Surgical Treatment in Squamous Cell Lip Carcinoma

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Introduction: Lip cancer is the most frequent malignant tumors of the oral cavity. Lip carcinoma could appear on pre-cancerous lesions (such as radio-dermitis, chronic cheilitis, xeroderma pigmentosum etc.) and is related with other risk factors like smoking, chronic alcohol consumption, immunosuppression, HPV infection etc. Materials and Methods: This study was conducted on a representative sample made of 164 patients diagnosed with squamous cell carcinoma and 62 patients with squamous cell lip carcinoma from 2010 to 2018 at the Plastic Surgery Compartment at the Emergency County Hospital of Braila. The incidence of squamous cell lip carcinoma increases in the last years from 20% in 2010 to 26% in 2018. This study analyses clinical characteristics and histopathological types of lip carcinoma, frequency of the squamous cell lip carcinoma, the relation between the resection margins and tumour size, types of local flaps used in the reconstruction of consecutive defects, local evolution and possible metastatic spread to the lymph node of the neck. Squamous cell lip carcinoma was located to the lower lip at 40 patients, to the commissure at 14 patients and to the upper lip at 8 patients. The youngest patient with squamous cell lip carcinoma was 22 years old. Results and Discussion: Lesions smaller than 1 cm were more frequent (62%) compare to the lesions which involved more than half of the lip (8%). For small tumors, under 1 cm, the resection margins were made at 4 mm, for tumors with sizes between 1-2 cm the tumor resection was performed 6 mm from the tumor margins and for large tumors, more than 2 cm, the resection margins increase to 1 cm. Early-stage tumors were treated by direct suture with a very good prognosis. For advanced lesions we used a variety of flaps for lip reconstruction: Gillies’s flap, Abbé flap, Karapandzic flap, McGregor flap, Estlander flap, nasolabial flaps (Fujimori and Ombredane) etc. Two patients return for commissuroplasty. We used a Converse flap and a Zisser flap. Conclusions: The successful reconstruction depends on preoperative planning according to the tumor site and size. Lymph node metastases significantly reduce long term survival. For a plastic surgeon the aesthetic appearance has the same importance like the functional results.