carried out. Lower lip reconstruction using unilateral nasolabial gate. The most common type of lip surgery is lip augmentation sometimes referred to as lip enhancement surgery. Lip reconstruction and aesthetics are the main focus of reconstructive, cleft and. In 22 cases, the excision was combined with neck dissection and facial artery ligation. Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge.
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