Reconstruction Of Lower Lip Defects Research Articles

Comparative evaluation of postoperative functional and esthetic outcomes for lip reconstruction with Fujimori gate flap versus Abbe-Estlander flap in patients being operated for oral squamous cell carcinoma

Background: Lip carcinomas account for 23.6% to 30% of tumors affecting the oral cavity. Lip reconstruction aims to achieve a competent oral sphincter with a good cosmetic appearance while avoiding microstomia. There are various techniques for lip reconstruction like Fujimori gate flap, Abbe-Estlander Flap, Gillies fan flap, Nasolabial flap, Karapandzic flap, bilateral advancement flap, perialar crescentic advancement flap, Bernard-Burow flap, and free flap. Aims and Objectives: To compare the Fujimori gate flap and Abbe-Estlander flap in terms of functional and esthetic outcomes when used for reconstruction of the lip. Materials and Method: Ten patients diagnosed with oral squamous cell carcinoma requiring resection and reconstruction of lip were included in the study. Functionally, maximal interincisal opening, lip competence, speech intelligibility and esthetically, scar, symmetry of lip during mouth opening, and symmetry of lip at rest were evaluated at the end of 1 week and 1 month. Results: On evaluation of functional and esthetic parameters, the Fujimori gate flap provides superior results in terms of mouth opening, speech intelligibility, and symmetry of lip at rest. However, results were comparable in both groups in terms of lip competence, scar, and symmetry of lip during mouth opening. Conclusion: The results of this study suggest that the Fujimori gate flap provides superior results with respect to function and esthetics when used for the reconstruction of lower lip defects with minimal or less complications.

Full-thickness nasolabial facial artery flap: A modified surgical approach for reconstruction of lower lip defects.

Reconstruction of large lower lip defects remains challenging in terms of aesthetics, function and safety. The aim of this study is to explore a modified nasolabial flap to repair large lower lip defects. The full-thickness nasolabial facial artery flap was used for reconstruction of defects in lip squamous cell carcinoma (LSCC) patients after tumor ablation. The postoperative recovery of patients was obtained through clinical review and follow-up in the first and sixth month. There were four LSCC patients who received tumor ablation at the Beijing Stomatological Hospital of Capital Medical University from November 2022 to March 2023, were included in our study. All patients did not suffer from postoperative infection, orocutaneous fistula, flap necrosis, and flap loss. One patient had the trapdoor deformity. These patients achieved better lip closure function. One patient developed cervical lymph node metastasis 2 months after surgery. The modified nasolabial flap could achieve good outcomes in terms of aesthetics, function, and safety. It provided a supplementary strategy for the using of nasolabial flap in larger defects of lower lip.

Reconstruction of Broad Lower Lip Defects Using Karapandzic-Type Flaps.

Reconstruction of lower lip defects is challenging because of the functional and aesthetic demands of the lower face. We review the functional and aesthetic outcomes of the Karapandzic-type flaps for reconstructing lower lip defects. A retrospective review of patients who underwent repair using Karapandzic-type flaps. Fifty patients with lower lip defects ranging from 20% to 95% (mean 59.2% ± 20%) were included. Eighteen patients (36%) were repaired using a bilateral flap, and 32 (64%) were reconstructed using a unilateral flap design. All patients had preservation of oral competency and a satisfactory aesthetic result. No patient complained of microstomia. A complication rate of 8% was noted ( n = 4) with postoperative wound infection and small areas of dehiscence. There was no statistically significant difference in complication rates in patients older than 75 years, in patients with a history of head/neck radiation, or in defects greater than 70% of lower lip breadth. Karapandzic-type flaps are versatile and reliable for the reconstruction of a broad range of lower lip defects. This one-stage procedure can produce superior functional and aesthetic results as compared with other local and distant flaps with minimal risk of functional microstomia.

Use of the Superthin Superficial Circumflex Iliac Artery Perforator Flap for Reconstruction of Lower Lip Defects.

Wide local excision remains the main treatment modality for primary lip cancer, which often results in considerable deficits of lip tissue and requires reconstruction using free tissue transfer. Although diverse free flaps, such as radial forearm flap or anterolateral thigh flap, have been used, their application is often limited by their inherent limitations, including donor-site morbidity and flap bulkiness. This report details the authors' experience of lower lip reconstruction using a superthin superficial circumflex iliac artery perforator (SCIP) free flap. Two patients with primary squamous cell carcinoma spanning their lower lip underwent wide local excision with an 8-mm lateral excision margin and superficial layer of orbicularis oris muscle. To cover the shallow but extensive lower lip defects, a superthin SCIP flap elevating along the intraadipose tissue layer and a pure-skin perforator SCIP flap elevating along the subdermal layer were harvested. The thickness of the harvested SCIP flap was 3 mm in both cases. The microvascular anastomoses of pedicles were conducted using the inferior labial artery and adjacent subcutaneous vein as recipient vessels, and the flaps were inset. The flaps survived completely without any perfusion-related complications. The patients were discharged uneventfully. Postoperatively, both patients displayed complete functional recovery with good lip competence and aesthetically pleasing results, without requiring secondary debulking operations. The authors' results suggest that the superthin or pure-skin perforator SCIP flap might be considered as an effective method for covering shallow and wide lower lip defect.

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.

Reconstruction of Lower Lip Defect with Unilateral Karapandzic Flap

The choice of reconstructive option for full thickness lower lip defects depends on the size of the defect. Defects between one-quarter to one-third of the lip can be closed primarily. Defects measuring between one-third and two-thirds of the lip may be closed with the Karapandzic, Abbe or Estlander flaps. When the commissure is involved, both the Karapandzic and Estlander flaps can be used. In case of larger lip defects, if there is sufficient adjacent tissue, Karapandzic flap or the Bernard techniques can be used to reconstruct the entire lower lip. In this article, we present a case of post-traumatic, lower lip defect along with chin defect, and parasymphyseal fracture mandible was reconstructed with a Karapandzic flap along with fracture reduction and fixation.

Effective method for reconstruction of remaining lower lip vermilion defect after a mental V-Y advancement flap.

BackgroundThe mental V-Y advancement flap method is useful for reconstruction of lower lip defect because of its many advantages. However, it is not easy to select the optimal reconstructive method for the vermilion defect that remains after application of the mental V-Y advancement flap. In choosing the representative surgical method for vermilion mucosal reconstruction including mucosal V-Y advancement flap, buccal mucosal flap, and buccal mucosal graft. We describe an efficient technique to large lower lip defects combining mental V-Y advancement flap and buccal mucosal graftMethodsThis study included 16 patients who underwent reconstructive surgery for full-thickness and large defect (> half the entire width) of the lower lip from October 2006 to September 2017. The operation was conducted using mental V-Y advancement flap with various vermilion mucosal reconstruction methods considering the location of the defect and the amount of residual tissue of the lip coloboma after excision.ResultsAll patients underwent mental V-Y advancement flap. In vermilion mucosal reconstruction, five patients underwent mucosal V-Y advancement flap, three underwent buccal mucosal flap, and eight underwent buccal mucosal graft. There were good aesthetic and functional results in all patients who underwent buccal mucosal graft. However, two patients who underwent mucosal V-Y advancement flap complained of oral incompetence, and all patients who underwent buccal mucosal flap had oral commissure deformity.ConclusionBuccal mucosal graft combined with mental V-Y advancement flap can produce suitable functional and aesthetic outcomes in near total lower lip reconstruction in patient with large mucosal defect including vermilion portion.

Karapandzic Flap: A Useful Option for Reconstruction of Lower Lip

Lip carcinoma is a common cancer of the head and neck region and it more commonly affects the lower lip (>90%). Out of all the carcinomas affecting the lower lip, squamous cell carcinoma accounts for 95% of the patients. Reconstruction of lower lip is a challenging task, as it requires taking into consideration the restoration of function as well as aesthetics. In this study, a patient for whom successful reconstruction of lower lip defect was done using the Karapandzic flap was presented.

Facial Artery Perforator and Depressor Anguli Oris Muscle Chimeric Flap: A New Design of an Old Flap.

The aim of this study was to investigate the reliability and outcomes of the facial artery perforator and separately elevated depressor anguli oris (DAO) muscle chimeric flap for the reconstruction of partial or total lower lip defects. Eleven patients with malignant skin tumors located at the lower lip were operated between 2013 and 2015. After the excision of the tumor with adequate clear margins using margin controlled excision technique, an appropriate flap fitting to the resultant defect based on the perforators of the facial artery and DAO muscle was prepared and placed into the defect. The DAO muscle activity was tested with electromyography in the postoperative first year examination. Besides 1 patient with transient venous insufficiency, all the flaps healed well without a partial or total flap loss. The mean follow-up period was 10 months. No new primary tumor or recurrence was observed. Although in 1 patient, transient asymmetric smiling and mild drooling was observed, the overall oral competence results were found to be quite satisfactory. The electromyography evaluation of DAO muscle of 5 patients who reached the postoperative first year examination showed action potential results in normal limits with a slight decrease. All patients were satisfied with the final esthetic and functional result. The facial artery perforator and depressor angel oris muscle chimeric flap is a valuable option for reconstruction of lower lip defects providing esthetically and functionally good results.

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.

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.

Reconstruction of lower lip with myomucosal advancement flap

In this article, a new surgical procedure that can be used for reconstruction of lower lip defects of any size is described. In this prospective study, the surgical procedure was applied in 16 patients. In this procedure, the mucosa and the orbicularis oris muscle of the lower lip are repaired with a composite flap, and the skin defect is closed using local skin flaps. The patients were assessed in terms of complications, mouth opening, sphincter function of the mouth, and sensation in the lower lip. The aesthetic results obtained in all patients were satisfactory. Sufficient oral sphincter function was achieved in all patients. Reconstruction of lower lip defects using the procedure described here can be performed in patients with lower lip defects of any size as long as the mucosal and skin repair lines are not superimposed. This procedure yielded good sphincter function and aesthetic results.

Reconstruction of lower lip defects after tumor excision: An aesthetic and functional evaluation

We are presenting a new questionnaire to evaluate the functional and aesthetic aspects after reconstruction of defects of the lower lip resulting from tumor excision. The questionnaire is based on objective parameters with numerical values. The application of the questionnaire is carried out based on 2 different surgical techniques, which have been used in the Department of Oral and Maxillofacial Surgery of La Princesa University Hospital in Madrid. These techniques are used in the reconstruction of surgical defects and concern the location and percentage of the lip resection. These techniques are the rotation-advancement flap by Yu and the rotation-advancement in island flap by Colmenero et al. The defects are located laterally and they include 40% to 60% of the length of the lip, avoiding the commissure. There is also one case with a defect that is almost 100% of the length of the lip. According to the questionnaire, we conclude that in unilateral defects that exceed 50% (up to 70%), Yu's technique provides better results from an aesthetic and functional point of view than Colmenero's technique. In subtotal defects, bilateral Yu flaps provide optimum function, with good position of the scars. This is a technique to be considered when confronted with extensive defects of the lip that do not include the commissures. (Otolaryngol Head Neck Surg 2000;123:317–23.)

The step technique for the reconstruction of lower lip defects after cancer resection. A follow-up study of 165 cases.

One hundred and sixty-five patients with localized cancer of the lower lip were excised and reconstructed over a 25-year period using Bengt Johanson's step technique. Eight-eight percent of the tumors were less than 2 cm in size and 65% were of high histopathological differentiation. Fifty-six percent were reconstructed with bilateral step flaps. Nine local recurrences appeared in 5 patients, none of whom died of lip cancer. Eight patients later developed regional metastases and 3 of these patients died of lip cancer. The 5-year survival rate was 98%. The step technique is recommended for reconstruction of lip defects of up to 2/3 of the lower lip and may, in larger resections, be combined with either a fan flap or an Estlander flap. The outstanding functional results are due to the use of adjacent tissue for the reconstruction which preserves the normal arrangement of muscles, vessels and nerves.

Reconstruction of lower lip defects by the Tennison triangular flap method

Reconstruction of lower lip defects by the Tennison triangular flap method

Reconstruction of lower lip defects by the Tennison triangular flap method

Reconstruction of lower lip defects by the Tennison triangular flap method