Technique For Lip Reconstruction Research Articles

Functional and aesthetic outcome of different technique for lip reconstruction after ablative surgery of lip carcinoma at a comprehensive cancer care center in Nepal

Functional and aesthetic outcome of different technique for lip reconstruction after ablative surgery of lip carcinoma at a comprehensive cancer care center in Nepal

ВРОЖДЕННАЯ ИЗОЛИРОВАННАЯ СРЕДИННАЯ РАСЩЕЛИНА ВЕРХНЕЙ ГУБЫ: ТЕХНИКА И ПРИНЦИПЫ ХИРУРГИЧЕКОГО ЛЕЧЕНИЯ

Objectives. A clinical case of elimination of a rare congenital pathology in a patient with a median isolated cleft lip. Congenital cleft lip is not only a functional malformation in which the structure and function of the orbicular muscle of the mouth is impaired, but also located in an aesthetically significant place that cannot be hidden from the eyes of others. Sucking disorders and aesthetic dissatisfaction are important factors for surgical intervention as soon as possible in order to avoid problems with the social adaptation of the child and his parents in society. Medical care for congenital cleft lip should be timely, highly qualified and accessible to all children in the regions, regardless of the social and financial situation of the family. Reconstructive plastic surgery of the upper lip is the only way to eliminate a congenital cleft, which affects the quality of life, social adaptation and psychological atmosphere in the family. Cheilorhinoplasty is performed at different age periods depending on the type of defect, and the technique of operations for each type of congenital facial defect has its own characteristics. In the literature, we did not find data on the frequency of the birth of children with an isolated median cleft of the upper lip, since this is a rather rare form of congenital cleft.
 Purpose. Description of the stages and basic principles of cheilorhinoplasty to restore the aesthetics and functionality of the orbicular muscle of the mouth in a rare form of congenital isolated median cleft of the upper lip.
 Methodology. The paper presents the results of a clinical observation of a 5-year-old patient with congenital isolated median cleft lip and the basic principles of cheilorhinoplasty.
 Conclusions. There are many types of congenital cleft lip, but adhering to the basic principles above will improve the aesthetic outcome of any upper lip reconstruction technique.

Comparative Aesthetic Evaluation of Lip Reconstruction Using Abbe's Flap in Secondary Cleft Lip Deformities: A Retrospective Study.

To objectively evaluate the surgical outcome of deformed cleft lip treated by Abbe's flap using Digimizer image analysis software. Fifteen Abbe's flap (AF) reconstruction cases with satisfactory photographic records were acquired in Digimizer image analysis software. Anthropometric landmarks were marked on the lip. Bilateral lip lengths, height and width were measured preoperatively and postoperatively after AF reconstruction for comparison. It was observed that by AF reconstruction, we could increase vermillion lip length and Cupid's bow width, hence providing adequate bulk to the middle of the lip. In addition to it, in some cases we could achieve the acceptable anatomy of the centre of the Cupid's bow with which it was sometimes disturbed during primary cheiloplasty. Lip length and lip height became proportionately equal bilaterally, leading to adequate lip symmetry in all cases. Computer-assisted anthropometric analysis of photographs using Digimizer image analysis software (MedCalc Software, Belgium) demonstrates that AF lip reconstruction technique produces aesthetic lip consistently.

Composite pronator quadratus: radial forearm free flap in functional lip reconstruction.

Reconstruction of lip defects following neoplasia and trauma is a common procedure in plastic surgery. Reconstruction of large lip defects is a difficult undertaking and some degree of residual functional impairment and disability are likely to occur. Microsurgical reconstruction is the recommended technique for large lip defects; however, limitations exist regarding optimal aesthetic and functional outcomes with current free flap options. We propose a new composite flap design based on the innervated pronator quadratus with the radial forearm free flap for a more dynamic reconstruction of total or near total lip defects. Results of our series of four patients have been reviewed. The radial forearm flap - innervated pronator quadratus flap has been used in four patients thus far for lip reconstruction. This flap, in our limited series has shown excellent results in achieving oral competence, good motor function and acceptable cosmetic appearance. The composite radial forearm-pronator quadratus flap is a promising new lip reconstruction technique that has potential to provide a higher level of oral competence, sphincteric function and symmetrical lip movement, than current microsurgical options in dynamic lip reconstruction. This method warrants further investigation in plastic surgery literature.

Dermatofibrosarcoma protuberans of the maxillofacial region: Report of a rare case and literature review

Dermatofibrosarcoma protuberans is a low-grade malignancy that rarely occurs. When it occurs, it typically involves the trunk or extremities, but seldom occurs in the maxillofacial region. Its management in the maxillofacial region characteristically presents an esthetic challenge to the surgeon, especially because its surgical management often requires wide excision. We report a case of dermatofibrosarcoma protuberans of the lip and adjacent structures in a 42-year-old male. Wide excision of the tumor was done, and immediate reconstruction was achieved with a combination of platysma flap and Karapandzic lip reconstruction technique. The acceptable esthetic outcome was achieved, and the patient is currently being followed up. Although dermatofibrosarcoma protuberans infrequently occurs in the maxillofacial region, it may occur nonetheless; therefore, clinicians should be aware of this possibility. Surgical treatment of this tumor in the maxillofacial region often presents daunting reconstructive challenges.

Lip reconstruction technique: A modified Abbe-Estlander with a myomucosal advancement flap

Lip cancer represents between 12–15% of all oral cavity cancers; 95% affect the lower lip. The main objectives in lip reconstruction after tumoral mass resection are functionality and esthetics. We present the case of an 81-year-old male with a past medical history of squamous cell carcinoma of the maxilla. The patient consults with the Maxillofacial Surgery Department due to a hypertrophic lesion in the left oral commissure. The defect is considered intermediate in size (between 50% and two-thirds). For reconstruction of the lip, a classical rotation flap (Estlander flap) is used together with a myomucosal flap, which is both innervated and expandable. According to medical literature, for intermediate defects of the lower lip advancement or rotation flaps should be used. One of these is the Abbe-Estlander flap, a rotation flap dependent of the superior or the inferior labial artery. The Karapandzic flap and Johansen's staircase flap are other recommended techniques.

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.

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 With Neck Flaps as a Salvage Procedure

There are many surgical reconstructive techniques after lower lip ablation. As the lower lip defect gets larger, the required reconstructive techniques become more complex. Despite the indication of free flaps, some situations require local flaps for reconstruction. These situations may be donor and/or recipient vessel problems or systemic disorders of the patient. In this article, a total lower lip reconstruction technique using the neck skin was described. The technique was applied successfully in 2 cases. An acceptable cosmetic result was obtained, and there were no early or late surgical complications in 2 years' follow-up. The patients were satisfied with the results. Lower lip reconstruction with the neck flaps must be kept in mind as a quicker alternative and a salvage method when the free flaps cannot be applied.

Reconstruction of lip defects with the Karapandzic technique.

To study the use and effects of Karapandzic technique of lip reconstruction by long-term assessment. A descriptive study. CMH Rawalpindi from January 1994 to January 2002. Thirty seven consecutive patients who underwent Karapandzic technique of lip reconstruction with a minimum follow-up period of two years have been included. The variables assessed were hemorrhage, wound infection, flap necrosis, microstomia, reconstruction time, hospital stay and dynamic lip functions. Results drawn were analyzed. A total of 37 patients were included in the study. Thirteen (35%) patients were outdoor cases while 24 (65%) were in-patients. Average time of reconstruction was 40 minutes, which was done under general anesthesia in 21(57%) patients and under local anesthesia in 16 (43%) cases. Mean hospital stay of the indoor cases was 26 hours. There was no flap loss except for marginal necrosis in 04 (11%) patients. Wound infection and wound dehiscence was observed in 03 (08%) patients. Sensations were completely intact in 29 (78%) patients and aesthetically 28 (76%) patients gave normal look at the end of two years (2Y). Twenty-seven (74%) patients had no change in speech and only one (3%) patient had unsatisfactory speech after 2 years. Varying degree of microstomia was observed in all the cases at immediate postoperative stage of one month but 35 (95%) patients showed gradual improvement with active mouth opening and stretching by prosthetic splints over 2 years. The Karapandzic technique of lip reconstruction is strongly recommended over the other techniques as it is a single stage, quick and safe procedure which gives cosmetically and functionally excellent results. Microstomia, occurring in early postoperative stage, shows gradual improvement on long-term follow-up.

Severe microstomia due to burn by caustic soda

The lesions that compromise the labial commissures can cause microstomias (reduction of the size of the mouth), with important aesthetic and functional impairments (feeding, speech and oral hygiene). They are more frequent among children in the preschool and school age [1]. The congenital causes are rare, detachment in epidermolysis bullosa [2] and Freeman–Sheldon Syndrome [3]. Most of the cases are acquired, having as main etiology electric, thermal and chemical burns [4] (the Estlander’s technique for lip reconstruction is another acquired cause of microstomia) [5]. These deformities generally need surgical treatment, with a careful postoperative accompaniment.

Mimicking lip features in free-flap reconstruction of lip defects

This paper introduces a technique of lip reconstruction using free flaps in which recognisable landmarks are mimicked by strategic placement of flap junctions. The technique was applied in 15 patients undergoing reconstruction of combined cheek and lip defects using single (n= 9) or double (n= 6) free flaps. Attention to flap design and strategic placement of flap junctions successfully created the vermilion-cutaneous junction, oral commissure and labiomental groove. The presence of these distinguishing features improved the appearance of the reconstructed lip.

Aesthetics and function in lip reconstruction.

Reconstruction of the lip following excision of malignant tumors is a frequent task of the plastic surgeon. Adequate oncological treatment must be followed by a satisfactory aesthetic and functional result. A simple and successful technique of lip reconstruction is revisited. It consists in using the remaining lip, which is released by way of a horizontal mucomyocutaneous flap(s) and stretched to fill the gap. Twenty-six consecutive cases of T2-T3 squamous cell carcinoma of the lip were treated using this technique, with excellent aesthetic and functional results.

A modified step technique for lip reconstruction

Purpose: This study evaluates the clinical and radiologic results after open reduction and lag-screw osteosynthesis of fractured mandibular condyles.Materials and Methods: Eleven adult patients underwent surgery for displaced or dislocated mandibular condyle fractures via a submandibular approach. The repositioned fragments were fixed using lag screws designed by Krenkel or Eckelt. Maxillomandibular fixation was used postoperatively for 2.6 weeks on average (range, 1 to 4 weeks) in nine patients.Results: Slight transient weakness of the mandibular branch of the facial nerve occurred in three cases. Occlusal adjustment was needed in another three cases. Radiologically, the fracture line disappeared at 22.5 weeks on average (range, 8 to 38 weeks). Three screws had to be removed because of loosening. There were signs that the screws had migrated caudally from their original position in seven cases. Twenty-one months on average after operation (range, 8 to 31 months), patients were satisfied with treatment. Clinically, all patients had a stable occlusion and symmetry of the face. All had greater than 5-mm symmetrical lateral jaw excursions. Ten patients had wide (>40 mm) painless mouth opening. Healing in malposition occurred in four cases and there was considerable shortening of the mandibular ramus in four cases.Conclusions: Despite good clinical results, lag screws do not meet the needs for rigid internal fixation in the treatment of mandibular condyle fractures.