The principal function of the lips is oral competence. This is more so when the resection is total and a complete lip has to be constructed. 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. 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. Reconstruction of upper lip with lower lip abbe flap youtube. Nasal and upper lip reconstruction of a case of squamous. 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. Thepurposeofthisstudywastofurther analyze larger upper lip skin defects repaired with. Reconstruction of the lower vermilion with a musculomucosal flap from the upper lip in the repair of extensive lower lip and chin defects. Lip reconstruction critical in speech, sustenance, and conveyance of emotions, functional integrity of the lips requires preservation of oral aperture and competence as well as sensation and mobility. The fullthickness lip is incised, rotated 180 degrees, and sutured into the upper lip defect in layers, based on an ipsilateral pedicle of posterior vermilion and muscle, at least 0. These flaps of skin are added to the injured lip to restore it.
Reconstruction of the lip commissure with upper and lower lip. Upper lip reconstruction with lower lip abbe flap surgery, the patient underwent cleft lip surgery first at 3 months of age. A case of upper lip and moustache reconstruction using a submental artery perforator smap flap. Reconstruction of an aesthetically acceptable and functional upper lip requires a careful consideration of the transverse and vertical soft tissue, muscle, and skin deficiency. For more than 100 years, it has remained a versatile technique for upper and lower lip reconstruction, providing good functional and aesthetic results.
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. Lip reconstruction list of high impact articles ppts. Onestage reconstruction of the large, fullthickness. The basic principle of lip reconstruction according to gillies is to repair the lip by circumcision of the mouth and rotation of the upper lip flaps so that good function. Outcomes following vy advancement flap reconstruction of. Perialar crescentic advancement flap for upper cutaneous. Becoming familiar with the principles of a few flaps is important because the actual defect size is not often known until immediately prior to reconstruction. The reconstruction of large, full thickness upper lip defects presents many surgical challenges because of the several cosmetic subunits and unique landmarks. Division of the left nasolabial flap and the forehead flap was done at the same time figure 6 and figure 7. Lip reconstruction requires familiarity with the surface anatomy, underlying muscular anatomy, and neurovascular anatomy of the lower face.
The abbe flap is an excellent choice for reconstruction of fullthickness defects of the lip excluding the oral commissure. She was born with a cleft lip and palate along with a cleft alveolus. The abbe flap for upper lip reconstruction pubmed central pmc. We present a case of lip reconstruction following a total resection of the upper lip. Not distorting the commissure is also desirable for upper lip reconstruction. The muscles must be carefully repaired to avoid numbness in the lip. Without lip coverage, saliva and leakage of food will. In the second stage of the lip reconstruction, crosslip flap abbe was used to restore the symmetry and volume of the upper and lower lips figure 4. Moreover, the reconstructed lip should allow adequate opening for food and dental prosthesis. 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 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.
The defect of the upper lip was covered with a fan flap with incorporation of zplasty flap. Pdf total upper lip reconstruction with a free temporal. Cureus modified bilateral perialar crescent flap for. The patient is a 12yearold girl from guwahati in assam, india. Fm publishers volume 01, issue 01 frontiers journal of surgery 3 we have started using dermal fat flap, mucobuccal flap and muscle transfer in lower lip reconstruction elmelegy, 2017. Lip reconstruction connecticut stanislawmdstanislawmd. Two lower lip defects were reconstructed with estlander. The patient is a 12yearold boy from vizag in andhra pradesh, india who was born with bilateral cleft lip and palate. In this case report, we present a modification of the bilateral perialar crescent flap for reconstructing the combined defect of upper lip and premaxilla in a single stage. Their utility in large fullthickness upper lip defects continue to be a challenge for reconstructive surgeons to avoid the above mentioned disadvantages lip distortion, microstomia, poor oral continence, perioral scarring 9. Pdf lip reconstruction poses a particular challenge to the plastic surgeon in that the lips are the. The upper and lower lips represent the most important. Lip tumors, lip trauma, lip reconstruction, lip malignancy upper lip.
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. Likewise, upper lip reconstruction methods and the number of patients that the methods applied are very limited. Traditionally, the approaches to reconstruction of lip defects have followed a simple algorithm of defect size. Total upper lip reconstruction with a free temporal scalp flap. Restoration of the upper lip provides a reconstructive challenge because of its anatomical and aesthetic requirements. Upper lip reduction reconstruction question how can i reduce the size of the upper lip swelling and correct the. Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. There is also potential sensory return in the neo upper lip with preservation of the auriculotemporal nerve acting as a scaffold. Lip reconstruction after tumor ablation world journal of plastic. Sep 02, 2016 squamus cell carcinoma of the lip prophylactic neck dissection levels i, ii, iii, iv. The submental island flap was harvested figure 5, based on the submental branch of the ipsilateral side and after completion of the neck dissection, starting from the contralateral side in the subplatysmal plane, incorporat.
We performed nose and upper lip reconstruction at 8 months after the onset. If there is a deep wound or hole in the lip, mucosa, or mucus membranes can also be used to fill in the area. Reconstruction of medium to large upper lip defect with a modified unilateral karapandzic flap. Illustrated the reconstruction of a lip with an upper arm flap. We used a forehead flap for the nasal reconstruction and a free forearm flap for the lining. In those patients who have had cancerous lesions, lip reconstruction should be a part of the complete management of their treatment. The abbe flap its use in single and double lip clefts. Vermilion defects the vermillion is the most prominent feature. Aug 01, 2018 upper and lower lip defects are best described separately. Importance the reconstruction of cutaneous defects of the cheek and lip is a foundational topic for facial plastic and reconstructive surgeons.
Aug 27, 2014 the abbe flap is an excellent choice for reconstruction of fullthickness defects of the lip excluding the oral commissure. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal. A case of upper lip reconstruction with 402 mafiadoc. Mar 10, 2020 lip reconstruction surgery in these cases typically uses skin grafts. Inferior labial artery an overview sciencedirect topics. The main goal is functional restoration of the upper lip. The aesthetic or functional abnormalities that prompted revision surgery and the specific techniques.
This approach takes into account the differences in shape, size, and pliability of the lower lip compared to the upper lip. Upper and lower lip defects are best described separately. Dieffenbach 16 was the first to describe local flaps for the same purpose. 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. Modified bilateral perialar crescent flap for reconstruction. Lip reconstruction lips provide expressions to your face. 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. Parents were counselled extensively regarding their. The reconstruction of a subtotal to total lower lip defect, whether it be due to trauma or cancer resection, presents a significant challenge for the plastic and reconstructive surgeon. 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. Lip reconstruction an overview sciencedirect topics. This article provides a where is it on the lip approach to reconstruct small to subtotal defects of the upper lip that are feasible to perform in the office setting.
Luce in which upper lip reconstruction is discussed and an algorithmic approach based on the aesthetic subunit principle is proposed. This lip switch method is termed as the abbe estelander flap. Nasolabial flaps, submental flap, and mucosa graft following. The upper lip can be divided into 2 lateral compartments separated centrally by the philtrum, 10 which terminates inferiorly at cupids bow.
The marginal artery of the inferior labial artery and fibers of the pars marginalis of the orbicularis muscle are included. Due to these com plex functions, the reconstruction of lip defects can pose. Pdf a case of upper lip and moustache reconstruction using. However, satisfactory cosmetic results can be achieved if precise reconstruction plans are taken with consideration of the different esthetic subunits present on the upper lip. Hairbearing temporoparietal fascial flap reconstruction. There are two goals to achieve in upper lip reconstruction. The division of the lips into aesthetic subunits can prove very beneficial in designing lip reconstruction procedures. Nasal and upper lip reconstruction of a case of squamous cell. 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. Any patient who has suffered trauma to their lips, for example a dog bite or laceration, must be treated immediately.
The upper lip is divided into three aesthetic subunits. B lesion removed, flap rotated and sutured into defect. Total reconstruction of the upper lip using bilateral nasolabial. The alternative would be to perform a singlestaged free tissue transfer for upper lip reconstruction or tunnel a hairbearing island of skin. In elderly edentulous patients, functional restoration of the upper lip is a critical priority and large, fullthickness postoncologic defects require tissue recruitment rather than redistribution. Several methods defined in the reconstruction of entire upper lip defects, so far. Full upper lip reconstruction with bilateral nasolabial. The lips must cover the prosthesis from a functional and aesthetic point of view. Surgical instruction upper lip reconstruction for noma by facing africa, nasolabial flap, plastic surgery, flap, sulcus, inner lining, reconstructive surgery, facing africa, flap surgery, incision. Original article outcomes following vy advancement. Pdf on sep, 2016, arthur charpentier and others published simultaneous total upper and lower lip reconstruction during a humanitarian surgical mission. At the same time, the aesthetic importance of the lips is obvious by their central location, subtle variations in surface contour, color, and texture, and importance as. Conversely, traumatic defects occur more often in the upper lip. Whether you are happy, sad, excited or worried, every emotion is expressed through your lips.
Thepurposeofthisstudywastofurther analyze larger upper lip. Reconstruction of substantialsized upper lip defects may require an abbe flap reconstruction to avoid excessive tightness and deformity. The second goal is to ensure an aesthetically pleasing surgical outcome. The result of fullthickness defect involved almost 75% of the upper lip. Lip competence with the prosthesis is required, so surgical reconstruction or management of the lips may be needed. His nose and upper lip fell into necrosis afterwards. Since then there have been many different techniques described for reconstruction of large lower lip defects with 123. His upper lip was reconstructed with bilateral nasolabial orbicularis oris myocutaneous flaps. Cleft lip surgery had been performed at 3 months of age.
Though the choices of flaps abound, perhaps understanding the principles of a few flaps is best. 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. The lips contribute to chewing, speech, facial expressions, and oral competence. Reconstruction of the lip commissure with upper and lower. Nose and upper lip reconstruction for purpura fulminans. During the repair of a defect of the upper lip, tissue is used from the lower lip and vice versa. Many methods have been reported for repair of full thickness defects between one third and two thirds the. Flap is designed with height 1 to 2 mm greater than defect to be reconstructed. Original article outcomes following vy advancement flap. Aesthetic upper lip reconstruction with vermilion submucosal. Pdf a case of upper lip and moustache reconstruction. Pdf simultaneous total upper and lower lip reconstruction during. As a result of the relatively lower incidence of cancer, the reconstructive techniques for defects of the upper lip are fewer than lower lip.
The challenges associated with central upper lip reconstruction result from the complexity of the subanatomic zones that lie within the upper lip. Combined submentaltongue flap for reconstruction of subtotal traumatic avulsion of lower lip. In addition to the clear immediate need for soft tissue coverage, there is. Lower and upper lips are the most important aesthetic and functional structures of the lower segment of the face. Onestage reconstruction of the large, fullthickness central. The upper lip is composed of the philtrum and tubercle centrally, the paired philtral columns laterally, and the white roll of the vermiliocutaneous junction. Stanislaw is an expert at lip reconstruction caused by these conditions. Total reconstruction of the upper lip using bilateral. A method for reconstruction of the lower lip following larger subtotal excision is described. The lips are a focus of facial beauty, impact in patient self image and their central location does not permit concealment of unsightly scars. The design of the abbe or lip switch flap harvested from the lower lip is important for a satisfactory aesthetic and functional result.
Upper lip reconstruction with lower lip abbe flap surgery. Reconstruction of the lip commissure with upper and lower lip fullthickness defects using submental and nasolabial flaps. Perialar crescentic advancement flap for upper cutaneous lip. Lip surgery and reconstructive questions real doctor. Questions about lip surgery and reconstructive, with answers from boardcertified doctors. Bilateral inferiorly based nasolabial island flaps with the facial artery as its pedicle were.
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