Lip Defects Research Articles

Thin submental artery perforator flap for upper lip reconstruction: A case report

Reconstruction of upper lip defects can be challenging even for experienced surgeons. In order to restore both function and morphology, the use of quality soft tissue is essential. To this effect, the most common solution is the use of local flaps, or, in extreme situations, a free flap. However, a thin cutaneous upper lip defect may require a different approach. Perforator flaps are versatile and may allow an efficient reconstruction of soft tissue defects using adjacent similar tissues, providing the benefit of "like with like" coverage. We present the case of a 41-year-old female with a 1 × 1.5 cm basal cell carcinoma of the right-side upper lip, initially treated with a full thickness skin graft. Due to poor aesthetic and functional result, a thin submental artery perforator (SMAP) flap reconstruction was performed. Flaps' dimensions were 6 cm long and 4 cm wide and it was based on a perforator arising from the submental artery. Dissection was conducted above the platysma muscle, and the SMAP flap was transferred into the defect through a subcutaneous tunnel created below the mandible and posterior to the anterior belly of digastric muscle. The pedicle length of 6.5 cm was adequate for a tension free inset of the flap. Postoperative course was uneventful and the patient was discharged after 2 days. The 4-month follow-up showed a satisfying functional and aesthetic outcome with a concealed donor site scar. This report points out the coverage potential of the thin SMAP flap, which can be successfully used for a harmonious reconstruction in both color and texture of the upper lip.

Tongue flap for lip defects: Our experience.

Background: Background: Lip defects following neoplasm surgery are usually complicated. Appropriate reconstruction is vital in improving the quality of life of such patients. In this study, we have assessed the usefulness of the dorsal/lateral tongue flap in cases of lip reconstruction.
 Methodology: A retrospective data of patients who reconstructed with either dorsal or lateral tongue flap between November 2015 and June 2018 was collected. Departmental Ethical clearance was done.
 Results: A total of four patients who underwent tongue flap reconstruction during this period were analyzed. The size of the defect following excision of the lesion ranged from 3-5.5 cm. There was no partial or total loss of flap in our series. Postoperatively all the patients had adequate mouth opening, good swallowing.
 Conclusion: Dorsal or Lateral tongue flap is a simple and reliable flap for lip reconstruction. It helps in providing good functional results with less morbidity.

A comparative assessment of secondary surgeries between nasoalveolar molding-treated and non nasoalveolar molding-treated patients with unilateral cleft lip and palate

Introduction: Secondary surgeries are a commonly documented element of cleft treatment. It adds to the surgical and economic burden of care. Nasoalveolar molding (NAM) is one of the techniques which has gained popularity as it has proven to reduce the pre surgical severity. NAM has also been proposed to reduce the need for future secondary surgeries. In this retrospective study, we aimed to compare the incidence of secondary surgeries in NAM treated and non-NAM-treated patients with unilateral cleft lip and palate (UCLP). Methods: In this retrospective study, all consecutively treated NAM and non-NAM patients with UCLP who had undergone primary surgeries in 2011–2013 were considered. Only those patients who had a complete clinical and surgical record at 5 years of age were included for this study. Thirty-eight patients in NAM group and 48 patients in non-NAM group were compared. All patients had received the same protocol with the exception of NAM. The cleft severity index was used to check the preoperative cleft severity. The type of lip defect was described for all patients who had received the secondary surgery. Results: Pre NAM clefts were found to be more severe than the non-NAM group. However, after the NAM therapy, the cleft severity was less than the non-NAM group. Non-NAM group had a statistically higher number of lip revision surgeries with a broader variety of defects than the NAM group. There was no statistically significant difference for the Fistula closures. Conclusion: NAM reduced the cleft severity at the pre surgical stage. At 5 years of follow-up, NAM-treated patients had a lower surgical burden of care in comparison to the non-NAM-treated patients.

Single flap use for synchronous reconstruction of full-thickness upper and lower lip defects due to high-voltage electrical burn

<br>High-voltage electric burns are a major source of morbidity and mortality, with significant socioeconomic and psychosocial implications. Electric burns rarely cause injury to atypical areas including the oral region with a reported incidence of 2.2%–3.5%. The ratio of burn area to total lip is critical for reconstruction options. Locally usable flap choices will be insufficient for subtotal defects of lips. Electrical burn of both lips is a rarely seen entity that is surgically challenging for both lip reconstruction with the minimum morbidity. It is known that a radial forearm free flap (RFFF) is suitable for total lip reconstruction and in addition, is one of the best options for simultaneous upper and lower lip reconstruction using only one RFFF. In this study, a case with both lower and upper lib necrosis, a rarely affected area due to high-voltage electrical burn, is presented. Reconstruction with a free radial forearm flap was successfully performed although the patient was presented in the subacute period as timing.<br>

The neurotised estlander flap for lip reconstruction

SummaryThe Estlander flap is an axial-pattern, lip-switch technique used to reconstruct lip defects that include the oral commissure. We describe a neurotised modification that may confer functional advantages by preserving sensation and helping to maintain oral competence. This is achieved by preservation of the mental nerve branches to the lip and facial nerve branches to the orbicularis oris muscle in the flap.

Modificación de la técnica de Bernard-Burow en la reconstrucción total del labio inferior: presentación de un caso

El carcinoma de labio es uno de los más comunes de la cabeza y el cuello. Siendo el tipo histológico más frecuente el carcinoma escamo celular, que afecta predominantemente el labio inferior. Distintas técnicas existen para la reconstrucción de los defectos del labio inferior posterior a la resección de la lesión, sin embargo, preservar la funcionalidad y la estética de esta zona es un desafío, a consecuencia de la posición anatómica que hace que se acumule la saliva retardando el proceso cicatrización. Se presenta reconstrucción total de labio inferior ampliada hacia mentón utilizando el triángulo de Burow mejorando notablemente los resultados funcionales y estéticos.

Infolding of Nasolabial Flap: An Excellent Surgical Technique for Full-Thickness Defect of the Lip.

To find out the usefulness of the infolding technique of nasolabial flap to reconstruct full-thickness defects of the lower lip. It is a retrospective analysis of 5 surgically operated cases. The infolding nasolabial flaps were utilized for the full thickness defect over the lower lip in carcinoma of the oral cavity from January 2018 to July 2019. The patients were followed up for a minimum period of 12months, and the outcomes were evaluated. The mean age of the patients was 39.72 ± 7.58years (range 30-52years). The infolding nasolabial flap has used each case for the reconstruction of the lower lip. The average length and breadth of the flaps were 65mm (range 60-75mm) and35mm (range 30-40mm), respectively. One patient presented with partial necrosis of the flap its tip. The functional and cosmetic outcomes were found satisfactory till 12months of follow-up, and none of the patients had a recurrence of the disease. Infolding of the nasolabial flap can be a good surgical technique for the reconstruction of the full-thickness defect of the lower lip, ensuring satisfactory functional and cosmetic outcomes without causing major intraoperative/postoperative complications in patients with carcinoma of the lower lip.

Reconstruction of lower lip defects with free super-thin anterolateral thigh flap.

Lower lip is a vital organ with important functions as well as aesthetic importance. It is critical to provide an aesthetically appealing lower facial subunit with maintenance of understandable speech and oral competence. Achieving these targets is very difficult especially in total lower lip defects. This report presents a technique using super-thin anterolateral thigh (ALT) flaps with fascia graft for reconstruction of large, complex oral sphincter defects. Six patients with squamous cell carcinoma (SCC) and one patient with a gunshot injury were presented in this report. All of them had full-thickness defects including skin, orbicularis muscle and oral mucosa. The mean age was 58 (range, 32-85) years. Defects of the lower lip were reconstructed with a super-thin ALT flap. Super-thin flaps were obtained by planning as close to the knee as possible and elevating at the level of superficial fascia. The fascia graft was used for achieving lip suspension. Overall flap survival was 100%. The flap size ranged from 8 × 6 cm to 14 × 10 cm. The follow-up periods ranged from 6 to 14 months. All the patients achieved acceptable oral competence, both in the resting condition and during speaking and eating, except for one patient who had a drooping lower lip developed in the post-operative 3rd month and underwent a secondary tightening procedure. Another patient needed liposuction due to bulky appearance. Super-thin ALT flaps seem to be a useful option for functional and aesthetic reconstruction of extensive lip defects.

USO DE HIPERPLASIA GENGIVAL FIBROSA EM REGIÃO DE TUBER COMO ALTERNATIVA PARA CORREÇÃO DE DEFEITO ALVEOLAR: RELATO DE CASO

The various preprosthetic periodontal surgical techniques proposed currently, provide a future prosthetic work with better aesthetic results and functional.The objective of this study was to report a clinical case of periodontal surgery for correction of the defect in the alveolar border, by means of the subepithelial connective tissue graft. Patient presented fibrous hyperplastic growth, in the region of the maxilla túber and lip defect in the region of the upper central incisor. After planning the event,were carried out, concomitantly, two plastic surgeries prosthetic periodontal lunches. In the first surgery, a connective tissue graft was removed from the donor area, the maxila túber and then was adapted in the anterior region, receiving area where the defect of flange. Thoughtout a postoperatory period of 45 days, that the choice of surgical technique, the type of graft used for correction of the defect of rim, were pre-requisites for the future success in aesthetic and functional prosthetic rehabilitation.

Reconstruction of Subtotal Defect of the Lower Lip: Combined Use of Karapandzic and Nasolabial Flap.

Subtotal reconstruction of the lower lip after excision of the tumor is always a challenge for surgeons. It is because of the difficulty in regaining the function of the lip, including the oral competency and restoring the aesthetic subunit. A 46-year-old patient presented with an ulceroproliferative growth involving 70% of the lower lip, including the right commissure. After theconfirmation to be a malignancy, patient underwent excision of the tumour and reconstruction of the lowerlip using the left Karapandzic flap and right nasolabial flap. The patient was on regular follow-up in the postoperative period to assess the surgical outcomes. The combined use of Karapandzic flap and the nasolabial flap can be reliably used for subtotal reconstruction of the lower lip in advanced oral cavity malignancy, involving one of the commissures. Later can ensure good postoperative results in terms of aesthetic and functional lip reconstruction without any significant intraoperative or postoperative complications.

A novel strategy for repairing middle upper lip defects: Bullhead flap

Facial deformities affect the impression people have of an individual, especially when located in the central face. 1 Godoy A. Ishii M. Byrne P.J. Boahene K.D.O. Encarnacion C.O. Ishii L.E. How facial lesions impact attractiveness and perception: differential effects of size and location. Laryngoscope. 2011; 121: 2542-2547 Crossref PubMed Scopus (33) Google Scholar The subunit of the upper lip is located in the very center and plays an important role in facial aesthetics. Ideal surgical repair includes reconstructing normal anatomy and striving for aesthetic restoration.

Early Cleft Lip Repair and Its Effect on Infant Weight Gain

Cleft lip and palate (CLP) is the most common congenital birth defect of the head and neck. Infants with CLP experience difficulties with feeding, leading to low weight gain and failure to thrive.1 At our institution, a paradigm shift has occurred where children with unilateral cleft lip defects are repaired in the late neonatal to early infantile period.2 Before the introduction of early cleft lip repair (ECLR), wide complete cleft lip defects were treated with adjuvant nasoalveolar molding (NAM) and repaired at the age of 3-6 months. The advantage of ECLR lies in the avoidance of the cumbersome and irritating NAM process that requires frequent biweekly dental clinic visits and parental adherence to an appliance protocol. Because little is known about the effects of ECLR on infantile feeding and weight gain, the purpose of this study is to compare the effect of ECLR on weight gain in contrast to NAM and standard timing of cleft repair.

Reconstruction of acquired lip defects: Ten-year experience at a tertiary care center

AimThe purpose of this paper is to describe different acquired conditions necessitating lip reconstruction and present our ten-years’ experience in managing the same at a tertiary care hospital. Materials and methodsData of patients undergoing reconstruction of acquired lip defects from January 2009 to December 2019 were analyzed for demographic details, etiology, extent of defect, reconstruction option used, outcome and complications. Results89 patients underwent lip reconstruction after excision of malignant tumors (81%), vascular malformations (12%) and traumatic injuries (7%). Mucosal and cutaneous lip defects were seen in 8 (9%) and 3 (3%) patients respectively, which were treated by primary closure, local advancement flap and tongue flap. Full thickness defects involving less than 1/3rd of lip (36%) and involving up to 2/3rd of lip (33%) were treated by primary closure, Abbe, Abbe Estlander flap and Karapenzic, Bernard Webster & peri-alar crescentic flaps respectively. Sub-total lip defects were repaired using distant and free vascularized flaps. All the localized cutaneous/mucosal defect repair healed uneventfully. Complications associated full thickness defect reconstruction included reduced stoma, flap necrosis and hypertrophic scar. ConclusionsRepair of localized cutaneous/mucosal defects of lip are simple with no significant documented complication. However, full thickness tissue loss necessities careful surgical planning. The choice of surgical technique depends on the extent of lip length lost. While Karapandzic flap was most commonly utilized to reconstruct lip defect involving up to 2/3rd of the lip, radial forearm flap was a choice in managing subtotal lip tissue loss.

Zygomatic Implants for Restoration of Complex Nasal Defects – A Case Report and Outcome

Total rhinectomy defects pose a challenge for the reconstructive surgeon, but since the introduction of osseointegrated implants, maxillofacial implant–retained prosthetic rehabilitation has provided the patient with an alternative option that has an excellent cosmetic result. Traditionally, zygomatic implants are used for prosthodontic restoration in patients with severely atrophic maxilla or to retain an obturator after tumor ablative surgery. More recently, the nonconventional use of zygomatic implants for retention of a nasal prosthesis has been reported in cases involving rhinectomy defects where the length of conventional dental implants is a limiting factor. In this article, we describe the use and value of transversely-oriented zygomatic implants in combination with an acrylic keeper and maxillary denture to optimize retention of a complex, multi-unit prosthesis in an edentulous patient with a total rhinectomy and upper lip defect.

Reconstruction of a Lower Lip Defect with Bilateral Nasolabial Musculocutaneous Flap. Case Report

Abstract Squamous cell carcinoma is the most common form of malignant tumour in the lower lip and its radical excision sometimes leads to complex defects. The treatment of squamous cell carcinoma of the lower lip is mainly surgical and consists of complete excision of the tumour, followed by immediate reconstruction. Although the nasolabial flap is a common flap used in the reconstruction of facial defects, it is an underestimated option in the reconstruction of the lower lip. We describe the reconstruction of a large defect of the lower lip that includes the bilateral commissures and ¼ of the upper lip, left side, in a 76-year-old male patient. Bilateral musculocutaneous nasolabial flap was used, with good functional results and an acceptable cosmetic result. We believe that the nasolabial flap is a good alternative for large lip defects both for patients with an affected general condition, but also as an alternative to existing flaps.

Split zygomaticus major muscle sling reconstruction for significant lower lip defects

Defects to the lower lip remain surgically challenging to reconstruct. Restoration of aesthetics and function are crucial, of which the aims include restoring the tissues of the lower lip, maintaining oral competence, speech articulation, and restoring lip height and the vermillion. Further surgical techniques continue to be explored, with local flap surgery being the generally preferred method. However, many reconstructions leave the patient with pronounced deformity and morbidity. In this case report, we describe a new technique for the reconstruction of an 80% lower lip defect with an ipsilateral split zygomaticus major muscle sling, nasolabial flap, and facial artery musculomucosal flap. The reconstruction provided good oral competence, speech articulation and aesthetics, in addition to maintaining the oral commissure and lower lip height/length. Iatrogenic microstomia was avoided and zygomaticus functioning was normal. We are confident this technique will be useful to reconstructive surgeons in select cases of significant lip defects.

Reconstruction of Large Lower Lip Defect with Bilateral Nasolabial Flap: A Report of Case Series

Reconstruction of Large Lower Lip Defect with Bilateral Nasolabial Flap: A Report of Case Series

Reconstruction of Large Lower Lip Defect with Bilateral Nasolabial Flap: A Report of Case Series

Reconstruction of Large Lower Lip Defect with Bilateral Nasolabial Flap: A Report of Case Series

The combination of the Wilson bridge flap with A-T advancement flap for extensive red lip defects and defects of the skin of the lip.

The combination of the Wilson bridge flap with A-T advancement flap for extensive red lip defects and defects of the skin of the lip.

Hybrid Reconstruction of the Upper Lip Following Major Cancer Resections

Major defects of the Upper lip due to cancer surgery are relatively less common compared to Lower lip. Standard techniques such as Karapandzic’s are capable of reconstructing up to fifty percent of the lip otherwise, microstomia and oral incompetence may result. The Upper lip has few aesthetic characteristic details due to the philtrum, its columns and cupid’s bows. Here we are proposing incorporation of an Abbe Flap to reconstruct the central unit of Upper lip, associated with Karapandzik flaps from both sides. Use of a Lip sharing concept has an additional advantage of producing harmony to the reconstructed region, and avoidance of crowding phenomena to the Lower lip