Reconstruction of Lower Lip with Innervated Serratus Anterior Muscle Flap
Özlem GündeşlioğluDem ÖzenLorenc JasharllariNebil SelimoluFigen GüneyBetigül YürütenMehmet Bekerecioğlu
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Abstract:
Introduction: Main principle in reconstruction of lower lip, like in other tissues, is to reconstruct the defect by using similar tissues. In cases where defect is more than ⅔ of lower lip, reconstruction with local tissues causes microstomia. Although reconstruction of upper and lower lips with functional gracilis muscle flap, which was first performed by Burt, has been used in lip reconstruction of 13 patients in total by different authors (1, 2); no other functionally used flap has been encountered when reviewing the literature. Here are presented four cases in which patients underwent wide lower lip reconstruction due to squamous cell carcinoma, and in which we performed lower lip reconstruction with innervated serratus anterior muscle flap.Keywords:
Microstomia
Lower lip
Microstomia
Lower lip
Orbicularis oris muscle
Sulcus
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Lower lip reconstruction in cases with a full-thickness defect over one-third of the vermilion is challenging. Numerous conventional techniques have been applied with unsatisfactory surgical outcomes because of microstomia and oral commissure blunting due to shortened horizontal lip length. Herein, we present a case in which a full-thickness lower lip defect of more than one-third of the horizontal lip length was covered with a novel mucosal roofing flap reconstruction to minimize the loss of horizontal lip length and to preserve mouth opening. No recurrences or metastases were observed during 3 years and 6 months of follow-up, with horizontal lower lip length maintained and mouth opening of 2.5 finger breadths.
Microstomia
Lower lip
Vermilion
Floor of mouth
Commissure
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Squamous cell carcinoma of the lower lip is a common tumor. Of the many methods available for reconstructing lower lip defects after radical excision, we found double cross lip flaps from each lateral side of the upper lip philtrum rotated into the defect of the lower lip to be an effective method, not only functionally but also cosmetically. The main reason why satisfactory results were obtained by this procedure is that the anatomical structure (skin-orbicularis oris muscle-mucosa, vermilion) of the upper lip is very similar to that of the lower lip. Our experience is with double cross lip operations in the management of lower lip cancers are described.
Vermilion
Lower lip
Philtrum
Orbicularis oris muscle
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Relations between parameters of lower-lip movement and upper-lip movement were investigated during. bilabial opening and closing gestures. Upper- and lower-lip movements of five normal adults were transduced in the inferior-superior dimension with a strain gauge system. Visual feedback of lower-lip movement was employed to manipulate the displacement of the lower lip. Systematic modifications in upper-lip movement were observed as a function of the variation in lower-lip movement. The effects of lower-lip movement on upper-lip movement were larger when the jaw was fixed with a bite block. The temporal relations between lips were maintained at all lower-lip displacements both with and without the bite block. These data will be discussed relative to acoustical, mechanical, and motor control factors that may influence the interactions between lips. [Work supported by NIH.]
Lower lip
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Major defects of the Upper lip due to cancer surgery are relatively less common compared to Lower lip. Standard techniques such as Karapandzic’s are capable of reconstructing up to fifty percent of the lip otherwise, microstomia and oral incompetence may result. The Upper lip has few aesthetic characteristic details due to the philtrum, its columns and cupid’s bows. Here we are proposing incorporation of an Abbe Flap to reconstruct the central unit of Upper lip, associated with Karapandzik flaps from both sides. Use of a Lip sharing concept has an additional advantage of producing harmony to the reconstructed region, and avoidance of crowding phenomena to the Lower lip
Microstomia
Lower lip
Philtrum
Cancer surgery
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Microstomia
Lower lip
Cheek
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Drooling
Lower lip
Mandible (arthropod mouthpart)
Microstomia
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Summary: A defect of the central upper lip vermillion generally requires “like for like” reconstruction because this part of the upper lip can attract attention and has a unique structure and color. In this article, we report use of a labial artery-based horizontal long cross-lip flap for central upper lip vermillion reconstruction. In the first stage of surgery, a horizontal long vermillion flap from the lower lip starting at the left commissure with a vascular pedicle containing an inferior labial artery was raised and transposed to the upper vermillion defect. In the second stage, 12 days later, the pedicle was divided to complete the reconstruction. There were no postoperative complications in articulation or eating, and the patient was satisfied with the esthetic outcome. This surgical technique reduces microstomia and inconvenience in eating and speaking compared with a common horizontal cross-lip flap and provides better color- and texture-matched tissue compared to reconstruction using a tongue flap or mucosal flap. The technique is simple, requires a relatively short surgical time, has minimum donor-site morbidity and permits good esthetic and functional reconstruction of the central upper lip vermillion for a relatively small defect.
Microstomia
Lower lip
Articulation (sociology)
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<p>Major defects of the upper lip due to cancer surgery are relatively less common compared to lower lip. Standard techniques such as Karapandzic’s are capable of reconstructing up to fifty percent of the lip otherwise microstomia and oral incompetence may result. The upper lip has few aesthetic characteristic details due to the philtrum, its columns and cupid’s bows. Here we are proposing incorporation of an abbe flap to reconstruct the central unit of upper lip, associated with Karapandzic flaps from both sides. Use of a lip sharing concept has an additional advantage of producing harmony to the reconstructed region, and avoidance of crowding phenomena to the lower lip.</p>
Microstomia
Lower lip
Philtrum
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