Inferior labial artery an overview sciencedirect topics. The abbe flap is an excellent choice for reconstruction of fullthickness defects of the lip excluding the oral commissure. Many lip repair techniques are aggressive requiring general anesthesia and a prolonged postoperative period. A method for reconstruction of the lower lip following larger subtotal excision is described. In large defects of the lower lip, the challenge is to accomplish a result that meets the criteria of successful reconstruction. For total upper, lower, or extensive combined softtissue. The authors describe a modification of the karapandzic lower lip reconstruction technique in which the flaps are extended by recruiting tissue from the perioral cheek, allowing reconstruction of. Lower lip reconstruction using unilateral nasolabial gate.
The sensory innervation of the lower lip is provided by the mental nerve. Total reconstruction of the upper lip using bilateral. Early view after tumor excision and reconstruction, d. For more than 100 years, it has remained a versatile technique for upper and lower lip reconstruction, providing good functional and aesthetic results. Lower lip carcinoma reconstruction using abbe estlander flap.
As a result of the relatively lower incidence of cancer, the reconstructive techniques for defects of the upper lip are fewer than lower lip. Lip reconstruction can generate a considerable challenge to the plastic surgeon because of their role in aesthetic balance, facial expression, speech and deglutination. Any reconstruction of the lips must include both functional and cosmetic considerations. Seven useful surgical approaches are discussed, and an algorithm to assist in deciding which reconstructive option to use is provided. Surgical technique the split orbicularis myomucosal flap. The lips are a focus of facial beauty, impact in patient self image and their central location does not permit concealment of unsightly scars. Lip defects can be classified according to thickness of the defect ie, skin or mucosa only, fullthickness and overall size of the defect. Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. During the last 2 years in the oral and maxillofacial surgery department of the county emergency clinical hospital in tirgu mure. During the treatment, microstoma developed, which was corrected by commisurotomy and mucosa plasty in the final phase of the series of operations. Subtotal lip reconstruction using an innervated free gracilis muscle flap.
Their role in aesthetic balance, facial expression, speech, and deglutination is not replicated by any other. Modified extended karapandzic flap for large lower lip. The lips are considered the beginning of the oral cavity and are the most common site of oral cancer. T2 n0 squamous cell carcinoma subtotal lower lip defect reconstructed with a karapandzic flap. 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. Upper lip reconstruction special considerations include presence of central structures cupids bow, philtrum in men, facial hair aids in hiding scars in men, nonhairbearing flaps brought into hearbearing areas can be noticeable the upper lip is less important in oral competence more lower lip tissue can be borrowed.
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. We describe our approach to lip repair and present novel methods to maintain symmetry and function, and optimize cosmetic results. The estlander flap is a hardy local flap which can be used to reconstruct defects of 23 of both the upper and lower lip. There were concomitant chin and mandible defects in three and four patients. The infraorbita nerve provides sensation to the upper lip, cheek, ala, and nasal sidewall. This is more so when the resection is total and a complete lip has to be constructed. Individual patient factors, such as previous operations, underlying comorbidities, compliance, and mechanisms for the wound defect, may affect choices of reconstruction.
Vermilion defects the vermillion is the most prominent feature. Facial defects have a significant impact on patient quality of life that has been well demonstrated. The nasolabial crease separates the upper and lower lips from the cheeks and the labiomental crease separates the lower lip from the chin. Reconstruction of lateral lower lip defects with transverse lip advancement flap. Seven useful surgical approaches are discussed, and an algorithm to assist in deciding which reconstructive. Jagadeesh abstract department of plastic surgery, medical college, calicut. 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. Plastic and reconstructive surgery ebook pdf free download edited by ross d. Sep 02, 2016 squamus cell carcinoma of the lip prophylactic neck dissection levels i, ii, iii, iv. Pdf myomucosal lip island flap for reconstruction of. 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. The etiology was squamous cell carcinoma in six patients, malignant melanoma in one, firearm injury in three and microstomia in two. Pericommisural defect reconstruction using the abbe or estlander flaps tend to pilfer tissue from the lower lip, contributing to microstomia, with its attendant problems. Functional reconstruction of lower lip with free s.
Jun 30, 2010 upper lip reconstruction special considerations include presence of central structures cupids bow, philtrum in men, facial hair aids in hiding scars in men, nonhairbearing flaps brought into hearbearing areas can be noticeable the upper lip is less important in oral competence more lower lip tissue can be borrowed. 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. Methods all patients presenting to the senior author y. Original article fan flaps for cheiloplasty lower lip reconstruction. Bulstrode and sabrina cugno approaches and techniques published by wiley blackwell. The patients underwent lip reconstruction using the karapandzic technique, which was first described in 1974. During this period, one patient who underwent reconstruction with a myomucosal flap and. Novel flaps for lip reconstruction skin therapy letter.
Lower lip reconstruction is more significant, because oral competence depends greatly on a functional lower lip having good muscular function, adequate height and sensation. Reconstruction of the lower lip due to subtotal and total tissue defects was performed using latissimus dorsi free flap on twelve patients, between 20 and 2017. Vshaped lower lip flap based on the inferior labial artery and designed opposite the area of defect for the central upper lip region. The split orbicularis myomucosal flap for lower lip. Lip reconstruction after tumor ablation world journal of plastic. Reconstruction of the lips requires careful attention to aesthetic and functional goals. Reconstructed lower lip 3 months postoperative i in modified fig. Lower lip reconstruction with nasolabial flap going back. Lip reconstruction for defects which involve the commissure remains a significant challenge to the facial plastic surgeon. 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. A a 21yearold man with a sclerosing basosquamous cancer of the left inner lower lip and chin. In the second step, a bilateral symmetric staircase flap is used to complete the lower lip reconstruction described above fig. 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 modification of the classic gillies fan flap as used in reconstructing full thickness defects of the lower lip is described.
Modified bernardburow cheek advancement and crosslip. Functional lower lip reconstruction with the partial. Estlander flap for lip reconstruction sciencedirect. The lips are very important aesthetic and functional unit of the face during articulation, mastication, smile, kissing and oral competence.
A new technique for onestage total lower lip reconstruction. Outcomes following vy advancement flap reconstruction of. A modification of the webster flap zilinsky 2001 dermatologic surgery wiley. Larrabee, jr, md procedure selection for surgical reconstruction of lip defects depends on the location and extent of the defect. The labiomandibular flap for upper lip and pericommissural. The right oral commissure and 50% of the lower lip were excised. Gordon buck, during the civil war, was the first surgeon in the englishspeaking world to describe a cross lip reconstruction. Reconstruction of total lower lip and chin defects using the. Patient reports that over the past 6 years the lesion has increased in size, has bled at intervals, and was not healing. Mcgraw hill medical, new york, chicago, san francisco, lisbon, london, madrid. Postburn scar sequelae in this area often result in cosmetic disfigurement and psychological upsets in patients, especially young adult females.
Lip reconstruction surgery in these cases typically uses skin grafts. The total lip defects resulted from tumor resection n6, trauma n3, and noma n1. We describe a case of squamous cell carcinoma of lower lip in a. The nasolabial flap, while a common flap for the repair of other facial defects, is an underrecognized option for the reconstruction of the lower lip. They are particularly notorious due to the polymicrobial nature of human saliva inoculated in the wound and the risk they pose for transmission of infectious diseases. The method is suitable for defects involving part of the width of the lip up to defects of the entire lip. Old age lower lip cancer defects reconstruction by abbe. Reconstruction of small to medium lower lip defects commonly includes mucosal advancement and wedge excision with primary closure. Microvascular free flap is the main choice for lip cancer reconstruction recently but still have several. The upper lip receives its sensibility from the infraorbital nerve, which is a branch of the maxillary division of the trigeminal nerve.
Total lip reconstructive efforts usually are suboptimal in providing an adequate oral sphincter, an acceptable aesthetic result, or both. In this study, we aim to design a flap for more superficial defects, in which the underlying orbicularis oris muscle can be preserved when resecting pericommisural skin. Reconstruction of large defects of the lower lip after mohs. Pdf plastic and reconstructive surgery ebook free fbfa. In the second stage of the lip reconstruction, cross lip flap abbe was used to restore the symmetry and volume of the upper and lower lips figure 4. Early treatment, appropriate prophylaxis and surgical evaluation are the key to achieving desired treatment outcomes. Mohs surgery and other surgical techniques are used for the removal of squamous cell carcinoma of the lower lip and may leave a large defect in the vermilion and underlying tissue. Reconstruction of lower lip defect is a challenge for oral and maxillofacial surgeons. The aesthetic or functional abnormalities that prompted revision surgery and the specific techniques. Seven years ago, the patient underwent mohs surgery for the same diagnosis on the lower lip. These flaps of skin are added to the injured lip to restore it. The planning and choice of operative methods depended on the quality of the surrounding tissue and the patients age, sex, occupation, and general health.
Lower lip reconstruction with nasolabial flap going back to basics. Clinical study sensory recovery with innervated and. Pdf lip reconstruction poses a particular challenge to the plastic surgeon in that the lips are the dynamic center of. Lower lip reconstruction using the karapandzic technique.
We present a case of lip reconstruction following a total resection of the upper lip. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal. Mimicking lip features in freeflap reconstruction of lip defects. This pdf is available for free download from a site hosted by medknow publications. If the inline pdf is not rendering correctly, you can download the pdf file here. This report includes 2 cases of large lower lip defects, affecting 80% and 60% of the surface structure that resulted from lacerationcontusion trauma and epidermal tumor resection, respectively. The muscles must be carefully repaired to avoid numbness in the lip. The scalp visor flap offers a simple but extremely versatile tool for use in midfacial reconstruction, especially in the male, providing neo lip tissue, a moustache and a beard.
Reconstruction was performed with a folded radial forearm flap with a strip of skin measuring 3. This procedure was used in 5 patients with 80100% lip defect resulting from squamous cell carcinoma. Reconstruction of the lips is a challenging task for the dermatologic surgeon. Patients underwent assessments at 2, 4, 6, 12, and 18 months postoperatively. The following is the supplementary data related to this article. The goal of this study is to describe our experience with composite free radial forearmpalmaris longus tendon flap for total or near total lower lip reconstruction.
The authors describe a new technique of onestage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome. Lower and upper lips are the most important aesthetic and functional structures of the lower segment of the face. The lower lip reconstructed by this method has good appearance and this method is easy to be master. Human bite injuries are both deceptive and challenging in their presentation and management. We recently repaired a modified extended karapandzic flaps to reconstruct total or near total lower lip defects. Reconstruction of the lip commissure with upper and lower lip fullthickness defects using submental and nasolabial flaps. Pdf on jan 23, 20, aditya sood and others published lower lip reconstruction.
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. Apr 15, 2019 reconstruction of lateral lower lip defects with transverse lip advancement flap. Total lower lip reconstruction with innervated muscle. This is the first report of a simultaneous total upper and lower lip reconstruction using a scalp visor flap, in the english literature. Hence, reconstruction of new lip tissue with non lip tissue is necessary, such as the websterbernard, 810 mcgregor, 11 nakajima12, and free flap. D associate chief, department of reconstructive surgery and head and neck. The goals of lip reconstruction therefore should be to restore the complex function and form of this anatomical unit. Reconstruction of total lower lip and chin defects using. The patient is a 61 year old man with a shave biopsy proven squamous cell carcinoma scc of the lower lip. Lip reconstruction may be required after trauma or surgical excision.
The goals of lip reconstruction include oral competence, speech, and cosmesis. Rbcp lower lip reconstruction using the karapandzic technique. Visor flap for total upper and lower lip reconstruction. Total lower lip reconstruction using free neurotendinofasciocutaneous anterolateral thigh composite flap.
Griffin and coauthors analyzed larger upper lip skin defects repaired with vy advancement flap reconstruction to identify defect characteristics that might predict the need for revision surgery. The lip is a part of the face that is frequently affected by burn injury. Total lip reconstruction with tendinofasciocutaneous radial. If there is a deep wound or hole in the lip, mucosa, or mucus membranes can also be used to fill in the area. Microvascular free flap is the main choice for lip cancer reconstruction recently but still have several morbidities presented, especially for elderly, like long surgical time and difficulty in denture fabrication. Importance the reconstruction of cutaneous defects of the cheek and lip is a foundational topic for facial plastic and reconstructive surgeons. Lip reconstruction, modified extended karapandzic flap, depressor anguli oris. This study compares innervated and denervated flaps for the lower lip reconstruction in terms of oral sphincter function and sensation. Reconstruction of the lip commissure with upper and lower lip. Aug 01, 2018 lip defects can be classified according to thickness of the defect ie, skin or mucosa only, fullthickness and overall size of the defect. We present 3 patients with large defects of the lower lip from tumor ablation who underwent satisfactory reconstruction with a new method not previously descried in the englishlanguage literature. A case of lower lip carcinoma in which reconstruction was performed with a lateral tongue flap based on the tongue dorsum. Lower lip reconstruction using unilateral nasolabial gate flap fujimori technique.