Appearance 3 years following lip reconstruction, a frontal, b adequate opening of oral aperture. This study presented a simplified, systematic, and literaturebased strategy for planning lower lip reconstructions using efficient and reproducible. Along with the pharyngeal constric tors, the orbicularis and buccinator form a functional. Upper lip augmentation and lower lip reduction procedures in the class iii patient also tend to look and feel unnatural. Younger patients with a short philtral length may not have sufficient skin. Pribaz function the lips play an important role in both human physiology and culture. The white roll circumferentially outlines the upper lip at the border of the cutaneous element and the vermilion substance. This pdf is available for free download from a site hosted. While there are beautiful flap designs for reconstruction, the lip. Major defects of the lower lip have been repaired in many ways. The goals of lip reconstruction are both functional and aesthetic. Lip reconstruction connecticut stanislawmdstanislawmd.
As people age, their skin loses elastin and collagen, which give skin its firmness and ability to snap back into place. The flap designs for the second stage reconstruction are outlined. The healthy upper lip of the patient was extremely large, so that easily two lips could. A second surgery is necessary to reconstruct the commissure angle. Reconstruction of both upper and lower lips 171 excised in the nasolabial and lateral mental regions. Reconstruction of lower lip defect is a challenge for oral and maxillofacial surgeons. The incorporation of the labial mucosa guaranteed a complete and uncomplicated wound healing of the flap. Use old photos, taken before your intial surgeries to communicate with your surgeon your aesthetic ideals but be prepared to have staged reconstruction. Nasal and upper lip reconstruction of a case of squamous. The lower lip is much higher affected by scc than bcc and vice versa for the upper lip. In those patients who have had cancerous lesions, lip reconstruction should be a part of the complete management of their treatment. Established techniques, such as the abbeestlander flap, often require multiple procedures.
Reconstruction of the lip commissure with upper and lower lip fullthickness defects using submental and nasolabial flaps. The differences between lower and upper lip nmsc are obvious. My upper lip was damage extensively to the point where it looks like its burned. The latter flap has the disadvantage of causing microstomia, while the. 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. The split orbicularis myomucosal flap for lower lip. Total reconstruction of the upper lip using bilateral.
Thepurposeofthisstudywastofurther analyze larger upper lip. The lips contribute to chewing, speech, facial expressions, and oral competence. Surgical technique the split orbicularis myomucosal flap for. In fact, excellent results can be obtained under proper circumstances by. Two lower lip defects were reconstructed with estlander.
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. There is a wide array of reconstructive options for both the upper and lower lip. Feb 08, 2012 functional and cosmetic considerations must be included in any lip or chin reconstruction. Any patient who has suffered trauma to their lips, for example a dog bite or laceration, must be treated immediately. A central lip defect that extends from the defect to the base of the nasal columella would have no reserve skin for flap reconstruction. We reserve the abbe flap for transfixant philtrum and medial defects that cannot be reconstructed by direct closure, 1 as described previously. We have developed a new technique and successfully repaired a large defect in the upper lip of three men. Lip reconstruction list of high impact articles ppts. Lip reconstruction can generate a considerable challenge to the plastic surgeon in that the lips are the primary aesthetic and dynamic center of the lower third of the face. Reconstruction of the lower lip involved the rotation of a lateral area of the upper lip to the commissure. The division of the lips into aesthetic subunits can prove very beneficial in designing lip reconstruction procedures. A radial forearm flap has been thought to be ideal for reconstruction of the lower lip.
These flaps of skin are added to the injured lip to restore it. Reconstruction of oncologic defects of the eyelid, lips and ear. Some methods required incisions through nerves supplying the orbicularis oris and the flaps used for the lower lip reconstruction. This is more so when the resection is total and a complete lip has to be constructed. Lip reconstruction poses a particular challenge to the plastic surgeon in that the lips. Lip reconstruction can generate a considerable challenge to the plastic surgeon because of. Prelamination can combine reliable functional muscle transfers with thin. Luce for this important contribution to further clarify the approaches to upper lip reconstruction.
Sep 02, 2016 squamus cell carcinoma of the lip prophylactic neck dissection levels i, ii, iii, iv. A method for reconstruction of the lower lip following larger subtotal excision is described. Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. Lower and upper lips are the most important aesthetic and functional structures of the lower segment of the face. The nasal defect was closed with an internal mucosal advancement flap, a cartilage graft from concha of the ear, and a paramedian forehead flap for external reconstruction. Aesthetic upper lip reconstruction with vermilion submucosalpedicle cross lip flap mutsumi okazaki, md, tsuyoshi hisatomi, md,1 shunji sarukawa, md2 tokyo, japan the localized cutaneous amyloidosis occurring on the upper lip of a 48yearold man was surgically treated andaestheticallyreconstructed with vermil. 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 mental vy advancement flap is a useful reconstruction method for the cutaneous lower lip. Eyelid reconstruction, reconstruction of ear, reconstruction of lips. During the course of burn reconstruction, we often have to reconstruct the upper lip with tissue borrowed from the lower lip, a process called an abbe flap. Occasionally nlf is designed medial to the nasolabial fold. In this case, the lip reconstruction involved reconstruction of both the cutaneous and mucosal layers of the lip.
We present a case of lip reconstruction following a total resection of the upper lip. Accurate analysis of the defect and a thorough understanding of the anatomy and. Pdf total upper lip reconstruction with a free temporal. Tissue borrowing from the op posing lip was first described by sabattini in 1838,7andis. Respect for the anatomic landmarks of the lip, such as the white roll or vermilioncutaneous junction, allow for a cosmetically natural reconstruction. Simultaneous reconstruction of the upper and lower lips has been inconclusive and presents a challenge to the surgeon. Old age lower lip cancer defects reconstruction by abbe. Even small abnormalities can be apparent because of the prominent location on the face. Reconstruction of medium to large upper lip defect with a modified unilateral karapandzic flap. Original article aesthetic reconstruction of philtrum. 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.
Reconstruction of an aesthetically acceptable and functional upper lip requires a careful consideration of the transverse and vertical soft tissue, muscle, and skin deficiency. The split orbicularis myomucosal flap for lower lip reconstruction. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal. Due to these com plex functions, the reconstruction of lip defects can pose.
Lower lip reconstruction strategies introduction the upper and lower lips are the most important functional and aesthetic anatomical structures of the lower seg ment of the face. Not distorting the commissure is also desirable for upper lip reconstruction. Total lower lip reconstruction what techniques should. Full thickness excision marked for a lesion in upper lip. Technique for the reconstruction of oral commissure ijsrp. Apr 18, 2020 lip reconstruction surgery in these cases typically uses skin grafts. This leads to sagging skin and wrinkles, including those on the upper lip. Thus, when possible, in cases of lower lip reconstruction, tissues from the remaining lip should be employed or a flap should be taken from the upper lip, according to defect size and location 19. Endotracheal tube fastening devicerelated pressure. Reconstruction of both upper and lower lips sciencedirect. A flap used to reconstruct the lower lip must contain the appropri. Squamous cell carcinoma is one of the most common malignant tumors of the skin and oral mucosa. Reconstructive surgery in advanced perioral nonmelanoma. The defects varied in size and location, often extending beyond a single aesthetic subunit.
Advanced squamous cell carcinoma involving both upper and. Vermilion defects the vermillion is the most prominent feature. Functional lower lip reconstruction with bilateral cheek. Upper lip basal cell carcinoma reconstruction based on anatomical characteristics using skinmucosa double opposing vy advancement flap. The reconstruction of the upper lip following the tumor resection or trauma with abbe flap or its modified methods may not be always satisfactory because it leaves parallel scars extending to. Oral mucosa was stitched to skin to create a vermilion.
The modified estlander flap is based more medially to the initially proposed flap and seeks to avoid lip commissure deformations. Eleven patients underwent mohs surgery for basal cell carcinoma and one patient for squamous cell carcinoma of the upper lip. Aesthetic upper lip reconstruction with vermilion submucosalpedicle cross lip flap mutsumi okazaki, md, tsuyoshi hisatomi, md,1 shunji sarukawa, md2 tokyo, japan the localized cutaneous amyloidosis occurring on the upper lip of a 48yearold man was surgically treated andaestheticallyreconstructed with. Their role in aesthetic balance, facial expression, speech, and deglutination is not replicated by any other tissue substitute. Reconstruction of acquired lip deformities plastic surgery key. Original article aesthetic reconstruction of philtrum using deepidermized scar flap in secondary unilateral cleft lip ying xia1,2, qingqing fang 2,3, xiaofeng wang, wanyi zhao 2,3, weiqiang tan 1department of plastic surgery, shaoxing peoples hospital, shaoxing hospital. If there is a deep wound or hole in the lip, mucosa, or mucus membranes can also be used to fill in the area. Images in endotracheal tube fastening devicerelated pressure necrosis of the upper lip. Upper lip defects less than onefourth of total upper lip length are typically closed directly, but larger defects require reconstruction. The basic principle of lip reconstruction according to gillies is to repair the. In older patients, the upper white lip tends to be longer, so there often is sufficient skin. Lip reconstruction requires familiarity with the surface anatomy, underlying muscular anatomy, and neurovascular anatomy of the lower face. 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.
Reconstruction of acquired lip deformities evan matros julian j. For lower lip lesions, reconstruction with a distant flap is necessary if the defect is large. The lips are a focus of facial beauty, impact in patient self image and their central location does not permit concealment of unsightly scars. Immediate postoperative photograph of the upper lip reconstruction with bilateral reverse karapandzic flap. Outcomes following vy advancement flap reconstruction of. Accurate analysis of the defect and a thorough understanding of the anatomy and options for reconstruction will maintain the functional and aesthetic quality of this sensitive area. Upper lip basal cell carcinoma reconstruction based on. Seven useful surgical approaches are discussed, and an algorithm to assist in deciding which reconstructive option to use is provided. The number and variety of technics available for lip reconstruction has suggested to some authors that no method is ideal. Functional reconstruction of the upper and lower lips and. However, the lower lip contains the orbicularis oris muscle, which plays an important role in oral sphincter function, which is. Upper lip reconstruction after a dog bite journal of oral medicine. Upper lip reconstruction is accomplished with the excision of four triangles of cheek skin, and lower lip reconstruction with the excision of three triangles. The aesthetic or functional abnormalities that prompted revision surgery and the specific techniques.
Reconstruction of a large upper lip defect with severe associated injuries by the combination of the kazanjian and abbe flaps janos varga1, sandor pinter2, mark antal3, akos varga4, lajos kemeny5, katalin nagy6 and gabor braunitzer7. Gordon buck, during the civil war, was the first surgeon in the englishspeaking world to describe a cross lip reconstruction. Reconstruction of the lower lip university of michigan. The upper lip is composed of the philtrum and tubercle centrally, the paired philtral. Reconstruction of the lip commissure with upper and lower lip. Original article outcomes following vy advancement.
Some of these procedures employed flaps without regard for the facial grooves or landmarks. Various methods have been employed for such wide defects. Methods all patients presenting to the senior author y. When the nasolabial flap is used for reconstruction of the upper lip lateral subunit and lateral limit of the resected skin falls medial to the nasolabial fold and second. Of these, some employed flaps from the chin, cheek or upper lip. As a result of the relatively lower incidence of cancer, the reconstructive techniques for defects of the upper lip are fewer than lower lip. Oral competence, muscle integrity, and adequate stomal aperture are critical to a functional lip reconstruction. Pdf lip reconstruction poses a particular challenge to the plastic surgeon in that the lips are the dynamic center of the lower. Hence, reconstruction of new lip tissue with non lip tissue is necessary, such as the websterbernard, 810 mcgregor, 11 nakajima12, and free flap. The place of nasolabial flap in orofacial reconstruction. However, squamous cell carcinoma involving near total upper and lower lip and oral commissure is rarely seen in the english literature.
Reconstruction of skin cancer defect by sam naficy, md, seattle plastic surgeon. Surgical technique the split orbicularis myomucosal flap. The upper and lower lips are the most important func tional and aesthetic anatomical structures of the lower seg ment of the face. Medical devices are a significant cause of preventable pressure injury in critically ill patients with nasogastric tubes and etts. Although these were originally described as fullthickness excisions, these are generally performed as cutaneous excisions only. Prelamination can combine reliable functional muscle. Upper lip reconstruction is a surgical challenge due to the high level of lip anatomy detail. Strategies for closure involve borrowing tissue eitherfrom theopposite lip or from the cheek. 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 main causes of upper lip wrinkles the most common cause of upper lip wrinkles is natural aging. In addition, it can restore lip volume without any difficulties. Individual patient factors, such as previous operations, underlying comorbidities, compliance, and mechanisms for the wound defect, may affect choices of reconstruction. To be fair to the patient and his or her family, the limitations of compensating orthodontics followed by surgical camouflage should be disclosed before the initiation of treatment. The problem with the upper lip is the uneven lip line new reconstructive surgery is necessary plus the scarring.
Jan 18, 2012 squamous cell carcinoma is one of the most common malignant tumors of the skin and oral mucosa. The innervated levator anguli oris flap is composed of the levator anguli oris muscle with overlying skin and mucosa. Conclusions reconstruction of large upper lip skin defects with a vy subcutaneous tissue pedicle advancement flap is associated with a 47% revision rate, and when the defect involves the ala or vermilion, the revision rate is increased. Reconstruction of cupids bow and the white roll is crucial in preserving the aesthetic nature of the lip. The muscles must be carefully repaired to avoid numbness in the lip. This has led to the development of a like for like reconstruction using the abbe or estlander flap for upper lip and commissural defects respectively. Larrabee, jr, md procedure selection for surgical reconstruction of lip defects depends on the location and extent of the defect. One half to two thirds of lower lip defects larger than one half of the lip cannot be closed primarily without undue wound tension. Although many techniques use hairbearing flaps to repair large upper lip defects in men, few preserve orbicularis sphincter function.
Successful reconstruction of the upper lip attempts to maintain the anatomic relationship of the philtrum central portion of upper lip and the base of the nose. Functional lower lip reconstruction with a forearm flap. The upper lip is composed of the philtrum and tubercle centrally, the paired philtral columns laterally, and the white roll of the vermiliocutaneous junction. Aesthetic upper lip reconstruction with vermilion submucosal. Total upper lip reconstruction with a free temporal scalp flap. 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. Casereportcaseseries bilateraltranspositionlipflaps. Aesthetic reconstruction for large upper lip defects in men. A defect or irregularity of the vermilion spoils the appearance of an otherwise excellently repaired lip. Vermilion reconstruction is a complementary operation of lip reconstruction.
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