DOCSLIB.ORG

Lip Reconstruction After Tumor Ablation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Lip Reconstruction After Tumor Ablation Review Article 15 Lip Reconstruction after Tumor Ablation Ali Ebrahimi1, Mohammad Hossein Kalantar Motamedi2*, Azin Ebrahimi3, Mohammad Kazemi4, Amin Shams5, Haleh Hashemzadeh6 1. Department of Plastic Surgery, Trauma ABSTRACT Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Approximately 25% of all oral cavity carcinomas involve the lips, 2. Department of Oral and Maxillofacial and the primary management of these lesions is complete surgical Surgery, Trauma Research Center, Baqiyatallah University of Medical resection. Loss of tissue in the lips after resection is treated with Sciences, Tehran, Iran a variety of techniques, depending on the extension and location 3. Medical student,Tehran University of Medical Sciences, Tehran, Iran of the defect. 4. Trauma Research Center, Baqiyatallah Here we review highly accepted techniques of lip University of Medical Sciences, Tehran, reconstruction and some of new trials with significant clinical Iran 5. Private Practitioner, Tehran, Iran results. Reconstruction choice is primarily depend to size of the 6. Dental Research Center, Tehran University defect, localization of defect, elasticity of tissues. But patient’s of Medical Sciences, Tehran, Iran age, comorbidities, and motivation are also important. According to the defect location and size, different reconstruction methods can be used. For defects involved less than 30% of lips, primary closures are sufficient. In defects with 35–70% lip involvement, the Karapandzic, Abbe, Estlander, McGregor or Gillies’ fan flaps or their modifications can be used. When lip remaining tissues are insufficient, cheek tissue can be used in Webster and Bernard advancement flaps and their various modifications. Deltopectoral or radial forearm free flaps can be options for large defects of the lip extending to the Jaws. To achieve best functional and esthetic results, surgeons should be able to choose most appropriate reconstruction method. Considering defects’ size and location, patients’ expects and surgeon’s ability and knowledge, a variety of flaps are presented in order to reconstruct defects resulted from Downloaded from wjps.ir at 14:57 +0330 on Thursday September 23rd 2021 tumor ablation. It’s necessary for surgeons to trace the recent innovations in lip reconstruction to offer best choices to patients. KEYWORDS Lip; Reconstruction; Tumor; Ablation Please cite this paper as: *Corresponding Author: Ebrahimi A, Kalantar Motamedi MH, Ebrahimi A, Kazemi M, Shams Mohammad Hossein Kalantar A, Hashemzadeh H. Lip Reconstruction after Tumor Ablation. World J Motamedi, MD; Plast Surg 2016;5(1):15-25. Professor of Department of Oral and Maxillofacial Surgery, INTRODUCTION Trauma Research Center, Baqiyatallah University of Medical The upper and lower lips are distinct facial anatomic parts Sciences, form majority features of lower 1/3 of face, and their functional P.O. Box: 1994943636, Tehran, Iran and aesthetic importance is undeniable. Although over 200 Tel/Fax: +98-21-88053766 Email: [email protected] methods have been described for reconstruction of lip defects Received: May 28, 2015 since 1000 BC and many have been considered to be ideal, none Revised: August 1, 2015 of them is perfect or suitable for the reconstruction of all kinds Accepted: November 3, 2015 of defects.1-4 www.wjps.ir /Vol.5/No.1/January 2016 16 Lip reconstruction after tumor ablation Defects of lips may occur as a result of Free flaps and grafts are the next choices for hereditary disorders (such as cleft lip), trauma and reconstruct ion of post tumor excision lip defects. tumors. Defects of the lips are more frequently As a result of the relatively lower incidence of encountered because of the high incidence of cancer, the reconstructive techniques for defects tumors of lips. Squamous Cell Carcinoma (SCC) of the upper lip are fewer than lower lip. Based is the most common malignancy related to the on classification was mentioned before, we will lips (95%) and the lower lip more commonly review current trends for lip reconstruction: involved in comparison with the upper lip (9:1). Loss of tissue in the lips is treated with a variety Vermilion Defects of techniques, depending on the extension and The vermillion is the most prominent feature location of the defect.5 Tumors of the lips should be of the lip. The preferred method for repair of treated with surgery and postoperative radiation vermillion-only defects is an advancement of when there are poor prognostic indicators that labial mucosa, which is then re-draped over include multiple levels of positive lymph nodes, the underlying orbicularis musculature.2,9 The extra capsular extension of the cancer in lymph plane of dissection is between the uninvolved nodes, deep invasion of the primary tumor, mucosa and underlying musculature.13 When neural and vascular invasion, tumor margins less simple advancement is not sufficient, other than 5 mm.6 techniques can be used. These include mucosal V-Y advancement flaps, cross-lip mucosal flaps, Goals of Reconstruction sliding vermilion advancement flaps, and tongue The aims of reconstruction should be to flaps. The cross-lip mucosal flaps and tongue maintain oral competence, maintain maximum oral flaps require staged secondary surgery after two aperture, maintain mobility, maintain sensation or three weeks.14 when possible, and maximize aesthetic result. For When vermilion replacement requires example a reduction to less than 50% of stoma more bulk or the oral mucosa is not available, size produces oral dysfunction, especially for anterior-based tongue flaps are useful and those who wear dentures.7,8 For lip reconstruction, when using W-shaped excisions in young first we should assess the lesion to determine the patients where disguising defects is more amount of mucosa, muscle, and skin that will be difficult, a design that places the W limbs in involved before incisions are made. the submental fold can be considered.11 Sand Classifications of lip defects are based on the et al.,15 in a recent study comparing vermillion anatomic location (skin, vermillion, or both), mucosal advancement flaps with direct primary thickness (partial thickness or full thickness), closure of vermillion defects, observed that Downloaded from wjps.ir at 14:57 +0330 on Thursday September 23rd 2021 and width of the defect relative to the overall mucosal advancement flaps resulted in better width of the lip.9 Using this defect based maintenance of vermillion width compared approach, defects can be divided into vermilion with primary closure. Mucosal cross-lip flaps only defects, partial-thickness (cutaneous) use the labial mucosa from one lip to reconstruct defects, defects less than one third of the total lip a vermillion defect of the opposing lip. A novel length, defects between one third and two thirds technique has been described by Manafi et al total lip length, and total lip defects.10,11 as Mutual cross lip musculomucosal flaps for In order to reconstruct the lips following correction of major vermillion defects which tumor ablation, the “reconstruction ladder” is very helpful in cases of lip hemangioma.16 starts with the simplest procedures, moving up The major disadvantage of these flaps is that to the most complex. Primary closure of the the reconstruction must be staged, with pedicle lip is the simplest technique for small defects. division occurring 2 or more weeks after initial The next steps of reconstruction are local flap positioning. flaps, and these have the advantage of good color match, easy accessibility, simplicity in Cutaneous Defects the surgical technique, and use of innervated Cutaneous defects are best reconstructed muscle for function. Local flaps also have some with local flaps from adjacent cutaneous lip disadvantages, including the need to make tissue, where incisions placed in the borders of extra skin incisions on the face and the lack of aesthetic subunits.9 Partial-thickness perilabial sufficient tissue for major defects.11,12 defects can be closed either by primary closure www.wjps.ir /Vol.5/No.1/January 2016 Ebrahimi et al. 17 or with local transposition flaps.2 Primary edge. This suture will secure the tip of the V closure is the ideal reconstructive option, with shaped flap in place without compressing the the long axis of the fusiform excision placed skin of the flap.11 within the perioral relaxed skin tension lines, The vermilion should preferably be marked which tend to be perpendicular to the horizontal prior to incision to prevent distortion of this axis of the lip.1,9 important aesthetic junction that occurs during When local tissue transfer is used, only outer injection and subsequent surgical dissection. skin and subcutaneous tissue are involved; the It is also important to remember that primary facial musculature will remain intact. Cutaneous closure of these defects should not result in lower lip can be reconstructed with a variety of any appreciable microstomia. If this occurs, a flaps from the chin and submandibular area. secondary reconstruction option should be used. Because the chin is a very visible aesthetic Advancement flaps are best suited for correcting unit, incisions should be planned where there central defects of the upper and lower lips. The is minimal chin distortion. Larger lower lip reconstructed lip tends to be tighter than the defects reconstruction can be done using an opposing lip, which may be more pronounced inferiorly based or bilateral inferiorly based when the lips are together. This effect will melolabial flaps.13 generally decrease over time.1,2 Upper lip cutaneous defects can be It’s worthy to mention that a V-Y advancement reconstructed with rotation advancement flaps flap is an excellent technique for reconstructing or transposition flaps.1,9,13,17 A laterally based lateral, skin-only lip defects larger than 1 cm2. transposition flap is good for small cutaneous This method places scars along aesthetic borders defects in the lower portion of the upper lip, as and advances skin of similar characteristics described by Converse.18 Larger defects which into the upper lip.
Load more

Recommended publications
  • A Dissertation on Study of Reconstruction in Head And
    A DISSERTATION ON STUDY OF RECONSTRUCTION IN HEAD AND NECK MALIGNANCIES - EVALUATION OF VARIOUS TREATMENT OPTIONS IN PARTIAL FULFILLMENT OF THE REGULATIONS FOR THE AWARD OF THE DEGREE OF MASTER OF CHIRURGIE (M.Ch) Plastic and Reconstructive Surgery (Branch III) August- 2013 THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY CHENNAI, TAMILNADU BONAFIDE CERTIFICATE This is to certify that the Dissertation entitled RECONSTRUCTION IN HEAD AND NECK MALIGNANCIES - EVALUATION OF VARIOUS TREATMENT OPTIONS is the bonafide original record work done by Dr. B. ARUNA DEVI under my direct supervision and guidance, submitted to THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY in partial fulfillment of University regulation for M.Ch. Plastic and Reconstructive Surgery- Branch III. DR. MOHAN, M.S., DR.C.BALASUBRAMANIAN M.S.,M.Ch DEAN, PROFESSOR & HOD MADURAI MEDICAL COLLEGE DEPARTMENT OF PLASTIC SURGERY MADURAI. MADURAI MEDICAL COLLEGE MADURAI. DECLARATION I, Dr. B. ARUNADEVI solemnly declare that the dissertation titled RECONSTRUCTION IN HEAD AND NECK MALIGNANCIES - EVALUATION OF VARIOUS TREATMENT OPTIONS has been prepared by me. I also declare that this bonafide work or a part of this work was not submitted by me or any other for any award, degree, diploma to any other university board either in India or abroad. This is submitted to THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY, Chennai in partial fulfillment of the rules and regulation for the award of M.Ch. Plastic and Reconstructive Surgery- Branch III to be held in August 2013. PLACE: Madurai. DATE: Dr. B. ARUNA DEVI ACKNOWLEDGEMENT I am greatly indebted to our DEAN, PROF.DR.MOHAN M.S., Government Rajaji Hospital, Madurai for his kind permission to allow me to utilize the clinical material from the hospital.
    [Show full text]
  • Surgical Planning for Resection and Reconstruction of Facial Cutaneous Malignancies 1Evren Erkul, 2Krishna G Patel, 3Terry Day
    IJHNS Surgical Planning for Resection and Reconstruction10.5005/jp-journals-10001-1281 of Facial Cutaneous Malignancies ORIGINAL ARTICLE Surgical Planning for Resection and Reconstruction of Facial Cutaneous Malignancies 1Evren Erkul, 2Krishna G Patel, 3Terry Day ABSTRACT carcinoma (SCC) and basal cell carcinoma (BCC) are Skin cancer can be categorized into cutaneous melanoma and the most common types of NMSC, although other less nonmelanoma skin cancer (NMSC). The latter includes such common cutaneous malignancies are well known and may histologies as Merkel cell carcinoma (MCC), basal cell carcinoma include Merkel cell carcinoma (MCC), angiosarcoma, and (BCC), and squamous cell carcinoma (SCC). Of these, BCC various malignancies of the adnexal structures. Currently, and SCC are the most common skin cancers of the head the NCCN guidelines list melanoma, nonmelanoma, and and neck while malignant melanoma is the most aggressive. Merkel cell as the only separate categories for cutaneous Sunscreen protection and early evaluation of suspicious areas remain the first line of defense against all skin cancers. When malignancy with dedicated guidelines. Surgery remains prevention fails, the gold standard of skin cancer management the mainstay of treatment of skin cancers of the head and involves a multidisciplinary approach which takes into account neck region. Surgical resection and reconstruction plan- tumor location, stage and biology of disease, and availability of ning is vital to outcomes but can be difficult to standardize resources. Proper diagnosis, staging, and treatment planning due to the diverse structures in the region, variability in must all be addressed prior to initiating interventions. When nodal metastases, and various specialists diagnosing and surgery is indicated, facial reconstruction is a key aspect of the overall treatment plan and requires informed forethought as treating these malignancies.
    [Show full text]
  • Upper Lip Anatomy, Mechanics of Local Flaps, and Considerations for Reconstruction
    CLINICAL REVIEW Upper Lip Anatomy, Mechanics of Local Flaps, and Considerations for Reconstruction Alexis L. Boson, MD; Stefanos Boukovalas, MD; Joshua P. Hays, MD; Josh A. Hammel, MD; Eric L. Cole, MD; Richard F. Wagner Jr, MD Cupid’s bow, and philtrum, leads to noticeable deformi- PRACTICE POINTS ties. Furthermore, maintenance of upper and lower lip • Comprehensive knowledge of static and dynamic function is essential for verbal communication, facial structural support is imperative in reconstruction of expression, and controlled opening of the oral cavity. upper lip wounds. Similar to a prior review focused on the lower lip,1 we • The surgeon should evaluate deficient structures as conducted a review copyof the literature using the PubMed well as characteristics of the defect to select the most database (1976-2017) and the following search terms: appropriate reconstruction method for optimal func- upper lip, lower lip, anatomy, comparison, cadaver, histol- tional and aesthetic outcomes. ogy, local flap, and reconstruction. We reviewed studies that assessed anatomic and histologic characteristics of thenot upper and the lower lips, function of the upper Reconstruction of defects involving the upper lip can be challenging. lip, mechanics of local flaps, and upper lip reconstruc- The purpose of this review was to analyze the anatomy and function tion techniques including local flaps and regional flaps. of the upper lip and provide an approach for reconstruction of upper Articles with an emphasis on free flaps were excluded. lip defects. The primary role of the upper lip is coverage of dentition The initial search resulted in 1326 articles. Of these, and animation, whereas the lower lip is critical for oral competence,Do 1201 were excluded after abstracts were screened.
    [Show full text]
  • Communication Rehabilitation with People Treated for Oral Cancer
    3/18/2019 Cancer ↔ malignant growth Communication Rehabilitation . Characteristics with People Treated for Oral Cancer . Cell growth that is • Ongoing • Purposeless • Unwanted Jeff Searl, Ph.D., CCC-SLP, ASHA-F • Uncontrolled Associate Professor • Damaging Department of Communicative Sciences and Disorders . Cells that Michigan State University • Differ structurally • Differ functionally Several types of cancer Formation of Cancer Squamous cell = we see most often in oral cavity . NORMAL: Genes in DNA = controlled division, growth, and cell death . CANCER . Genetic control lost or abnormal . Abnormal cell divides again and again . Mass of unwanted, dividing cells continues to grow . potential damage other cells/tissues in body . Controls that stop continued division lost/impaired Anatomy Lip & Oral Cavity Anatomy Review Regions for designating cancer location Regions for designating cancer location . Following six slides have Trivandrum Oral Lip (vermilion) = images from Cancer Screening reddish hued area, Project. International Agency for Research on Cancer (IARC) “A digital manual for the early diagnosis of oral Labial mucosa = Retrieved 05/28/2017 from neoplasia.” thin(ner) lining of the inside of the lips http://screening.iarc.fr/atlas oral.php?lang=1 IARC link to Trivandrum screening 1 3/18/2019 Lip & Oral Cavity Anatomy Review Regions for designating cancer location Lip & Oral Cavity Anatomy Review Regions for designating cancer location Buccal mucosa = lining of cheeks. Alveolar ridge = bony ridge that holds the teeth Stensen duct
    [Show full text]
  • Resection of Upper Lip Adenoid Cystic Carcinoma and Reconstruction with Reverse Yu Flap: Report of Three Cases and a Literature Review
    444 MOLECULAR AND CLINICAL ONCOLOGY 6: 444-450, 2017 Resection of upper lip adenoid cystic carcinoma and reconstruction with reverse Yu flap: Report of three cases and a literature review MARTA SANCHEZ‑SANCHEZ1, PEDRO INFANTE‑COSSIO1, RODRIGO LOZANO‑ROSADO1, LUIS‑MIGUEL GONZALEZ‑PEREZ1, MIGUEL‑ANGEL JAPON‑RODRIGUEZ2, JUAN‑DAVID GONZALEZ‑PADILLA1, ANGEL MARTINEZ‑SAHUQUILLO‑MARQUEZ3 and RODOLFO BELMONTE-CARO1 Departments of 1Oral and Maxillofacial Surgery, and 2Pathology, Virgen Del Rocio University Hospital; 3Department of Oral Medicine, Faculty of Dentistry, University of Seville, 41013 Seville, Spain Received September 22, 2015; Accepted January 24, 2017 DOI: 10.3892/mco.2017.1150 Abstract. The present study aimed to describe the tech- Introduction niques that were used, and the results obtained, with the reverse Yu flap to reconstruct medium‑sized upper lip defects Adenoid cystic carcinoma (ACC) is a common salivary gland following resection for adenoid cystic carcinoma (ACC). Data malignancy. Although its clinical and pathological features are concerning the clinical and pathological characteristics of well known, several controversial issues regarding its behav- tumours, the size and location of the defects, surgical resection iour and management remain to this day. In the World Health and the reconstructive procedure used were evaluated in three Organization (WHO) classification (2005) (1), ACC was clas- patients, as well as postoperative complications and outcomes. sified as a malignant epithelial tumour within the group of In all cases, a complete surgical removal of ACC was achieved carcinomas. Histologically, this neoplasm is composed of two with clear margins of at least 1 cm. Histopathological features types of cells: Duct‑lining and myoepithelial cells, arranged revealed two cases with a predominant solid growth pattern, in two subtypes designated as glandular (cribriform) and solid and one case of cribriform.
    [Show full text]
  • Abstracts of the International Medical Students' Congress of Bucharest (IMSCB) 2018
    Abstracts International Medical Students' Congress of Bucharest (IMSCB) 2018 Abstracts of the International Medical Students' Congress of Bucharest (IMSCB) 2018 CASE REPORTS congenital wandering spleen. The condition is not hereditary. Treatment for this condition involves removal of the spleen. CASE PRESENTATION: A 20 01. ROBOTIC MYOMECTOMY THE NEWEST APPROACH OF UTERINE months old girl is hospitalized in another institution for fever and cough; a FIBROMATOSIS routine ultrasound was requested and it revealed a pelvic tumor of 70/40 Andrei C, Manu. Maria Ilinca D. Iosub, Cătălin-Bogdan, Coroleucă mm, localized behind the bladder. At the clinical examination, the patient MD, PhD, Professor Elvira Brătilă MD, PhD, Diana Mihai MD, PhD, had a dystrophic facies, microcephaly, left polythelia and a tuberous Diana-Elena Comandașu, Ciprian-Andrei Coroleucă hemangioma on the left forearm. Positive history for occasional alcohol "Carol Davila" University of Medicine and Pharmacy, Bucharest, consumption during her mother's pregnancy and a diagnosis of fetal alcohol Romania. 2Affiliation: Clinical Hospital of Obstetrics and syndrome of the baby was established. The biological exam revealed hypochromic anemia with a low level of iron, eosinophilia, important thrombocytosis (952,000 / uL), elevated ESR and low alkaline reserve. A CT- BACKGROUND: Although benign, uterine leiomyoma is an affliction that the scan was performed and it showed the absence of the spleen in the left female population frequently confronts with and is associated with a upper abdomen, but a liquid structure with proteinaceous content located significant morbidity. Because a tendency of delaying the pregnancies has in the hypogastric region, postero-superior of the bladder and in front of been seen lately, uterine-sparing techniques are needed, hence the the rectum and sigmoid.
    [Show full text]
  • Journal of the American Osteopathic College of Dermatology Journal of the American Osteopathic College of Dermatology
    Journal of the American Osteopathic College of Dermatology Journal of the American Osteopathic College of Dermatology Editors Jay S. Gottlieb, D.O., F.O.C.O.O. Stanley E. Skopit, D.O., F.A.O.C.D. Associate Editor James Q. Del Rosso, D.O., F.A.O.C.D. Editorial Review Board Earl U. Bachenberg, D.O. Richard Miller, D.O. Lloyd Cleaver, D.O. Ronald Miller, D.O. Eugene Conte, D.O. Evangelos Poulos, M.D. Monte Fox, D.O. Stephen Purcell, D.O. Sandy Goldman, D.O. Darrel Rigel, M.D. Gene Graff, D.O. Robert Schwarze, D.O. Andrew Hanly, M.D. Michael Scott, D.O. Cindy Hoffman, D.O. Eric Seiger, D..O David Horowitz, D.O. Brooks Walker, D.O Charles Hughes, D.O. Bill Way, D.O. Daniel Hurd, D.O. Schield Wikas, D.O. Mark Lebwohl, M.D. Edward Yob, D.O. Jere Mammino, D.O. 2002-2003 OFFICERS President: Robert F. Schwarze, DO President-Elect: Stanley E. Skopit, DO First Vice-President: Ronald C. Miller, DO Second Vice-President: Richard A. Miller, DO Third Vice-President: Bill V. Way, DO Secretary-Treasurer: James D. Bernard, DO Immediate Past President: Cindy F. Hoffman, DO Trustees: Daniel S. Hurd, DO Jere J. Mammino, DO Brian S. Portnoy, DO Robert J. Signore, DO Executive Director: Rebecca Mansfield, MA AOCD 1501 E Illinois Kirksville, MO 63501 800-449-2623 FAX: 660-627-2623 www.aocd.org COPYRIGHT AND PERMISSION: written permission must be obtained from the Journal of the American Osteopathic College of Der- matology for copying or reprinting text of more than half page, tables or figures.
    [Show full text]
  • 5 Year Experience with Lower Lip Cancer Egils Kornevs, Andrejs Skagers, Juris Tars, Andris Bigestans, Gunars Lauskis, Olafs Libermanis
    SCIENTIFIC ARTICLES Stomatologija, Baltic Dental and Maxillofacial Journal, 7:95-8, 2005 5 year experience with lower lip cancer Egils Kornevs, Andrejs Skagers, Juris Tars, Andris Bigestans, Gunars Lauskis, Olafs Libermanis SUMMARY Retrospective study of 189 cases of lower lip cancer treated from 1996 - 2000 is done. There were 69% males and 31% females. Median age was 66.8 years. 84.4% of patients were with tumors stage I - II. Surgical treatment was performed in 83.6 % of patients . In all operated cases was squamous cell carci- noma as verrucous tumor in 17.4 %, as exophytic in 46% and as ulcerative in 36.6%.There were different methods of local excision, primary reconstruction and neck dissection depending from stage. In the patient group with clinically negative neck at the first attendance (170 patients) delayed cervical metastases developed in 6 patients (3.5%).Recurrence at the primary site developed in 11.3 % of patients and was associated with large tumor size and low cancer differentiation. Survival rate at 5-year follow-up was 95% for patients with I stage, 89.7% for II stage and 37% for III and IV stage patients or mean for all group 83.7%. Diagnosis and treatment of actinic cheilitis also is discussed. Key words: lip, cancer, surgery, outcomes INTRODUCTION Cancer of the lip is relatively common among malig- esis does not seem to be limited to a single agent, but rather nancies of the head and neck region, accounting for 12% of to a complex multistep process of interactions between pu- all head and neck cancers, excluding nonmelanoma skin can- tative risk factors (2) (Fig.
    [Show full text]
  • Outcomes Following V-Y Advancement Flap Reconstruction of Large Upper Lip Defects
    ORIGINAL ARTICLE Outcomes Following V-Y Advancement Flap Reconstruction of Large Upper Lip Defects Garrett R. Griffin, MD; Stephen Weber, MD, PhD; Shan R. Baker, MD Objective: To characterize revision surgery following nasal ala in 4 cases and the vermilion in 3 cases. At least V-Y subcutaneous tissue pedicle advancement flap re- 1 revision surgery was performed in 14 patients (47%). pair of large upper lip skin defects. Alar or vermilion involvement was a significant factor in revision by ␹2 analysis (P=.03). Larger defect size did not Methods: Retrospective review of upper lip skin predict a need for revision, even among cases where the defects at least 3.0 cm2 in area that were reconstructed defect did not involve the ala or vermilion (P=.68). with a V-Y subcutaneous tissue pedicle advancement flap at an academic tertiary care center. Depth and Conclusions: Reconstruction of large upper lip skin de- area of the defect, as well as involvement of the ver- fects with a V-Y subcutaneous tissue pedicle advance- milion and nasal ala, were recorded as independent ment flap is associated with a 47% revision rate, and when variables. Revision techniques were analyzed to iden- the defect involves the ala or vermilion, the revision rate tify patterns. is increased. Defect size alone cannot be used to predict the need for revision surgery. Revision techniques are Results: Thirty patients were identified as having up- demonstrated. per lip skin defects with a mean (range) area of 7.0 (3.0- 14.0) cm2 (median, 6.25 cm2). The defect involved the Arch Facial Plast Surg.
    [Show full text]
  • Lip Cancer Fact Sheet
    Cancer Association of South Africa (CANSA) Fact Sheet on Cancer of the Lips Introduction Lips are a visible body part at the mouth of humans and many animals. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech. Human lips are a tactile sensory organ, and can be erogenous when used in kissing and other acts of intimacy. [Picture Credit: Lips] The upper and lower lips are referred to as the ‘Labium superius oris’ and ‘Labium inferius oris’, respectively. The juncture where the lips meet the surrounding skin of the mouth area is the vermilion border, and the typically reddish area within the borders is called the vermilion zone. The vermilion border of the upper lip is known as the cupid's bow. The fleshy protuberance located in the center of the upper lip is a tubercle known by various terms including the procheilon (also spelled prochilon), the ‘tuberculum labii superioris’, and the ‘labial tubercle’. The vertical groove extending from the procheilon to the nasal septum is called the philtrum [Picture Credit: Lips 2] The skin of the lip, with three to five cellular layers, is very thin compared to typical face skin, which has up to 16 layers. With light skin colour, the lip skin contains fewer melanocytes (cells which produce melanin pigment, which give skin its colour). Because of this, the blood vessels appear through the skin of the lips, which leads to their notable red colouring. With darker skin colour this effect is less prominent, as in this case the skin of the lips contains more melanin and thus is visually darker.
    [Show full text]
  • Lip Repair After Mohs Surgery for Squamous Cell Carcinoma by Bilateral Tissue Expanding Vermillion Myocutaneous Flap (Goldstein Technique Modified by Sawada)
    Open Access Maced J Med Sci electronic publication ahead of print, published on January 10, 2018 as https://doi.org/10.3889/oamjms.2018.034 ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. Special Issue: Global Dermatology-2 https://doi.org/10.3889/oamjms.2018.034 eISSN: 1857-9655 Case Report Lip Repair after Mohs Surgery for Squamous Cell Carcinoma by Bilateral Tissue Expanding Vermillion Myocutaneous Flap (Goldstein Technique Modified by Sawada) Alberto Goldman1, Uwe Wollina2*, Katlein França3, Torello Lotti4, Georgi Tchernev5,6 1Clinica Goldman - Plastic Surgery, Porto Alegre/RS, Brazil; 2Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany; 3Department of Dermatology and Cutaneous Surgery, Department of Psychiatry & Behavioral Sciences; Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, FL, USA; 4University G. Marconi of Rome - Dermatology and Venereology, Rome, Italy; 5Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria; 6Onkoderma, Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria Abstract Citation: Goldman A, Wollina U, França K, Lotti T, Squamous cell carcinoma is the most common malignancy of the lower lip. Environmental factors such as Tchernev G. Lip Repair after Mohs Surgery for Squamous ultraviolet light exposure, arsenic and smoking are contributing factors to the increasing incidence. Mohs surgery Cell Carcinoma by Bilateral Tissue Expanding Vermillion Myocutaneous Flap (Goldstein Technique Modified by is the treatment of choice ensuring the lowest recurrence rates. The closure of the surgical defects, however, can Sawada). Open Access Maced J Med Sci. be a challenge.
    [Show full text]
  • Manuscript Type: Original Article DOI: 10.5152/Eurjther.2019.18040
    Manuscript type: Original Article DOI: 10.5152/EurJTher.2019.18040 Title: Squamous cell carcinoma of the lower lip; is prophylactic neck dissection required and evaluating predictive factors influencing prognosis 1Secaattin Gülşen, 2 Saffet Ulutaş 1Özel Hatem Hospital, Clinic of Ear Nose Throat, Gaziantep, Turkey 2Deva Hospital, Gaziantep, Turkey Corresponding author: Secaattin Gülşen E-mail: [email protected] Abstract: Objectives: This research is introducing our experience including a series of 87 cases of squamous cell carcinoma of the lower lip. We aimed to evaluate the efficacy of prophylactic neck dissection and determinative factors for local recurrence and regional metastasis in lower lip carcinomas. Methods: Medical records of the 87 consecutive patients diagnosed with squamous cell carcinoma (SCC) of the lower lip were analyzed retrospectively for specific parameters at Dr.Ersin Arslan Research and Training hospital Ear Nose Throat(ENT) and Plastic & Reconstructive surgery clinic and Gaziantep University hospital ENT clinic during a period between 2011 and 2017. Patients operated previously in other centers were excluded from the study. Tumor excision with safe margins confirmed by frozen sections and supraomohyoid neck dissection was performed to all the patients involved in this study. The minimum follow-up was 12 months for all patients. The median follow-up was 23 months (ranging from 12 to 72 months). Result: Data analysis indicated that local recurrence was significantly related to tumor size, depth and proximity of the tumor to surgical margins. Local recurrence was detected in 8(9,1 %) of 87 patients. Time from onset of disease to diagnosis, size of tumor and proximity of the tumor to lip commissure play important role in regional metastasis.
    [Show full text]