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. Reconstruction of its lesions is very important and offers a unique challenge to the surgeon. Lower lip reconstruction is more significant, because oral competence depends greatly on a functional lower lip having good muscular function, adequate height and sensation. According to this amount, defects are characterized as small, medium, or large. Lip cancer represents between 1215% of all oral cavity cancers. Defects considered small are those involving less than or equal to one horizontal third of the upper or lower lip. The lip and cheek serve key functional and aesthetic roles with regard to the face. Optimal reconstruction of extensive upper lip and scalp defects is achieved with local tissue that best mimics the normal face color, texture, and hairbearing qualities. Division of the left nasolabial flap and the forehead flap was done at the same time figure 6 and figure 7. Some children have a cleft lip or cleft palate because of changes in their genes. Not distorting the commissure is also desirable for upper lip reconstruction. Additionally, the lips are critical in eating and speaking. The split orbicularis myomucosal flap for lower lip reconstruction. The upper lip is composed of the philtrum and tubercle centrally, the paired philtral columns laterally, and the white roll of.
The lip is a part of the face that is frequently affected by burn injury. 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. Lower lip reconstruction using unilateral nasolabial gate flap fujimori technique. Nasal and upper lip reconstruction of a case of squamous cell. Outcomes following vy advancement flap reconstruction of. Basal cell cancers typically occur on the upper lip whereas squamous cell cancers occur on the lower lip. Their role in aesthetic balance, facial expression, speech, and deglutination is not replicated by any other. The muscles must be carefully repaired to avoid numbness in the lip.
Address for correspondencechi mao, md, department of oral and. 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. Lips are also common sites for occurrence of skin cancers. Nasal and upper lip reconstruction of a case of squamous. The main objectives in lip reconstruction after tumoral mass resection are functionality and esthetics. Due to their specialized structure, the lips and cheek pose special challenges when they are in need of reconstruction. There are many conditions that could benefit from a lip reconstruction such as trauma, congenital deformities, removal of cancerous lesions, or paralysis of facial nerve. Lower lip carcinoma reconstruction using abbe estlander flap. One half to two thirds of lower lip defects larger than one half of the lip cannot be closed primarily without undue wound tension. Aug 06, 2017 i had lip reduction a couple years ago because my bottom lip was huge and they were chapped 247. The use of submental island flap for total lower lip 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.
The aesthetic or functional abnormalities that prompted revision surgery and the specific techniques. Primary closure of the lip is the simplest technique for small defects. 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. Mcgraw hill medical new york chicago san francisco lisbon london madrid mexico. Jan 12, 2015 chapter 22 lip reconstruction introduction. Livestock indemnity program february 2020 fact sheet. Lip reconstruction list of high impact articles ppts. Any reconstruction of the lips must include both functional and cosmetic considerations. Lips serve a vital role in cosmetic beauty of the face and are an important. Total upper lip reconstruction with a free temporal scalp flap. The defect of the upper lip was covered with a fan flap with incorporation of zplasty flap.
Corrective 3d reconstruction of lips from monocular video. Postburn scar sequelae in this area often result in cosmetic disfigurement and psychological upsets in patients, especially young adult females. If there is a deep wound or hole in the lip, mucosa, or mucus membranes can also be used to fill in the area. Squamous cell carcinoma most frequently occurs in the mucosa of the lower lip. Plastic and reconstructive surgery continues to evolve as new techniques open up new possibilities for the surgeon. We present a novel approach to extract high quality lip shapes bottom from just monocular video footage top based on a learned. The mental vy advancement flap is a useful reconstruction method for the cutaneous lower lip. Pdf total upper lip reconstruction with a free temporal. Lip reconstruction requires familiarity with the surface anatomy, underlying muscular anatomy, and neurovascular anatomy of the lower face. One stage reconstruction of large lower lip carcinoma, with. Both the sharp and function of the lip were satisfactory at 4 months after surgery figure 4a, figure 4b. Lip reconstruction is driven by restoration or preservation of function and aesthetics.
Mimicking lip features in freeflap reconstruction of lip defects. From an aesthetic standpoint, lip reconstruction using distant tissue appears unnatural due to the discrepancy in tissue quality and colour. Procedure selection for surgical reconstruction of lip defects depends on the location and extent of the defect. This is more so when the resection is total and a complete lip has to be constructed. However, traumatic deformities comprise defects that may also require. 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. Total reconstruction of the upper lip using bilateral.
Gordon buck, during the civil war, was the first surgeon in the englishspeaking world to describe a cross lip reconstruction. With this modification, it is no longer necessary for the lateral margins of resection to extend beyond the commissure for technical purposes, and the shape of the resection does not have to be rectangular. Corrective 3d reconstruction of lips from monocular video pablo garrido 1michael zollhofer. The lips along with the eyes are the two most expressive structures in our face. In this case, the lip reconstruction involved reconstruction of both the cutaneous and mucosal layers of the lip. Mick jagger and functional role both sphincteric and fine motor movements the vermilion is highly sensitive to temperature, touch and pain aims of reconstruction are to restore function, maintain sensation and avoid cosmetic deformity. The reconstruction of the lips following the tumor ablation with abbe flap or its modifications may not be always satisfactory because it leaves parallel scars extending to the free vermilion margin, a trapdoor deformity and leave a cleft lip like appearance. However, this secondary reconstruction is even more difficult due to scarring and tissue deficiency of the repaired cleft lip. Lip reconstruction oral and maxillofacial surgery clinics.
We describe a case of squamous cell carcinoma of lower lip in a. 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. One of the latest techniques advocated for total lower lip reconstruction is thegate flap described by fujimori in 1980 3. 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. Cleft lip and cleft palate are thought to be caused by a combination of genes and other factors, such as things the mother comes in contact with in her environment, or what the mother eats or drinks, or certain medications she uses during pregnancy. 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 lips are considered the beginning of the oral cavity and are the most common site of oral cancer. Lower lip reconstruction using the karapandzic technique.
Lip reconstruction lips provide important aesthetic ie. Lip reconstruction connecticut stanislawmdstanislawmd. Lip reconstruction lip plastic surgery at the facial plastic surgery practice of dr. Since the early nineteenth century, several techniques have been described for lower lip reconstruction. Reconstruction of the lip commissure with upper and lower lip fullthickness defects using submental and nasolabial flaps. Lip reconstruction may be required after trauma or surgical excision. Aesthetic upper lip reconstruction with vermilion submucosal. Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. The lips are able to convey a myriad of minute expressions and emotions. During this period, one patient who underwent reconstruction with a myomucosal flap and. Yet, facial reconstruction can put a name on an unidentified body in a modern forensic case, or, in an archaeological investigation, a face on history. 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.
Reconstruction of the lips requires careful attention to aesthetic and functional goals. Their role in aesthetic balance, facial expression, speech, and deglutination is not replicated by any other tissue substitute. Lower lip reconstruction using unilateral nasolabial gate. For 2019 and subsequent program year lip losses, livestock owners and contract growers may apply for lip benefits in the physical location county where the loss occurred. For upper lip defects, functional considerations, including the ability to articulate and maintain oral competence during mastication, are important. Lip reconstruction can generate a considerable challenge to the plastic surgeon in that the lips are the primary aesthetic and dynamic center of. Reconstruction of the lip commissure with upper and lower lip. The doctor lied to me saying it would fix the chapped lips but he knew it wouldnt, all he cared about was the money. Lip reconstruction techniques are most commonly used in neoplastic disease cases because carcinoma of the lip is the most prevalent location for oral cavity carcinomas. This pdf is available for free download from a site hosted by medknow publications.
Visor flap for lower lip reconstruction introduction the lip plays an essential role in deglutition, articula tion and facial expression. In addition, it can restore lip volume without any difficulties. Secondary cleft lip reconstruction and the use of pedicled. Mar 10, 2020 lip reconstruction surgery in these cases typically uses skin grafts. 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. Individual patient factors, such as previous operations, underlying comorbidities, compliance, and mechanisms for the wound defect, may affect choices of reconstruction. Lower lip reconstruction using the karapandzic technique performance of these f unctions can be compromised by struc tural defects of the lips that result from trauma, infections, congenital malformations, and tumoral lesions. The new technique is an alternative for reconstruction of extensive upper lip defects in brachycephalic dogs and achieves satisfactory functional and cosmetic results. Cosmetic and reconstructive procedures page 1 of 8. Hairbearing temporoparietal fascial flap reconstruction.
Modified gate flap for lower lip reconstruction springerlink. Apr 15, 2019 lip reconstruction is driven by restoration or preservation of function and aesthetics. 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. Is it possible to perform a lip reconstruction to fix lips. Strategies for closure involve borrowing tissue eitherfrom theopposite lip or from the cheek. Described for use in intraoral reconstruction of a soft palate defect kloop and schurter 1956 variants of flap design for temporary or definitive coverage of small defects conley 1966 correction of lip deformities guerrerosantos and reconstruction for treatment of electrical burns ortizmonasterio closure of palatal.
Lip reconstruction and aesthetics are the main focus of reconstructive, cleft and aesthetic surgeons. 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. Lip reconstruction can generate a considerable challenge to the plastic surgeon because of their role in aesthetic balance, facial expression, speech and deglutination. Any patient who has suffered trauma to their lips, for example a dog bite or laceration, must be treated immediately.
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. Upper lip reconstruction after mastcell tumorresection in a french bulldog was achieved by using a transposition flap from the nasalskinfold and an oral mucosal flap. Plastic and reconstructive surgery wiley online books. Reconstruction of the lips is a challenging task for the dermatologic surgeon. Reconstruction for a large lower lip defect is surgically challenging, especially reconstruction with local flaps.
The upper lip is divided into three aesthetic subunits. The division of the lips into aesthetic subunits can prove very beneficial in designing lip reconstruction procedures. The goal of lip reconstruction is to have both functional and aesthetic lips that allow for oral competence, movement, and facial expression. This technique has been modified and used in two patients. Reconstruction of the lip commissure with upper and lower. Reconstruction of oncologic defects of the eyelid, lips and ear. Patients underwent assessments at 2, 4, 6, 12, and 18 months postoperatively.
Destruction, removal, alteration, covering or defacement of the original vehicle identification number may be cause for the department to refuse to title or register your vehicle. All lip defects were caused by resection of a squamous cell carcinoma that required repair by the plastic surgery team. Seven useful surgical approaches are discussed, and an algorithm to assist in deciding which reconstructive option to use is provided. 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. The postoperative reconstruction of large defects of the lower lip is far from optimal, but it is very important to restore an adequate muscle function, the lip continence and a satisfactory facial appearance. 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 trained sculptor, who is familiar with facial anatomy, works with a forensic anthropologist and uses clay to build the facial features. However, they ignore the rolling nature of the inner contour and thus sacri. The use of submental island flap for total lower lip.
Lip reconstruction surgery in these cases typically uses skin grafts. For defects involved less than 30% of lips, primary closures are sufficient. For the purposes of this section, cleft palate means a condition that may include cleft palate, cleft lip, or other craniofacial anomalies associated with cleft palate. The common lip reconstruction paradigm is based on the amount of horizontal lip involved in the defect. Ive click generate lip file so many times, but it never works. Because of their prominent location on the face, even small abnormalities can. If the inline pdf is not rendering correctly, you can download the pdf file here. Sep 02, 2016 squamus cell carcinoma of the lip prophylactic neck dissection levels i, ii, iii, iv. 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. Lip reconstruction after tumor ablation world journal of plastic. For postoperative lip deformity, some patients who underwent after oral cancer resection and reconstruction with flaps have been reported 11.
A cross lip vermilion flap of the lower lip has been reported as a useful technique to correct the form in the presence of upper lip atrophy 2. Seven useful surgical approaches are discussed, and an algorithm to assist in deciding which reconstructive. In this groundbreaking textbook, contemporary approaches are explained and demonstrated to allow trainee and experienced surgeons alike to. Larrabee, jr, md procedure selection for surgical reconstruction of lip defects depends on the location and extent of the defect. 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 11 in such instances, it is necessary to import distant tissue to provide oral lining and skin and to replace the missing lip segment. 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 the free vermilion margin and trapdoor deformity. We present a case of lip reconstruction following a total resection of the upper lip. Skinmucosal grafts have little utility for lip reconstruction. We describe our approach to lip repair and present novel methods to maintain symmetry and function, and optimize cosmetic results. We present the case of an 81yearold male with a past medical history of squamous cell carcinoma of the maxilla. The lips are necessary for speech, facial expression, and eating. Novel flaps for lip reconstruction skin therapy letter. Du bois published black reconstruction in america, a monumental study that portrayed reconstruction as an idealistic effort to construct a. We considered that the replacement of free margin of. These flaps of skin are added to the injured lip to restore it.
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