Lower Lip Defects Research Articles

Reconstructive surgery in advanced perioral non-melanoma skin cancer. Results in elderly patients.

Nonmelanoma skin cancer (NMSC) of the perioral region is not uncommon. Basal cell carcinoma is predominant in the upper lip area and squamous cell carcinoma in the lower lip area. While smaller lesions can be treated by excision followed by primary closure larger defects after tumor surgery can be challenging. Analysis of outcome after complete surgical excision with micrographical control of excision margins (delayed Mohs surgery) of large NMSC's of the perioral region (lips and chin). This is a retrospective, single-center analysis of patients with defects after delayed Mohs surgery of ≥ 3 cm of the perioral region. The study included a total of 25 patients (4 women and 21 men) with a mean age of 83.7 years. Twenty patients were diagnosed with squamous cell carcinoma and five had basal cell carcinoma. The lower lip was affected in 19 patients, the upper lip in 4 patients and the chin in 2 patients. Tumor stage was either T1N0M0 or T2N0M0. The most common procedure for lower lip defect closure was staircase or modified staircase technique. Cheek advancement flaps were used for upper lip defect closure. Inferiorly based nasolabial rotational flap, cheek rotational flap and modified Webster flap were also employed. In one patient Webster flap and unilateral staircase technique were combined. In all patients the tumor was removed completely with preservation of function and aesthetics. No local recurrence was observed after a median follow-up of 4.9 years. Perioral reconstruction after removal of large NMSC is a complex issue. The age group of over 70 years, frequently with comorbidities, requires a robust surgical technique with short operation times and tailored approaches for defect closure.

Superficial circumflex iliac artery perforator flap: identification of the perforator by computed tomography angiography and reconstruction of a complex lower lip defect

The purpose of this article is to present our approach to the reconstruction of head and neck defects using the superficial circumflex iliac artery perforator (SCIP) flap with the aid of preoperative computed tomography angiography (CTA) mapping. We describe the reconstruction procedure of a lower lip defect with a SCIP flap in a patient who underwent resection for a lower lip squamous cell carcinoma (SCC). Preoperative CTA is an effective method for detecting and predicting the course of perforator vessels. The SCIP flap may provide a superior functional and aesthetic restoration in selected cases, with an inconspicuous donor site scar and lower donor site morbidity. We believe that the SCIP flap is a viable option for soft tissue reconstruction of defects in the head and neck region with the aid of preoperative CTA mapping.

Fujimori gate flap: an old flap for reconstruction of lower lip defects due to lower lip carcinoma resection.

This study aims to present our clinic experiences on the Fujimori gate flap used for reconstruction of lower lip defect due to lower lip carcinoma. This retrospective study included 19 patients (7 females, 12 males; mean age 60.3 years; range 41 to 79 years) who underwent reconstruction with the Fujimori-gate flap between January 2006 and March 2011. Demographic features of all patients and postoperative long-term functional and aesthetic results were reviewed. The mean size of the defects was 34.2 mm (range, 10 to 60 mm). Totally 27 flaps were elevated. No complication was observed after surgical procedure. In the long-term, nine patients underwent minor revisions. None of the patients showed local recurrence. Fujimori gate flap may be used for the reconstruction of the soft tissue loss after tumor surgery at lower lip.

Technical details concerning myomucosal advancement method in the repair of large lower lip defects.

The most important decision that a surgeon has to make in large lower lip defect reconstruction is whether to use a free flap or local flap. Despite efficient transplantation, serious cosmetic problems can occur in total or in near-total lower lip reconstruction with a free flap. On the other hand, better cosmetic results can be brought about in reconstructions with local flaps when a repair is made in tissues with similar properties in terms of color, thickness, or pilosity. However, functional problems such as microstomy can be encountered when inefficient transplantation is carried out during local flap repairs. If a repair technique with local flap that enables efficient transplantation can be applied, satisfactory cosmetic as well as functional results can be provided. In this text, the technical details of the myomucosal advancement flap method, which is a successful functional local flap application with good cosmetic results, were reported and explained with the help of schematic drawings.

Application of Modified Karapandzic Flaps in Large Lower Lip Defect Reconstruction

Reconstruction of a lower lip defect with a Karapandzic flap often leads to greater rounding of the commissure. The aim of this study was to provide a new design of bilateral Karapandzic flap for large lower lip defect reconstruction. In this case-series retrospective study, a modification of the Karapandzic lip reconstruction technique was used with an additional incision to obtain more tissue. The esthetic outcome of the reconstruction was assessed using a 4-point scale with regard to the shape of the commissure, lip symmetry, appearance of the scar, and lip projection. Functional outcome was assessed by speech, preservation of oral competence, lip sensation, facial expression, diet, and denture usage. Seventeen patients (13 male, 4 female; age range, 52 to 82yr) with squamous cell carcinoma in the lower lip underwent single-stage lip reconstruction. Lip defects after tumor resection ranged from 50 to 90% of the lower lips. All patients achieved oral competence, without leading to greater rounding of the commissure. The esthetic outcome was considered good to excellent in 88% of cases and reconstruction did not lead to functional impairments in speech, oral competence, lip sensation, facial expression, diet, or denture usage. The modified bilateral Karapandzic flap is a reliable technique to reconstruct large lip defects without leading to rounding of the commissure. With this technique, good esthetic and functional outcomes can be achieved.

Karapandzic flap: A case-report

For full-thickness lip defects, the choice of reconstructive option depends on the size of the defect. Defects of one-quarter to one-third of the upper lip can be closed primarily. Larger defects measuring one-third to two-thirds of the lower lip width may be closed with the Karapandzic, Abbe or Estlander flaps. If the commissure is involved, both the Karapandzic and Estlander flaps may be used; however, the Karapandzic is probably the better choice because it is better at maintaining oral competence. In the case of larger lower lip defects (more than two-thirds of the lip), if there is sufficient adjacent cheek tissue, the surgeon may employ the Karapandzic (for defects up to three-fourths of the lower lip width) or the Bernard-Burow's techniques (to reconstruct the entire lower lip). A case of post-traumatic, lower lip defect, reconstructed with a bilateral karapandzic flap is presented here.

Functional Reconstruction of the Lower Lip With Fujimori Flap and Long-Term Follow-Up With Clinical and Electrophysiologic Evaluations

The Fujimori gate flap is an innervated flap raised from the nasolabial area for reconstruction of the lower lip. No electromyographic or clinical long-term studies have analyzed the long-term outcomes of lower lip reconstruction performed using this method. The aim of the present study was to assess the outcomes of lower lip reconstruction with the Fujimori gate flap using clinical and electrophysiologic examinations. Ten patients who had been treated with this procedure were evaluated clinically and electrophysiologically. The follow-up period was 1 year for all patients, and the patients underwent regular assessments. All flaps survived completely, and no wound healing problems were encountered. Four patients underwent revision in the late postoperative period. The electrophysiologic studies revealed the presence of reinnervation in all 10 patients. In the present study, we found that the Fujimori gate flap is a versatile flap for ideal reconstruction of lower lip defects. Our electrophysiologic assessments showed that the transferred muscle had undergone reinnervation and that the donor area innervation had been preserved. The findings from the serial clinical and electrophysiologic assessments indicated satisfactory results.

Unilateral one stage nasolabial flap for reconstruction of the lips.

Nasolabial flap (NLF) is one of the oldest described soft tissue flaps. Despite the great advances in maxillofacial reconstruction it still has a stable location in the reconstructive ladder of the face and oral cavity. Reconstruction of the lips, which are important structures that connect the oral cavity to the facial skin, with this flap is the interest of the surgeons. Experience of the authors for reconstruction of the upper lip philtrum, correction of lower lip contracture and subtotal reconstruction of the lower lip with emphasis on simultaneous correction of the red lip (volume and color) is explained in five cases. Satisfactory functional and aesthetic results were obtained. Iatrogenic epidermoid cyst occurred in one patient. One stage reconstruction of lateral lower lip defects with/without commissural involvement in full or partial thickness defects is possible by NLF. Supplementary flaps are needed when the vermilion needs simultaneous reconstruction.

Dorsalis Pedis Free Flap: The Salvage Option following Failure of the Radial Forearm Flap in Total Lower Lip Reconstruction.

Reconstruction after resection of large tumors of the lower lip requires the use of free flaps in order to restore the shape and the function of the lip, with the free radial forearm flap being the most popular. In this study we describe our experience in using the dorsalis pedis free flap as a salvage option in reconstruction of total lower lip defect in a patient with an extended lower lip carcinoma after failure of the radial forearm free flap, that was initially used. The flap was integrated excellently and on the followup the patient was free of disease and fully satisfied with the aesthetic and functional result.

Combined Bilateral Hatchet and Nasolabial Advancement Flaps for a Large Defect of the Lower Lip

A large full-thickness defect of the lower lip is difficult to reconstruct. Preservation of eating and speaking functions based on maintenance of oral sphincter and muscle function, sensation, and the oral aperture are the basic aims. It is also important to achieve a good aesthetic appearance. Here, we describe a new procedure using combined bilateral hatchet and nasolabial advancement flaps for a large full-thickness defect of the lower lip. The aim of use of the hatchet flap is to make a natural curve from the mentolabial fold to the mental protuberance using the "dog ear" resulting from suturing medially advanced bilateral hatchet flaps and to preserve a more certain blood supply to the medial edge of the flap. Our results indicate that the procedure using combined bilateral hatchet flaps and nasolabial flaps is useful for a U-shaped large full-thickness defect, with good functional and aesthetic outcomes.

Yu's flap for lower lip and reverse Yu's flap for upper lip reconstruction: 20 years experience

Reconstruction of defects of the lip caused by cancer with its requirements of a complicated anatomical structure, important physiological function, and acceptable cosmetic result, is a challenge for oral and maxillofacial and plastic surgeons. A method that combines rotation and advancement flaps was described by Yu in 1989 for the reconstruction of defects of the lower lip. In our department between January 1992 and December 2012, 8 patients had reverse Yu flaps for the reconstruction of upper lip defects and 56 patients had classic Yu flaps for lower lip defects. Patients with defects located laterally to the upper lips, ranging from ⅓ to ½, had unilateral reverse Yu flaps, and bilateral procedures were done for defects of less than ⅔ of the lips. However, if the defects were located in the centre of the upper lips, between ⅓ and ½, they were treated with bilateral reverse Yu flaps. Patients with defects between⅓ and ⅔ of lower lips had unilateral Yu flaps, and if the defects were wider than ⅔ of the lower lips, the procedure was bilateral. No flap failed and desirable functional and aesthetic outcomes were recorded in all cases. Here we report our experience with the Yu flap for the benefit of other surgeons.

Complex lower face reconstruction using a combined technique of Estlander flap and subscapular artery system free flaps

When advanced mandibular carcinoma is resected, the defect may include lip and oral commissure. Free flap insertion is commonly used to reconstruct the lip defect. Although improvements in the oral reconstructive method via free flap use have been reported, functional and aesthetic results of the oral sphincter remain limited. This case report describes two individuals presenting with massive lower face defects, including a lower lip defect and a mandibular bone defect. Reconstruction was accomplished using the Estlander flap and free subscapular system of flaps. In both cases, the free subscapular artery system flap was elevated from the mandibular bone defect and other mucosal defect. The lower lip and oral commissure defect was reconstructed via Estlander flap. Free flaps survived 100% and both cases healed without complication. Patients regained good oral sphincter function with no reports of drooling. Thus, in cases involving massive lower face resection, including that of the lower lip and mandibular bone, this method of reconstruction when combined with lip-switch flap and subscapular artery system flap can prove to be useful.

Lower Lip Reconstruction Using a Combined Technique of the Webster and Johanson Methods

Oral reconstruction, especially with lower lip defects greater than 80% of the lip, is still challenging for plastic surgeons. Webster technique is mostly used for lower lip defects greater than 80% of the lip; however, resulting scars in the chin area (Schuchardt flap, a half-circle scar) are relatively conspicuous in Asian populations because of the trapdoor deformity. On the other hand, Johanson staircase flap technique, which is used to reconstruct lower lip defects of up to two thirds of the lip, results in relatively inconspicuous scarring and prevents trapdoor deformity. Thus, instead of Schuchardt flaps, we designed staircase flaps with a Webster technique. Two patients with lower lip carcinoma were operated on using this new technique. Large triangles of the skin and subcutaneous fat were removed from the nasolabial folds, and small staircases were removed from the lower lip to allow medial movement of the cheek tissues. The cosmetic and functional results were improved from the original Webster technique.

Reconstruction of Lateral Lower Lip Defects With Transverse Lip Advancement Flap

Lower lip defects between one and two thirds of the lower lip are usually reconstructed with neighboring tissues from the upper lip, cheeks, or the mentum or a combination of these tissues. In this article, we offer a simple and effective reconstruction option that can be used for lateral defects between one third and two thirds of lower lip tissue. Utilizing the tremendous flexibility and expandability of the lip tissue, we tried to minimize the incisions and scar, and maximize the sensation and function with transverse advancement flap. Ten patients with lateral lower lip defects, after tumor ablation, were treated by this technique. After excision of tumor, the existing incision is extended to medial by following the natural labiomental crease. Full-thickness incision is ended at the level of commissure not to disturb the buccal and marginal mandibular branches of the facial nerve. Intraoral incision is made 1 cm above the gingivobuccal sulcus .The mental nerve was dissected and preserved to keep the sensorial innervation of the lower lip. Thus, transverse advancement labial flap that includes the orbicularis oris with intact neurovascular supply is freed to provide the desired advancement. Satisfactory functional, aesthetical, and sensational results were obtained. A dynamic reconstruction can be provided with superior results in terms of lip appearance and function with transverse lip advancement flap. In planning a lip reconstruction, we think that transverse lip advancement flap should be considered as a second ladder after primary closure.

Tongue Flap as a Reconstructive Option in Intraoral Defects

The reconstruction of intraoral defects can be challenging due to the different characteristics of the region, importance of preserving the anatomy and function, and shortage of available donor areas. The location and size of the defect guides the reconstructive surgeon through the treatment plan. Among the options available, tongue flaps have been found useful in intraoral defect reconstruction.In this study, we presented the use of tongue flaps in different kinds of intraoral defects, and compared the advantages and disadvantages with other methods. Between 2004 and 2011, tongue flaps were used in intraoral reconstruction of 11 patients (6 male and 5 female) with a mean age of 30.1. Six patients had palatal fistula, 3 had alveolar region and mouth floor defects, and 2 had lower lip defects. All of the tongue flaps planned were anterior based, 6 dorsal and 5 ventral. Second operations were carried out on the 15th or 20th postoperative days.Despite the disadvantages of being an interpolation flap which requires a second session and good patient cooperation, tongue flap is a choice for reconstruction of intraoral defects with its highly vascular structure, good mobility, localization, texture match, and low donor area morbidity.

PP149: Experience of the lip cancer treatment in latvian oncological center: 10 year review

Purpose A review of 201 patients who were diagnosed with lip cancer from 2001 to was undertaken to analyse the epidemiological data, to compare the results of surgical and radiation therapy and evaluate long term follow-up. Material and methods From 2001 to 2011, 201 patients (151 males and 50 females) with a primary squamous cell carcinoma of the lower lip were treated. Median age of patients was 65,4 years. 88 patients (43.7%) had I stage disease, 68 patients (33.9%) – II stage, 30 patients – III stage and 15 patients (7.5%) IV stage disease. At presentation, regional lymph nodes were clinically negative in 181 patients.100 patients underwent surgical excision as a primary treatment. Vermilionectomy was performed to five patients. “V” excision were performed to 63 patients, Reconstruction by Abbe flap was performed to 22 patients. Estlander method to four patients. According to J. Liu modified labila tissue sliding flaps for repairing lower lip defects were used in three cases, “stair case technique” were used in three cases. The cases classified as T3 (defects of 65–80%) were reconstructed with cheek advancement flaps in different types (Webster Bernard approach, Karapandzic technique, “Fan flap”) and nasolabial flap also. Microsurgical repair was used in five cases of total lip defect. 56 patients had radiotherapy as the primary mode of therapy and 45 patients received combined method of treatment (surgery and irradiation). In the patients group with clinically negative neck at the first attendance (181 patients), in the follow-up delayed cervical lymph node metastases developed in 12 patients (6.6%) within 2 years of follow-up. 32 patients underwent different types of neck dissections. Results The results of surgery were generally good Recurrence of primary tumor developed in 28 patients (13.9%) and was strongly associated with large tumor size, comissure tumors and poor differentiation. The determinate mean survival rate was found to be 82.4% at 2 yar follow-up. Conclusions We recommend surgery as the primary method of treatment because of the availability of histologically accurate tumour margin assessment and the short rehabilitation period.

A new technique for one-stage total lower lip reconstruction: Achieving the perfect balance

Reconstruction of extensive lower lip defects is difficult. The authors describe a new technique of one-stage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome. The authors applied their new reconstructive technique in a patient with extensive lower lip defect following excision of squamous cell carcinoma. Bilateral inferiorly based nasolabial flaps were used for reconstruction of lower lip. For vermillion reconstruction, a bucket-handle mucomuscular flap from upper lip was designed primarily using the pars marginalis portion of orbicularis oris. Compared with previously described techniques, this procedure is unique with respect to the alignment of the nasolabial flaps in relation to one another. Furthermore, this technique of vermillion reconstruction is a one-stage procedure with minimal morbidity, enables preservation of the vascular pedicle and innervation and maintains the orientation of orbicularis oris, thus providing a competent oral sphincter. To the authors' knowledge, this mucomuscular upper lip flap has not been described earlier and has definite advantages over the commonly used methods of vermillion reconstruction. The functional and aesthetic outcomes are satisfactory on follow-up, with normal lip movements and sensation, adequate mouth opening and oral competence, good colour and texture match with adjacent tissues, and excellent volume and quality of the vermillion. No subsequent corrective surgery is required. This technique is simple and achieves the main goals of total lower lip reconstruction in a single stage with minimal morbidity.

Reconstrução do lábio inferior pela técnica de Karapandzic

Lesões labiais extensas sempre representaram um desafio para a cirurgia plástica. Não existe técnica ideal para reconstrução labial. Neste artigo são relatados os casos de 2 pacientes que apresentavam grandes defeitos no lábio inferior, acometendo 80% e 60% da superfície dessa estrutura, após traumatismo lacerocontuso e ressecção de tumor epidermoide, respectivamente. Esses pacientes foram submetidos a reconstrução labial pela técnica de Karapandzic¹, descrita em 1974. No primeiro caso, o resultado foi considerado desfavorável, em decorrência da presença de deiscência. No segundo caso, foi obtido bom resultado estético e funcional, sem sofrimento dos retalhos ou hematomas. A técnica de Karapandzic constitui uma opção de fácil execução e reprodutível, apresentando bons resultados estéticos e funcionais.

Lower Lip Reconstruction Using Unilateral Nasolabial Gate Flap (Fujimori Technique)

Abstract Background: 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. Choosing the repairing procedure for larger lower lip defects must take into account two aspects: flap or flaps used should be local flaps, and suture lines should correspond to the natural facial creases or follow the functional lines of different facial aesthetic units. Finally, the flap or flaps should be large enough to restore the entire postexcisional defect. However, the more tissue is lost from the lower lip, the more challenging the reconstruction is from a functional and cosmetic point of view. Material and methods: During the last 2 years in the Oral and Maxillofacial Surgery Department of the County Emergency Clinical Hospital in Tîrgu Mureș, the unilateral Fujimori technique has been successfully used for the reconstruction of large lower lip defects in 4 patients with extended, neglected squamous cell carcinomas involving almost the whole lower lip tissue. These patients underwent complex surgical and oncological treatment. Surgery was performed in two stages: first, excision of the tumor and immediate lip reconstruction, and then removal of submandibular lymph nodes (level I), in the second stage. Results: The aesthetic and functional recovery of these patients was very good, with no need of other subsequent surgical corrections. Conclusions: The postoperative reconstruction of large defects of the lower lip is far from optimal, but it is very important to restore an adequate muscle function, the lip continence and a satisfactory facial appearance.

A new technique for reconstruction of lower-lip and labial commissure defects: a proposal for the association of Abbe–Estlander and vermilion myomucosal flap techniques

Reconstruction of large lower-lip defects is a complex surgical procedure, especially when associated with defects that compromise the oral commissure. Various wide resections have been proposed with the aim to preserve orolabial function and achieve a pleasant esthetic result. However, no consensus exists on the optimum procedure. We propose a new technique that combines an Abbe-Estlander flap with a vermilion myocutaneous lower-lip flap. Five consecutive patients presenting with lower-lip and oral commissure defects underwent surgical procedure. Surgical outcomes were analyzed based on oral competence, symmetry, sensibility, ability to wear denture prostheses, and postoperative complications. All patients achieved satisfactory functional and esthetic results during the 12-month follow-up period. The association of the Abbe-Estlander flap and the vermilion myomucosal lower-lip flap provides reliable results for the reconstruction of small and large defects involving the lower lip and the oral commissure.