Aesthetic reconstruction for large upper lip defects in men. Hairbearing temporoparietal fascial flap reconstruction. The aesthetic or functional abnormalities that prompted revision surgery and the specific techniques. Feb 08, 2012 functional and cosmetic considerations must be included in any lip or chin reconstruction. Old age lower lip cancer defects reconstruction by abbe. Basal cell cancers typically occur on the upper lip whereas squamous cell cancers occur on the lower lip. Upper lip defects can often be reconstructed using an advancementrotation flap with burows triangle excision and a crosslip flap such as the abbe flap or estlander flap. Full upper lip reconstruction following cancer excision springerlink. Is it okay to walk on my treadmill at a slower pace. Special considerations for upper lip reconstruction. Pdf the abbe flap for upper lip reconstruction researchgate.
Lip consists of two parts called upper lip and lower lip. 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. Aug 27, 2014 the abbe flap is an excellent choice for reconstruction of fullthickness defects of the lip excluding the oral commissure. En bloc resection of upper lip, lower lip, left oral commissure and buccal region was performed. Upper lip reconstruction after oncologic resection by a slid. The aesthetic or functional abnormalities that prompted revision surgery and.
This is more so when the resection is total and a complete lip has to be constructed. Lips serve a vital role in cosmetic beauty of the face and are an important functional structure for speech, chewing, and swallowing. Aesthetic upper lip reconstruction with vermilion submucosalpedicle crosslip 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. Lip reconstruction after tumor ablation world journal of plastic. However, nasal replantation is technically challenging.
Actually what we call lip is vermilion in medical terminology. I had upper lip mohs surgery and reconstruction 3 days ago and i am still pretty swollen. A 73yearold thai woman presented with a large rapidly growing squamous cell carcinoma involving the upper lip, lower lip, left oral commissure and left cheek. Nasolabial flaps, submental flap, and mucosa graft following. Reconstruction of the lower lip university of michigan. In the present case, two local flaps for reconstruction of the upper lip and paranasal defects were performed during one operation. Reconstruction of medium to large upper lip defect with a modified unilateral karapandzic flap. Hairbearing temporoparietal fascial flap reconstruction of upper lip and scalp defects. The use of submental island flap for total lower lip. Lip reconstruction connecticut stanislawmdstanislawmd. The lesion was removed and the resulting surgical defect measured approximately 2. Large upper lip defects, including skin and muscle, can be reconstructed using this technique. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal.
The procedure works well for the upper and lower lip due to the abundant reservoir of cheek and jowl tissue. 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. Due to these com plex functions, the reconstruction of lip defects can pose. Even small abnormalities can be apparent because of the prominent location on the face. Reconstruction of the upper lip reconstruction of the upper lip salmon, paul. Use old photos, taken before your intial surgeries to communicate with your surgeon your aesthetic ideals but be prepared to have staged reconstruction. Reconstruction of oncologic defects of the eyelid, lips and ear. Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. In reconstruction of the upper lip, it is important to observe the principle of aesthetic units and subunits. Lip reconstruction requires familiarity with the surface anatomy, underlying muscular anatomy, and neurovascular anatomy of the lower face. I had upper lip mohs surgery and reconstruction 3 days ago. 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. The following is the supplementary data related to this article. Reconstruction of skin cancer defect by sam naficy, md, seattle plastic surgeon. 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. Upper lip reconstruction using a modified perialar crescentic. Using a template drawn from the intact subunit on the opposite side of the upper lip, the flap is designed on the lower lip in a similar fashion as for lower lip reconstruction. 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. Not distorting the commissure is also desirable for upper lip reconstruction. Lower lip carcinoma reconstruction using abbe estlander flap.
We have developed a new technique and successfully repaired a large defect in the upper lip of three men. Jan 12, 2015 chapter 22 lip reconstruction introduction. The use of submental island flap for total lower lip reconstruction. 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 and vermilion reconstruction with the facial artery those of lip tissue. The lips are able to convey a myriad of minute expressions and emotions. B lesion removed, flap transposed and sutured into defect. Individual patient factors, such as previous operations, underlying comorbidities, compliance, and mechanisms for the wound defect, may affect choices of reconstruction. This pdf is available for free download from a site hosted by medknow. Larrabee, jr, md procedure selection for surgical reconstruction of lip defects depends on the location and extent of the defect. Lip reconstruction may be required after trauma or surgical excision. A method for reconstruction of the lower lip following larger subtotal excision is described. 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.
Although many techniques use hairbearing flaps to repair large upper lip defects in men, few preserve orbicularis sphincter function. Upper lip reconstruction after oncologic resection by a. 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. Reconstruction for labial defect is a therapeutic challenge imposing two main. Apr 16, 2016 lip and vermilion reconstruction with the facial artery those of lip tissue. Their role in aesthetic balance, facial expression, speech, and deglutination is not replicated by any other tissue substitute. Microcystic adnexal carcinoma of the upper lip misdiagnosed. The lips are considered the beginning of the oral cavity and are the most common site of oral cancer. As a result of the relatively lower incidence of cancer, the reconstructive techniques for defects of the upper lip are fewer than lower lip. But i want to ask if my understanding is right or not regarding to surface anatomy of the lip. Lip defects can be classified according to thickness of the defect ie, skin or mucosa only, fullthickness and overall size of the defect. For defects involving greater than 50% of the subunit, the entire subunit should be reconstructed. Four patients undergoing labioplasty and lip reconstruction for lip deformity kazuhide matsunaga1, akifumi enomoto1, takeshi shimoide1, sanae iwasaki1.
In the case of upper lip defect, what relation does it have with respect to the philtrum. A v shaped incision diagramed around lower lip lesion and proposed upper lip flap outlined. Full thickness excision marked for a lesion in upper lip. How long might it take for the swelling in the upper lip area take to go down. Hopefully you wouldnt need such a drastic procedure, but without seeing a current photo, its difficult to exclude it absolutely. Total reconstruction of the upper lip using bilateral.
Lips are also common sites for occurrence of skin cancers. Aesthetic reconstruction for large upper lip defects in. We read with interest the reconstructive conundrum article by wu and colleagues. This article is from archives of plastic surgery, volume 40. Functional and cosmetic considerations must be included in any lip or chin reconstruction. Stanislaw is an expert at lip reconstruction caused by these conditions.
We present a case of lip reconstruction following a total resection of the upper lip. Advancement flaps are generally drawn along the vermillion border with redundant tissue or tricone excised superiorly on the upper lip and inferiorly on the lower lip along relaxed skin tension lines radiating from the lip. Delineation of a righttriangular abbeestlander flap from the upper lip, measuring about 2x1. Outcomes following vy advancement flap reconstruction of. The division of the lips into aesthetic subunits can prove very beneficial in designing lip reconstruction procedures. Dermatologic surgeons commonly encounter carcinomas of the cutaneous upper lip and upper lip sulcus apical triangle. The upper lip is composed of the philtrum and tubercle centrally, the paired philtral columns laterally, and the white roll of the vermiliocutaneous junction. The lips along with the eyes are the two most expressive structures in our face. Upper cutaneous lip reconstruction after tumor excision. 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. Lips serve a vital role in cosmetic beauty of the face and are an important. Postoperative assessment of repair surgery comprises two basic criteria. A new technique using transposed nasolabial island flaps is presented for total reconstruction of the lower lip. Advanced squamous cell carcinoma involving both upper and.
Any reconstruction of the lips must include both functional and cosmetic considerations. Reconstruction of the upper lip, dermatologic surgery 10. Everyone knows what a lip is but im asking from a technical and anatomical standpoint. Aesthetic upper lip reconstruction with vermilion submucosal. This method enables the surgeon to close very large defects of the lower lip and since the flaps contain muscle the functional and cosmetic results are better than those achieved with traditional advancement flaps. In this article, the anatomy, dissection, and clinical applications for the use of the famm flap in lip and vermilion reconstruction are discussed. The lips contribute to chewing, speech, facial expressions, and oral competence. Lip reconstruction list of high impact articles ppts. 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. Pdf lip reconstruction poses a particular challenge to the plastic surgeon in that the lips are the. Conclusions ideal reconstruction of large upper lip and scalp defects is achieved with local tissue that best.
The new technique is an alternative for reconstruction of extensive upperlip defects in brachycephalic dogs and achieves satisfactory functional and cosmetic results. Reconstruction of the lip commissure with upper and lower lip fullthickness defects using submental and nasolabial flaps. Two arteries left dorsal nasal artery, left superior labial artery and 1 vein branch of. Martin et al 3 reported that plastic surgeons first choice for reconstruction of upper lip defects was the cheek advancement flap, followed by the abbe flap. Full upper lip reconstruction is a challenging area, the problems are those related to the restoration of all anatomical structures of this esthetic unit. Reconstruction of lower lip defect is a challenge for oral and maxillofacial. For more than 100 years, it has remained a versatile technique for upper and lower lip reconstruction, providing good functional and aesthetic results. A new method for creating a definite philtrum by the flipping. Upperlip reconstruction after mastcell tumorresection in a french bulldog was achieved by using a transposition flap from the nasalskinfold and an oral mucosal flap.
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. Upper lip reconstruction using a modified perialar. The abbe flap is an excellent choice for reconstruction of fullthickness defects of the lip excluding the oral commissure. Seven useful surgical approaches are discussed, and an algorithm to assist in deciding which reconstructive option to use is provided. The cheek advancement flap can be modified in such a way as to achieve this. Since the early nineteenth century, several techniques have been described for lower lip reconstruction. A 17yearold male sustained a complete nose and upper lip amputation in a motor vehicle accident. The upper and lower lips are distinct facial anatomic parts form majority. Dec 01, 2011 upper cutaneous lip reconstruction after tumor excision upper cutaneous lip reconstruction after tumor excision goulao, joao 20111201 00. The abbe flap for upper lip reconstruction pubmed central pmc. Again, care is taken to preserve the vascular pedicle.
Abbeestlander flap was first performed on cleft deformity to switch a lower lip flap into upper lip defect in 1898. The new technique is an alternative for reconstruction of extensive upper lip defects in brachycephalic dogs and achieves satisfactory functional and cosmetic results. Total reconstruction of the upper lip using bilateral nasolabial. Additionally, the lips are critical in eating and speaking. A new method for creating a definite philtrum by the. 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. Available techniques can also result in an unnatural appearance, because the entire upper lip is covered by a dense region of hair.
Gate flap for the total reconstruction of the lower lip. Microcystic adnexal carcinoma of the upper lip misdiagnosed benign desmoplastic trichoepithelioma, oral and maxillofacial surgery, 20, pp. 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 lip commissure with upper and lower lip. For the upper lip, the superficial version of the web ster flap. Reconstruction of a large defect of the upper lip can be performed by a variety of local flaps or by microvascular freetissue transfer. Reconstruction of the lip commissure with upper and lower. 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. 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.
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. Address for correspondencechi mao, md, department of oral and. Vermilion defects the vermillion is the most prominent feature. Reconstruction of a lateral upper lip defect italian. Abstractthe philtrum plays a key role in the appearance of the upper lip and nostril sill. Any patient who has suffered trauma to their lips, for example a dog bite or laceration, must be treated immediately. In those patients who have had cancerous lesions, lip reconstruction should be a part of the complete management of their treatment. Novel flaps for lip reconstruction skin therapy letter. May 01, 20 reconstruction of the upper lip reconstruction of the upper lip salmon, paul. To the best of our knowledge this has never been reported. Lower lip reconstruction using the karapandzic technique.
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