Lower Lip Cancer Research Articles

Inferiorly based nasolabial flap for reconstruction of full-thickness medium-sized lower lip and commissural defects following ablative cancer surgery.

Information regarding the design and usage of inferiorly based nasolabial flap for lower lip and commissural defect reconstruction following ablative cancer surgery remains limited. This study aimed to provide our design and experiences for such reconstructive purpose. Patients with lower lip or oral commissural cancer who received curative surgery involving reconstruction with inferiorly based nasolabial flap were included. The demographic data and clinical outcomes of these patients were obtained by retrospective chart review. A total of eight patients were enrolled in this study. All patients received ablative surgery at the National Cheng Kung University Hospital during May 2019 to May 2021, with their surgical defects reconstructed with unilateral inferiorly based nasolabial flap successfully. Among the five patients with lower lip cancer, one had a limited area of necrosis at flap tip. Another patient had a small orocutaneous fistula that healed spontaneously. No trismus or oral incompetence was noted following recovery. For the three patients with commissural cancer, a second stage commisuroplasy was needed after primary reconstruction. One patient had limited wound dehiscence at mouth angle following surgery, resulting in mild oral incompetence. Although mild trismus was noted in these three commissural cancer patients, all patients resumed normal diet during follow-up. Inferiorly based nasolabial flap is an excellent local flap for lower lip reconstruction following cancer ablative surgery. It is also a viable option for reconstruction of oral commissural defects. Minimal donor side morbidity, good functional recovery, and esthetic outcomes can be achieved with meticulous flap design.

PHOTODYNAMIC THERAPY AS RESOURCE TO CONTROL OSTEORADIONECROSIS IN ALVEOLAR BONE: A CASE REPORT

A 38-year-old White male smoker for 20 years, diagnosed with lower lip cancer who underwent adjuvant radiotherapy (60 Gy) showed exposure and suppuration of the anterior region of the alveolar mandibular bone after 6 months after radiotherapy treatment. The size of the lesion was ±2 cm and caused fenestration of the buccal mucosa and bony with root exposition. A pulp sensitivity test of the teeth was performed and only teeth 25 and 26 were not vital. Based on radiographic and clinical features, the diagnosis was osteoradionecrosis. Antibiotic therapy (amoxicillin 500 mg), photodynamic therapy (PDT; 660 nm, 12 J/2 cm2, scan), and topical rifocin comprised the treatment established. Previous endodontic treatment was carried out. After 10 sessions of PDT associated with antibiotic therapy the suppuration was reduced, and the osteoradionecrosis was controlled. Rigorous follow-up has been recommended for the patient. PDT is a relevant therapy for the control of osteoradionecrosis. A 38-year-old White male smoker for 20 years, diagnosed with lower lip cancer who underwent adjuvant radiotherapy (60 Gy) showed exposure and suppuration of the anterior region of the alveolar mandibular bone after 6 months after radiotherapy treatment. The size of the lesion was ±2 cm and caused fenestration of the buccal mucosa and bony with root exposition. A pulp sensitivity test of the teeth was performed and only teeth 25 and 26 were not vital. Based on radiographic and clinical features, the diagnosis was osteoradionecrosis. Antibiotic therapy (amoxicillin 500 mg), photodynamic therapy (PDT; 660 nm, 12 J/2 cm2, scan), and topical rifocin comprised the treatment established. Previous endodontic treatment was carried out. After 10 sessions of PDT associated with antibiotic therapy the suppuration was reduced, and the osteoradionecrosis was controlled. Rigorous follow-up has been recommended for the patient. PDT is a relevant therapy for the control of osteoradionecrosis.

Karapandzic Flap for Functional & Cosmetic Reconstruction of Lower Lip Cancer with Review of Literature

The incidence and prevalence of lip and oral cavity cancer has increased over the last decade, worldwide and in India. It ranks at 1st position in males in india, all ages, in 2020. Lips are essential organ of the body which carries dynamic role in facial expression, speech, sensuality, deglutition. Resection of central, large, lower lip cancer creates a more than 2/3rd large defect. Covering of this defect with maintenance of oral competency is a difficult task for a treating surgeon. Number of techniques are described for covering of large lower lip defects. Out of these techniques, karapandzic flap is a successful, accepted, simple, easy to learn reconstructive procedure with good cosmetic results. It is a modification of Gillie’s fan flap and it involves unilateral or bilateral full-thickness circumoral advancement-rotation flaps. The feature which distinguishes it from other techniques is preservation of neuro-vascular integrity, symmetry and oral competency. We are reporting a case of an elderly gentleman with large, central, lower lip cancer who underwent oncological resection with reconstruction by karapandzic flap technique.

Specialized medical care for patients with malignant neoplasms of the maxillofacial area in the Penza region of Russia

This article analyzes domestic and foreign sources, regulatory documents of the Russian Federation, in order to determine the etiological factors of oral cancer, assess the statistical data on morbidity and mortality from malignant neoplasms of the maxillofacial region in the Penza region. The results of changing the routing, an interdisciplinary approach to treating patients with malignant neoplasms of the maxillofacial region in the Penza region are presented. The epidemiology, clinical manifestations, main diagnostic methods, routing, treatment and rehabilitation of patients with head and neck oncology are considered. The results of treatment of patients with oral cavity and lower lip cancer using photodynamic therapy (PDT), both alone and in combination with radiation and chemotherapy, are analyzed. The study showed that PDT of tumors of the lower lip and buccal mucosa in mono-mode made allowed achieving 100% efficiency. After the completed treatment, all participants in the experiment were provided with a complex of rehabilitation, including nutritional support, psychological assistance, exercise therapy, training in correct swallowing tactics, percutaneous endoscopic gastrostomy, and a course of oral cavity massage. An interdisciplinary approach to treating malignant neoplasms of the maxillofacial region is the most correct in modern practice.

The relevance of miRNAs as promising biomarkers in lip cancer.

This study aimed to analyze the expression of miR-181b, miR-21, miR-31, and miR-345 in actinic cheilitis with and without epithelial dysplasia and lower lip squamous cell carcinomas, and to verify if the deregulated expression of these miRNAs would be indicative of malignant transformation. The sample was selected from formalin-fixed paraffin-embedded tissues of 19 actinic cheilitis without epithelial dysplasia, 32 actinic cheilitis with epithelial dysplasia, 42 lower lip squamous cell carcinomas, and 10 nonaltered oral mucosa of the lip. The microRNA (miR, miRNA) expression was quantified by real-time RT-PCR and the expression of the selected miRNAs among the groups of actinic cheilitis and lower lip cancer was compared by chi-square. A higher expression of miR-181b, miR-31, and miR-345 was found in actinic cheilitis without epithelial dysplasia in comparison to that in actinic cheilitis with epithelial dysplasia and with lower lip cancer. There were no differences in miR-21 expression between actinic cheilitis and lower lip cancer. Hierarchical clustering analysis showed a tendency for a downregulation of miR-181b, miR-21, miR-31, and miR-345 in most patients with lower lip cancers. The upregulation of miR-181b, miR-31, and miR-345 expression in actinic cheilitis without epithelial dysplasia and the decrease in the expression of these miRNAs in actinic cheilitis with epithelial dysplasia and in lower lip cancer are potential biomarkers of malignant progression. This miRNA signature can help to identify actinic cheilitis with potential to progress to lip cancer.

Possibilities of pain management during photodynamic therapy

The authors consider the possibilities of pain management during photodynamic therapy (PDT) of visible tumors based on the observation of 102 patients. Of the total number of patients, 62 had verified basal cell skin cancer, 10 people - squamous cell skin cancer, another 10 - oral and oropharynx mucosa cancer, 8 - oral leukoplakia and dysplasia, in 6 - lower lip cancer, in 4 - breast cancer, in 2 - other localizations of neoplasms. In 15 patients, nonsteroidal anti-inflammatory drugs (NSAID) were used as pain management, in 69 - a combination of NSAID with tramadol, in 14 - nerve block anesthesia, in 4 - PDT was performed under general anesthesia. The intensity of pain syndrome during laser irradiation of the tumor was assessed on the verbal rating scale (VRS). The absence of pain was recorded in 9% of cases. Mild pain was noted by 58% of patients, moderate pain - 20%, severe pain - 10%, very severe pain was noted by 3% of patients.The degree of expression of pain syndrome during PDT depends on the incidence of a lesion, histological form of tumor, and method of anesthesia. NSAID alone, or in combination with an opioid analgesic, allows effective control of pain syndrome in PDT of basal cell skin cancer in 89%, in PDT of squamous cell skin cancer in 66% of observations. Nerve block anesthesia allows stoping pain syndrome during PDT of oropharyngeal tumors.

LOWER LIP CANCER – A CASE REPORT

LOWER LIP CANCER – A CASE REPORT

Effects of modified lip and cheek fan-shaped flap in repairing the defect after lower lip cancer resection

Objective To observe the clinical effect of repairing the defect after extended resection of lower lip cancer by modified lip and cheek fan-shaped flap. Methods Six cases of lower lip cancer were treated. The defect of the lower lip was about 1/3-1/2 after 1 cm of enlarged resection outside the margin of the mass. The defect was repaired with modified lip and cheek fan-shaped flaps. The morphology and function were observed 3-36 months after operation. Results All patients healed in one stage, and the shape and function of lower lip recovered well without complications. Conclusions Lower lip defect about 1/3-1/2 of patients with modified lip and cheek fan-shaped flap is an ideal method of restoration and reconstruction, with satisfactory results after surgery. Key words: Lip; Carcinoma; Defect; Modified lip and cheek fan-shaped flap; Restoration and reconstruction

Lip cancer: Reconsidering the at-risk patients with pathological assessment.

This study was aimed to overview the treatment protocols of lip cancer and find out a cutoff point of tumor diameter and depth of invasion (DOI) for the survival parameters. One hundred and ninety-one patients with lip SCC were studied. The average age of the patients was 62years. Among 191 patients, 82.7% of the patients were men, 96.4% of them had lower lip cancer, and 84% were staged as early (pT1, pT2 ). Primary tumor excision with neck dissection was applied to 62.3% of the patients. Lymph node metastases rate was found to be 11%, and recurrence rate was 6.3%. There was statistically significant difference in between the tumor diameters and DOI values of patients with and without metastasis, and recurrence (p<0.01, p<0.05, respectively). Regarding to the lymph node metastasis, the optimal cutoff point was found to be 7.5mm for DOI and 21.5mm for tumor diameter. Regarding to the recurrence, the optimal cutoff point was found to be 7.5mm for DOI and 24.5mm for tumor diameter. T2 lip cancer patients also seem to be in at-risk group for metastasis and recurrence. As a conclusion, elective neck dissection and frequent follow-up are recommended for these early-stage lip cancer patients.

The Role of Chemical Factors in Oro-Maxi-Facial Surgery. The effiency of surgical act in lower lip cancer

Oro-facial soft parts may be the site of benign or malignant tumors, which, although presenting histological similarities, aspects and clinical development vary depending on the affected region. An upper lip lesion that does not heal in a few days could be a big health problem. Also, the presence of chronic inflammation, thickening, or whitish appearance in the lip are all alarm signals. Lip cancer is manifested by the presence of the upper or lower lip tumor, which may be solitary or multiple, ulcers that do not heal for more than three weeks, haemorrhages in the tumor. Sometimes it is considered as being a trenant/delayed herpes, the spinocellular carcinoma of the lip is the most common form of localized cancer in the head and neck level. The lip cancer occurs predominantly in men between 50 and 70 years of age but cases have been identified in young patients aged 20-30 years, too. The study includes 95 patients with lower lip cancer studied in 2016-2017. A good collaboration between ablative surgeon and restorer surgeon gives the patient the best opportunity for complete resection and restoration of the shape and function of the involved structures; the ablative surgeon can remove the tumor without compromising the excision due to a specific reconstruction plan. Reconstruction possibilities from the lower lip were adapted to each patient, depending on the size of the tumor and the properties of the facial tissues.

The association between immunoexpression levels of oxidant and antioxidant enzymes and lip squamous cell carcinoma.

The aim of this study was to investigate the associations among the immunoexpression levels of manganese superoxide dismutase (Mn-SOD), glutathione peroxidase (GPx), and myeloperoxidase (MPO) in lip squamous cell carcinoma (LSCC) tissues and the clinicopathological characteristics, and prognostic factors in patients with LSCC. The immunoexpression levels of Mn-SOD, GPx, and MPO were examined in 76 LSCC tissue samples using immunohistochemical staining on tissue microarray slides, and compared to those in normal lip mucosa adjacent to venous lakes (normal controls), normal tissue adjacent to corresponding tumors (NTACT), and recurrent tumors. Associations between immunoexpression levels and clinicopathological characteristics were analyzed using the Student's t-test. The prognostic factors were analyzed using Cox regression. The immunoexpression levels of Mn-SOD, GPx, and MPO were significantly different among the normal controls, NTACTs, tumors, and recurrent tumors (Mn-SOD: p=0.001, GPx: p<0.001, MPO: p<0.001). Lower lip cancer was associated with higher Mn-SOD immunoexpression levels (p=0.04) and probably indicated higher oxidative stress. Lymph node involvement with a lower immunoexpression level of MPO (p=0.007) indicated compensatory mechanism to attenuate oxidative damage. A low Mn-SOD immunoexpression level was borderline significantly associated with a worse prognosis for disease-specific survival, and it was probably related to a lower capacity for coping with oxidative stress.

Clinicopathological study of lip cancer: a retrospective hospital-based study in Taiwan.

To evaluate the clinicopathological characteristics, high-risk lifestyle factors (HRLF: chronic exposure to sun, betel quid, alcohol, and tobacco), and prognostic factors of lip cancer. The hospital records of patients with pathologically confirmed lip squamous cell carcinoma (LSCC, n=112) and lip basal cell carcinoma (LBCC, n=21) were reviewed. Differences in clinicopathological characteristics between LSCC and LBCC, upper and lower lip, and status of second primary tumors were compared by chi-square test and logistic regression. The prognostic factors for LSCC were analyzed by Cox regression. Compared with LBCC patients, LSCC patients were men-predominant (p<0.001), had younger ages at onset (p<0.001), and higher rates of lower lips involvement (p<0.001) and HRLFs. Patients with second primary tumors were highly associated with lower lip cancer involvement (adjusted odds ratio=2.91, p=0.03). Patients with lower lip cancer had more HRLFs with an increasing linear trend (p=0.004). The poorer prognostic factors of LSCC for disease-specific survival were advanced stage III/IV [crude hazard ratio (CHR)=11.16, p<0.001], tumor dimension>4cm (CHR=8.19, p=0.006), lymph node involvement (CHR=11.48, p<0.001), and recurrence (CHR=3.96, p=0.01); whereas for disease-free survival were moderately to poorly differentiated LSCC (CHR=4.97, p=0.002) and alcohol consumption (CHR=3.13, p=0.04). LSCC and lower lip cancer were highly associated with HRLFs.

The treatment results of patients with lower lip cancer and the relationship of tumor size and depth with neck metastasis

The treatment results of patients with lower lip cancer and the relationship of tumor size and depth with neck metastasis

Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer

ABSTRACTObjective This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites.Material and Methods A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type.Results From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015).Conclusions Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors.

Free radial forearm flap for reconstruction of head and neck soft tissue defects after tumor resection

To explore the clinical effect of the free radial forearm flap on repairing tissue defects and reconstructing functions after tumor resection. From January, 2003 to December, 2011, 70 patients, including 43 squamous cell carcinomas of tongue, 12 buccal cancers, 5 carcinomas of the soft palate, 4 basal cell carcinomas of external nose, 3 lower lip cancers, 2 upper lip cancers, and 1 posterior wall of hypopharynx carcinoma, with the soft tissue defects in the head and neck underwent reconstructive operations with the free radial forearm flap after the malignant tumor resection. The area of defects ranged from 5 cm × 4 cm to 14 cm × 8 cm with the process of diseases from 4 to 30 months. The technique for grafting the free radial forearm flap and the appearance at sites of the donor and recipient, and the influence on the anatomy and function in both local sites were analyzed. In the 70 patients, only 1 case of flap appeared necrosis due to venous reflux obstacle, and the remaining (98.4 ﹪) survived. During the follow-up for 12-36 months, one case of hypopharyngeal carcinoma died from distant metastasis a year later, 2 cases of tongue cancer died of cardiovascular accident. Morphology and function for the sites at donor and recipient were satisfactory. Free radical forearm flap is a good choice for the repair and functional reconstruction for tissue defects after tumor resection.

2843 3D-image based high-dose-rate interstitial brachytherapy as monotherapy for lower lip cancer: A preliminary study

2843 3D-image based high-dose-rate interstitial brachytherapy as monotherapy for lower lip cancer: A preliminary study

No evidence for a survival difference between upper and lower lip squamous cell carcinoma

It is generally assumed that upper lip cancer has a worse survival than lower lip cancer, but this notion is not convincingly supported by limited literature. Therefore, we tested whether upper lip cancer has a worse survival than lower lip cancer. All primary squamous cell carcinoma (SCC) of the lip in the North-East of the Netherlands from 1989-2009 were extracted from the Netherlands Cancer Registry database. We calculated overall and relative survival rates. In this series of 979 lower lip and 126 upper lip SCC, men were 2.6 times more often affected, while the proportionate share of upper lip cancer was larger in women. The 5-year overall survival for lip cancer equaled 74% (95% confidence interval (CI) 70–77%), while the relative survival equaled 97% (95% CI 93–100%). The overall and relative 10-year survival rates were 51% (95% CI 47–54%) and 90% (95% CI 84–96%), respectively. The 10-year relative survival rate for patients with SCC of the upper lip was 94% (95% CI 74–111%) compared to 90% (95% CI 83–96%) for patients with SCC of the lower lip. There appears to be little evidence that patients with upper lip SCC have a worse survival rate.

Videolaryngoscopy offers advantages over classic laryngoscopy in a patient with seriously limited lip opening

To the Editor: Inability to intubate the trachea is a leading cause of anesthesia-related injury [1]. Videolaryngoscopy offers advantages over direct laryngoscopy and is less traumatic [2, 3], as the miniature videocamera on the tip of the blade enables the intubator to provide an indirect view of the upper airway. We report a patient with limited lip opening in whom videolaryngoscopy proved to be helpful to provide a patent airway. A 73-year-old woman (160 cm; 75 kg; American Society of Anesthesiologists [ASA] physical status II), scheduled for lip reconstruction following lower lip cancer, underwent extensive lower lip resection with upper lip rotation (AbbeEstlander flap) to fill the lower lip defect [4]. Both lips were sewn together for 6 weeks, leaving an oral opening of 2.6 cm (intercommissural width). At the time of lip reconstruction (dividing the pedicle and releasing the lips), the patient showed asymmetric and limited mouth opening (interincisor distance 1.2 cm, oral width 2.6 cm; thyromental distance 6.8 cm; Mallampati grade IV), normal neck movement, and an adequate oral space. Precautions were taken to deal with a difficult airway: i.e., the provision of a difficult airway trolley, and personnel skilled in performing a surgical airway. After preoxygenation, anesthesia was induced with i.v. propofol 200 mg. Face mask ventilation was successful with capnographic tracing, and 100 mg succinylcholine was administered. The narrow mouth orifice prohibited any direct vision of the oral cavity during direct classic laryngoscopy (Cormack–Lehane grade IV), resulting in excessive tension on both lips. Channeled indirect videolaryngoscopes (Pentax-AWS , Tokyo, Japan; Airtraq , Prodol-Meditec, Vizcaya, Spain) were considered, but they were found to be too bulky to fit into the patient’s mouth, and failed to work, indicating that the wider blades of channeled videolaryngoscopes are a weak point. The insertion of a V-MAC videolaryngoscope (Karl Storz , Tutlingen, Germany), which consists of a less wide Macintosh-blade size three, into the mouth (Fig. 1) showed a Cormack–Lehane grade I on the monitor, and oral endotracheal intubation was successful at the first attempt, without the need to use a stylet. Normally a Macintosh-blade laryngoscope is introduced into the right side of the mouth, deflecting the tongue to the left, and the length of the blade is passed over the contour of the tongue. Subsequently the tongue is lifted upwards and forwards, so that enough room is created next to the blade to both visualize the glottic entrance and to insert the endotracheal tube in situ. In this patient no such maneuvers were an option. This case highlights the advantage of indirect videolaryngoscopy (Macintosh intubation blades incorporating optics in the tip for video-imaging) in patients with very limited mouth openings. The intubator does not need to see the vocal cords directly, as videolaryngoscopy offers both better laryngoscopic views and more successful intubations than classic laryngoscopy [2, 3, 5]. Management of difficult laryngoscopy in the patient with seriously reduced opening of the lips offers a unique and ongoing challenge for the anesthetist. With the present A. van Zundert (&) B. Pieters Department of Anesthesiology, Intensive Care and Pain Therapy, Catharina Hospital-Brabant Medical School, Michelangelolaan 2, NL-5623EJ, Eindhoven, The Netherlands e-mail: zundert@iae.nl

Lower lip cancers: analysis retrospectively for a period of 10-years

Oral cavity cancers are reported to constitute 2-4% of all cancers. Being the most common among oral cancers, 95% of lip cancers are located on the lower lip, 4% on the upper lip and the remaining one percent at the commissure. The purpose of this article was to analyze retrospectively in lower lip cancer patients who were operated in our clinic. Between October 1999 and December 2009, 57 patients with lip cancer were analyzed retrospectively, with regards to their age, state of oral hygiene, etiological factors, nodal status at the first visit, period from the onset of symptoms to the patient's first application to our clinic, follow-up period, neck dissection, postoperative radiotherapy and the TNM classification of the tumors. Hereby, we aimed at presenting our results and comparing them with the current data. The mean ages of the patients were 63.21 years and 70.17% were male and the remaining 29.83% were female. General oral care and hygiene was good in 8.77% and bad in 49.12% of males and good in 5.35% and bad in 19.29% of females. 52.64% of males and 5.35% of females were active smokers, and 44.5% of all patients had lymphadenomegaly at first admission. According to TNM classification, 43.88% of patients had T1, 33.32% had T2, 17.53% had T3 and 5.27% had T4 tumors. The tumors were excised with 1 cm surgical margins and 39 patients had cervical lymphatic dissection. 33.34% of the patients were given postoperative radiotherapy. During the first two years postoperatively, 89.48% of the patients visited the clinic on a regular basis, however, the intervals between visits increased thereafter. Lip cancers are commonly seen in males of advanced age. Following treatment, a long survival is evident in cases of early staged tumors. With this study, we aimed at comparing our results with existing data in the literature.

The Use of Radial Forearm Free Flap for Total Lower Lip Reconstruction:The Analysis of 10 Consequentive Cases and Quality of Life Evaluation

Background: Postresective defect of the total lip, especially when associated with soft tissues of lower face still remains a challenge for adequate reconstruction. Among many options microvascular free tissue transfer is the latest major advance and the main contributing factor in the quality of life improvement. The modern techniques are able to deliver well-vascularised tissues which allow to reconstruct even most complex and extended defects. The aim of lip restoration is to provide proper oral lining and external cheek skin and to reconstruct oral competence. There are several issues in lower lip reconstruction using microvascular tissues that must be considered, including defect's size, aesthetic units, support, recreation of the vermillion and defects of associated tissues. Among many certain donor sites the radial forearm free flap (RFFF) has become a golden standard for majority of patients with total lip postressective defects. Materials and Methods: The aim of this paper is to present the group of 10 consecutive patients with lower lip cancer, where RFFF was used for functional lower lip reconstruction, with analysis of life quality. In the material the patient characteristics is presented with the details of RFFF modifications according to the type of lip suspension. Based on own QOL questionnaire, the functional and aesthetic results were analysed. Results: The results suggest that the careful and detailed planning of the size, shape and type of lip suspension influence both functional and aesthetic results. Static lip suspension for defects limited to lower lip only is comparable to dynamic suspension in cases where the defect is complex and extended. Results of quality of life analysis may be a predictive factor influencing the choice of individual flap modification including the type of lip suspension Conclusions: Our experience with free radial forearm free flap for total lip reconstruction suggests that the careful and detailed planning of the size, shape and type of lip suspension influence both functional and aesthetic results.