Abstract
PURPOSE: Lip reconstruction outcomes after head and neck cancer resection have been limited to small series. Herein, we report a 20-year experience with lip reconstruction in this population and delineate the rates and predictors of postoperative outcomes. METHODS: We conducted a retrospective cohort study of consecutive patients who underwent lip reconstruction following cancer resection from January 1994 to January 2015. Patient demographics, surgical characteristics, defect dimensions and flap type were correlated with surgical and functional outcomes using multivariable regression. RESULTS: We identified 244 patients with mean follow-up time of 28.7±37.6 months. Most defects involved the lower lip (44.0%, n=80), without oral commissure resection (67.6%). Lip advancement (21.0%), primary closure (16.2%), Webster-Bernard (11.4%), and folded-fasciocutaneous free flaps (11.4%) were the most common reconstruction techniques. A minority of patients developed surgical complications (25.2%), microstomia (16.7%), food intolerance (14.6%), oral incompetence (11.9%), speech difficulty (3.3%), lip tethering (2.4%), and dysphagia (1.9%). 5-year survival probability was 43.5%. Tobacco use (OR, 3.18; P=.007), diabetes mellitus (OR, 2.29; P=.035), and concurrent mandible reconstruction (OR, 2.31; P=.018) were associated with surgical complications. Recurrent disease (OR, 2.62; P=.043) and oral commissure resection (OR, 2.71; P<0.001) were associated with oral incompetence. Tobacco use (OR, 12.02; P=.023), concurrent upper and lower lip resection (OR, 4.70; P=.028), and larger upper lip resection size (OR, 13.8; P=.028) were associated with microstomia. CONCLUSION: Lip reconstruction after oncological resection may contribute to improved function with relatively low complication rates. Careful consideration of risk factors and preoperative planning is imperative for successful lip reconstruction outcomes.
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