For the upper lip, defects of up to 14 25% of the lip may be closed primarily. Even small abnormalities can be apparent because of the. Lower lip carcinoma reconstruction using abbe estlander flap. The most common reason for creation of a lip defect is to remove a lip cancer. Aug 01, 2001 reconstruction of the lower lip cook, jonathan lambert 20010801 00. We report the case of an advanced squamous cell carcinoma involving both the upper lip, lower lip, left oral commissure and buccal area and simultaneous reconstruction with local flap coverage that, to the best of our knowledge, has never been reported. Surgical technique the split orbicularis myomucosal flap. Functional lower lip reconstruction with the modified. If there is a deep wound or hole in the lip, mucosa, or mucus membranes can also be used to fill in the area. Lower lip reconstruction using unilateral nasolabial gate. Strategies for closure involve borrowing tissue eitherfrom theopposite lip or from the cheek. Reconstruction of the lip commissure with upper and lower. The goals of lip reconstruction therefore should be to restore the complex function and form of this anatomical unit.
The method is based on the principle introduced by stein and modified by estlander, abbe, kazanjian, and converse, and seems to be especially valid in cases of older patients with redundant upper lip tissue. Various plans of lip reconstruction with switched flaps the patient was returned to the operating room where the flaps were separated and wider excision was obtained from the lower lip. Since the early nineteenth century, several techniques have been described for lower lip reconstruction. No gold standard in the reconstruction of both upper and lower lips has been established.
After successfully completing the written examination, the candidate will register for the oral examination. Reconstruction of total lower lip and chin defects using the. For the reconstruction of defects of the lateral parts of the lower lip the abbe or estlander cross lip transposition flap may alternatively be employed depending on involvement of the commissure 21. Lip chin cancer surgery skin cancer surgery treatment. Reconstruction of the lower lip, dermatologic surgery 10. During this period, one patient who underwent reconstruction with a myomucosal flap and. A case report yuxing guo, md 1 chi mao, md1 1department of oral and maxillofacial surgery, peking university school and hospital of stomatology, beijing, china facial plast surg 2016. Giles fa gillies fan flap for lower lip reconstruction. Its potential disadvantages include notching of the central lip incision and effacement of the gingivobuccal sulcus. The most common type of lip surgery is lip augmentation sometimes referred to as lip enhancement surgery.
Functional and cosmetic considerations must be included in any lip or chin reconstruction. Modified gate flap for lower lip reconstruction springerlink. Innovative insertion of the palmaris major tendon after lower lip reconstruction. During the last 12 years, 17 patients with scc of the lower lip t2, n0, m0 were treated by surgery and lip reconstruction was performed by staircase n 12 or modified staircase technique n 5. Nov 07, 2016 general considerationsgeneral considerations for upper lip reconstruction, lower lip can be used, butfor upper lip reconstruction, lower lip can be used, but vice versa is avoided. A method for reconstruction of the lower lip following larger subtotal excision is described. For the lower lip, defects of up to of the lip may be closed primarily. Patients underwent assessments at 2, 4, 6, 12, and 18 months postoperatively. So the partialthickness crosslip flap was elevated sparing the orbicularis oris muscle of the lower lip, and normal movement and expression were restored in both the upper and lower lips.
This is the lip reconstruction technique used when more than seventyfive percent of the lip is affected by the defect. Lip defects can be classified according to thickness of the defect ie, skin or mucosa only, fullthickness and overall size of the defect. Local flaps are useful for reconstructing sensate lips. The main objectives in lip reconstruction after tumoral mass resection are functionality and esthetics. Reconstruction of large full thickness defect of the lower lip reconstruction of large full thickness defect of the lower lip 20011001 00. The mental vy advancement flap is a useful reconstruction method for the cutaneous lower lip. We present a case of lip reconstruction following a total resection of the upper lip. Any reconstruction of the lips must include both functional and cosmetic considerations. Lip reconstruction list of high impact articles ppts. Lip reconstruction and aesthetics are the main focus of reconstructive, cleft and.
Reconstructed lower lip 3 months postoperative i in modified fig. Lip reconstruction can generate a considerable challenge to the plastic surgeon because of their role in aesthetic balance, facial expression. Outcomes following vy advancement flap reconstruction of. Evaluation of bilateral mental nerve block as an alternative. This wound will be closed by moving the inside of the lower lip. Lip reconstruction connecticut stanislawmdstanislawmd. One stage reconstruction of large lower lip carcinoma. Modern surgical technics of lip reconstruction were developed in the mid1800s, and basics principles have not changed significantly since then 2, 3. Fusuma sliding flap for lip reconstruction of lower lip.
The primary goals of cheek reconstruction include the restoration of native function, maximization of aesthetic outcome, and limitation of repair related morbidity. Gordon buck, during the civil war, was the first surgeon in the englishspeaking world to describe a cross lip reconstruction. Risks of a vermilionectomy there are risks and complications with this procedure. Vermillion reconstruction with anal verge transitional. Aesthetically, facial units should be reconstructed with adequate tissue match in terms of colour and texture, aiming at symmetry as well as preservation of the apparent. The use of submental island flap for total lower lip reconstruction. The tumor was removed in two surgical stages, and the wound that resulted from tumor removal measured 2. Nasolabial flap reconstruction in oral cancer world journal. Reconstruction of small lip can be achieved with lip advancement primary closure if located in the middle to lower lip, but this might require excising a standing cutaneous deformity of the red lip.
Oct 30, 2012 the nasolabial flap is a simple flap used for reconstructing small intraoral defects created after the excision of malignant tumors. Care should be taken when planning this flap in patients who have had previous. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and. Jun 15, 2018 a number of surgical procedures for the repair of a unilateral cleft lip are well described, with a multitude of variations, including the lemesurier quadrilateral flap repair, randalltennison triangular flap repair, millard rotationadvancement repair, 14, 15 and skoog and kernahanbauer upper and lower lip zplasty repairs. Jan 18, 2012 the principle of lip defects involves reconstruction with the remaining or opposite lip but there are no existing studies that describe simultaneous reconstruction of both upper and lower lips. Reconstruction for a large lower lip defect is surgically challenging, especially reconstruction with local flaps.
In 22 cases, the excision was combined with neck dissection and facial artery ligation. The mas gradually became larger until it causes both cosmetic and functional problems. Evaluation of bilateral mental nerve block as an alternative to general anesthesia for resection of lower lip tumors abstract fulltext html xml download as pdf size. The split orbicularis myomucosal flap for lower lip reconstruction.
First lip reconstruction was performed in 25 ad by a roman surgeon who made relaxing incisions in the cheek to close defect of the lower lip 1. Lower lip reconstruction using the karapandzic technique. The defect involved the full thickness of the vermilion as well as adjacent cutaneous lip and measured 4. Pdf lip reconstruction poses a particular challenge to the plastic surgeon in that the lips are the dynamic center of the lower third of the face find, read and cite all the research you. However, with time, the philtrum will tend to return to its midline position. Jun 30, 2010 large lower lip defects karapandzic flap may be used in lesions up to 80% of lip, may cause microstomia bernardburows procedure provides new lip tissue, but sensation and competence problems can lead to drooling free flap may be needed in massive defects or those with insufficient lip or cheek tissue for reconstruction.
Apr 10, 2020 upper lip reconstruction is more difficult than lower lip reconstruction because the upper lip has a central structure, the philtrum. Because the chin is a very visible aesthetic unit, incisions should be planned where there is minimal chin distortion. Download file pdf local flaps in facial reconstruction 3e local flaps in facial reconstruction 3e getting the books local flaps in facial reconstruction 3e now is not type of challenging means. We present the case of an 81yearold male with a past medical history of squamous cell carcinoma of the maxilla. Larger lower lip defects reconstruction can be done using an inferiorly based or bilateral inferiorly based melolabial flaps. Squamous cell carcinoma scc is the most common malignancy of the lower lip, and depending on its size, can be infiltrative and destructive. Upper and lower lip soft tissue thicknesses differ in. Tissue borrowing from the op posing lip was first described by sabattini in 1838,7andis. But there are other types of lip procedures as well. Old age lower lip cancer defects reconstruction by abbe. You could not deserted going subsequent to books hoard or library or borrowing from your associates to entry them. All or part of the visible lower red lip will be removed. Here, the authors report their use of this method for lip reconstruction in a 94yearold japanese female after the removal of a cancerous mass.
One stage reconstruction of large lower lip carcinoma, with local flaps author. Reconstruction of neartotal loss of the upper and lower lips. The repair is completed in two treatments, which are at least two weeks apart. Reconstruction of the lower lip journal of plastic, reconstructive. Pdf lip reconstruction poses a particular challenge to the plastic surgeon in that the lips are the dynamic center of the lower third of the face find, read and.
Small defects of the upper and lower lip can be closed primarily. Although, tobacco use has also been implicated in their formation. Address correspondence and reprint requests to minoru miyake, dds, phd, department of oral and maxillofacial surgery, faculty of medicine, kagawa university, 17501 ikenobe, miki. Lower lip li the point denoting the vermillion border of the lower lip in the. Reports of simultaneous upper and lower lip reconstruction are rare. One of the latest techniques advocated for total lower lip reconstruction is thegate flap described by fujimori in 1980 3.
Reconstruction of skin cancer defect by sam naficy, md, seattle plastic surgeon. Plastic and reconstructive surgery wiley online books. Request pdf lip reconstruction the lips are the main feature of the lower third of the face. Individual patient factors, such as previous operations, underlying comorbidities, compliance, and mechanisms for the wound defect, may affect choices of reconstruction. Reconstruction of the lip commissure with upper and lower lip fullthickness defects using submental and nasolabial flaps. The nasolabial crease separates the upper and lower lips from the cheeks and the labiomental crease separates the lower lip from the chin. The modified estlander flap is based more medially to the initially proposed flap and seeks to avoid lip commissure deformations. Four patients undergoing labioplasty and lip reconstruction.
Extended karapandzic flap technique for reconstruction of lower. For the reconstruction of defects of the lateral parts of the lower lip the abbe or estlander crosslip transposition flap may alternatively be employed depending on involvement of the commissure 21. In this groundbreaking textbook, contemporary approaches are explained and demonstrated to allow trainee and experienced surgeons alike to understand and assimilate best practice. All of the flaps described below can be used on the upper or lower lip. In this case, the lip reconstruction involved reconstruction of both the cutaneous and mucosal layers of the lip. Large lower lip defects karapandzic flap may be used in lesions up to 80% of lip, may cause microstomia bernardburows procedure provides new lip tissue, but sensation and competence problems can lead to drooling free flap may be needed in massive defects or those with insufficient lip or cheek tissue for reconstruction. Upper and lower lip soft tissue thicknesses differ in relation to age and sex. This is a perfect technique in cases where more than half of the lip is affected by the defect. When reconstructing lip defects, it is important to consider not only the cosmetic appearance of the reconstruction but also the functional aspect of the lip. Squamous cell carcinoma most frequently occurs in the mucosa of the lower lip. Here, we present a 52yearold male with a large t3 scc, which started years before this treatment and involved nearly all of his lower lip, oral commissure and upper lip. Pelly and engpeng tan plastic surgery unit, the prince of wales hospital, randwick, sydney, australia summarymany well recognised and widely used methods of reconstruction of the lower lip. Supplementary appendix this appendix has been provided by the authors to give readers additional information about their work.
The patient noticed a small mass on the left side of the lower lip about 20 years ago. Address for correspondencechi mao, md, department of oral and. Choosing the repairing procedure for larger lower lip defects must take into account two aspects. Wounds adjacent to the philtrum that are closed primarily may shift the philtrum to the affected side. In some cases, surgeons will attempt vermillion reconstruction with the use of a skin graft. Lip chin skin cancers can and do affect the lip and its surrounding structure. Advanced squamous cell carcinoma involving both upper and. Reconstruction of total lower lip and chin defects using. A retrospective analysis of 26 cases of oral cancer treated with primary excision and nasolabial flap reconstruction was carried out. Lip cancer represents between 1215% of all oral cavity cancers. Cancers of the upper lip are less common but are more aggressive and more likely to.
Reconstruction of a lower lip deformity associated with leakage of saliva drooling and food spillage is challenging. Total reconstruction of the upper lip using bilateral. Squamous cell carcinoma scc of the lower lip is a frequently diagnosed malignant pathology in the maxillofacial region. Lip reconstruction after tumor ablation world journal of plastic. One stage reconstruction of large lower lip carcinoma, with. In many burn patients, performing one of these vermillion reconstruction options, such as an abbe flap, could worsen a patient already troubled by microstomia by further tightening the lower lip. We describe a case of squamous cell carcinoma of lower lip in a. The use of submental island flap for total lower lip. Mar 27, 2015 plastic and reconstructive surgery continues to evolve as new techniques open up new possibilities for the surgeon. In the flap donor site, the two zplasties were additionally. Lip reconstruction is the process of maintaining oral competence, sufficient oral access and preservation of sensation after severe injury, burn or in case of lip cancer.
In addition, it can restore lip volume without any difficulties. Lower lip reconstruction is more significant, because oral competence depends greatly on a functional lower lip having good muscular function, adequate height and sensation. This is more so when the resection is total and a complete lip has to be constructed. In 2017, he consulted us for resection of the lesion and correction of his lower lip. Lower lip reconstruction strategies patient had a lesion covering 90% of the lower lip that was reconstructed using the websterbernard technique and a tongue flap figure 7, table 1. Implicit in this statement is the intent to reestablished both internal and external coverage, expressivity, masticatory function and aesthetic contour and quality. Lip reconstruction surgery in these cases typically uses skin grafts. Reconstruction of the lower lip and chin with the composite radial forearmpalmaris longus. Luce et al concluded that general concepts for lower lip reconstruction are primary closured with vw or vy flap when defect size is less than one third lip. Address correspondence and reprint requests to minoru miyake, dds, phd, department of oral and maxillofacial surgery, faculty of medicine, kagawa university, 17501. Summarya modification of the classic gillies fan flap as used in reconstructing full thickness defects of the lower lip is described. These flaps of skin are added to the injured lip to restore it. To achieve complete closure of the mouth, the lips must have a sufficient and.
Defect of 30% of the upper or lower lip can be closeddefect of 30% of the upper or lower lip can be closed primarily great elasticity of. Defects that involve up to two thirds of the lips are reconstructed with local flaps, with tissue borrowed from the opposite lip, the remaining lip, or the adjacent cheek. Reconstruction of medial lower lip defects after tumour. 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. A composite flap from the lower lip supplied by the labiomental branch of the fa can be used to restore combined defects of the upper lip and nose or partial defects of the lower lip. However, they tend to result in tight lips due to a lack of tissue volume. The defect involved the full thickness of the vermilion as well as adjacent cutaneous lip and.
Cutaneous lower lip can be reconstructed with a variety of flaps from the chin and submandibular area. This is sewn to the skin below the red lip to make a new lower lip. Oct 01, 2001 reconstruction of large full thickness defect of the lower lip 20011001 00. Reconstruction of the lower lip involved the rotation of a lateral area of the upper lip to the commissure. The lips are considered the beginning of the oral cavity and are the most common site of oral cancer. Reconstruction of large full thickness defect of the lower lip. General considerationsgeneral considerations for upper lip reconstruction, lower lip can be used, butfor upper lip reconstruction, lower lip can be used, but vice versa is avoided. Mergime prekazi loxha, fellanza gjinolli, osman sejfija, aida rexhepi, zana agani subject. All but one patient were caucasian male, a single female was included. Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. Cancers of the lower lip are most common and most often caused by sun exposure.
In large defects involving both upper and lower lips, it is difficult to achieve all the goals of lip reconstruction but we desired to achieve both an. The muscles must be carefully repaired to avoid numbness in the lip. The oral examination will contain a section of theory and practice and a. All lip defects were caused by resection of a squamous cell carcinoma that required repair by the plastic surgery team. This technique has been modified and used in two patients. Lip reconstruction may be required after trauma or surgical excision.