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. Whenever possible, dynamic reconstruction should be attempted. The epithelium is grooved with abundant long dermal papillae that carry a rich capillary plexus and sensory innervation, which account for the red lip’s characteristic color and high discriminative sensitivity.  |  This is the lip reconstruction technique used when more than seventy-five percent of the lip is affected by the defect. Shortly thereafter, in 1834, Dieffenbach described the first cheek advancement flap techniques. Herein, we describe the operative technique of the Estlander flap for lip reconstruction. Various methods of reconstruction of large defects of the lower lip have been described. 2020 May/Jun;22(3):200-206. doi: 10.1089/fpsam.2020.0068. Get Support, Meet Families, Build Relationships. Facial Plast Surg Aesthet Med. In fact, most of the reconstructive techniques in present use are modifications or refinements of techniques that were described in the medical literature over the past two centuries. [Reconstruction of the lips after resection of malignant lesions]. All mentioned muscles receive their neural innervation from the posterior aspect of the facial nerve. 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. The goals of lip reconstruction are both functional and aesthetic, and the surgical techniques employed are often overlapping. 35 This requires careful assessment of the defect, including horizontal measurement under gentle tension. We have developed a new technique and successfully repaired a large defect in the upper lip of three men. Adequate adjacent cheek tissue. Therefore, a complete history is essential. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Curr Opin Otolaryngol Head Neck Surg. The superior border is the inferior margin of the nose. Revisiting the value of the 'bandoneon' flap for lower lip reconstruction: a report of two cases and outcome. The lip is no exception. Tissue borrowing from the op­ posing lip was first described by Sabattini in 1838,7andis Lip reconstruction performed by Dr. Simon Madorsky at SCARS Center. Emphasis is placed on adherence to core principles, attention to macroaesthetic and … Article by Michael R Shohet, MD and Maurice M Khosh, MD, http://emedicine.medscape.com/article/876634-overview, © Cleft Lip & Palate Foundation of Smiles 2019. Tagliacozzi originally popularized tissue transfer techniques in the late 16th century. The lips play a key role in facial expression, speech, and eating. When it comes to reconstructing the lips, Hillcrest Plastic Surgery offers superior results. Many lip repair techniques are aggressive requiring general anesthesia and a prolonged post-operative period. Adequate adjacent cheek tissue. However, microstomia, distortion of oral commissure, lip functional problems and sensory loss might be problems with these techniques. Karapandzic introduced the myoneurovascular pedicled advancement flap, and Harii and Ohmori performed the microvascular free tissue transfer for lip reconstructions in 1974. After. Combination of several techniques may be needed in the repair of complex eyelid reconstructions. Evidence supports that techniques used today were discussed as early as 1000 BC in the sacred texts of Susruta, India. Clipboard, Search History, and several other advanced features are temporarily unavailable.  |  Purpose of review: Techniques popularized by Karapandzic and Hari and Ohmori highlight the ability to more effectively address the largest lip defects. The free temporal scalp hair-bearing flap offers a reasonable alternative to conventional techniques in the reconstruction of large defects of the male upper lip or even a total upper lip. Von Burrow first used the technique of skin triangle excisions to facilitate flap advancement in the early 19th century. Strategies for closure involve borrowing tissue eitherfrom theopposite lip or from the cheek. This article discusses principles for the reconstruction of all lip defects of traumatic and neoplastic origin. Recent findings: There have been no major advances in lip reconstruction; rather, continued improvement on accepted techniques. A lip reduction is a surgical procedure that reduces the size of one or both lips by removing skin and tissue via an incision inside the mouth. Advanced lip reconstruction: functional and aesthetic considerations. Lip defects are classified by their depth and their size. Lower lip reconstruction strategies INTRODUCTION The upper and lower lips are the most important func-tional and aesthetic anatomical structures of the lower seg - ment of the face. "The baby face logo is a trademark of The Cleft Lip and Palate Foundation of Smiles, Inc." If you're looking for additional resources or would like to recommend resources for our site, please feel free to contact us. Anatomic considerations, including blood supply, sensation, muscular function, motor innervation, and the topographic subunits, are critical concepts that must be recognized if optimal results are to be achieved. The technique involves using circular flaps from around the patient’s mouth for repair. The lips in repose approximate a hexagon with superior, inferior, and paired superolateral and inferolateral borders. Lip reconstruction is a delicate procedure that requires the care and attention of a highly qualified professional such as Fellowship Trained Mohs and Reconstructive Surgeon Dr. Hayes B. Gladstone of Gladstone Clinic in San Ramon, CA. The use of permanent suspension sutures to the periosteum to aid in long lip repair also has mixed results. eCollection 2020 May. The pars marginalis is not limited solely to the vermilion but extends outward. Each quadrant consists of a pars peripheralis and a smaller pars marginalis. Lip Reconstruction Many procedures have been described to reconstruct various lip defects, and some of the oldest remain effective and in use today. The reconstructive surgeons at SCARs use the latest techniques and methods to restore every patient’s smile. 2/3 of upper lip, midline defect. The Karapandzic technique was introduced in 1974 for lower lip reconstruction. Myomucosal Lip Island Flap for Reconstruction of Small to Medium Lower Lip Defects. The region of opposition of marginal and peripheral parts is indicated by the red-white junction ventrally, and the mucosal-red lip junction posteriorly. 2019 Jun;27(3):219-226. doi: 10.1097/MOO.0000000000000531. However, traumatic deformities comprise defects that may also require the reconstructions discussed in this article. Estlander Flap. Optimally, the major goals of reconstruction must be addressed; these goals include reestablishment of oral competence, adequate oral aperture and motion, and normal anatomic proportions. Several algorithms have been described that match depth, size, and location of a defect with the suggested reconstruction. Call us at 616-329-1335. Local tissue should be used whenever possible to provide the least donor site morbidity and the best overall tissue color and texture match. Using the latest and most modern techniques, Dr. Elliot Duboys, MD and his team at Associated Plastic Surgeons & Consultants, PC perform reconstructive surgery to correct and minimize these deformities all while helping patients regain confidence in their appearance in a safe, comfortable, and nurturing environment. This requires meticulous attention to preoperative planning and surgical technique to maximize the functional and cosmetic outcome. Lip carcinoma is the most common oral cavity malignancy. 2019. The depressor labii inferioris and the platysmal pars labialis are the inferior tractors. We know this type of restoration is never about vanity; it’s about a sense of well-being. The pars marginalis is located anterior and superior to the most distal portion of pars peripheralis except at the mouth corner where it is located just anterior and inferior to the most distal portion of pars peripheralis, and anterior to the bundle of buccinator muscle.[2]. The procedures are typically not associated with other facial treatments. This 24-year-old woman underwent repair of her traumatic lip laceration. Occasionally, laser treatments are used to help camouflage skin scars. Do not perform closure of any defect after neoplastic excision until margins have been adequately examined. This system also allows for discussion of each subunit and its reconstructive possibilities. 2007 Jan;18(1):237-41. doi: 10.1097/01.scs.0000246738.76848.fe. Description. The junction between external hair-bearing skin and the red hairless surface in the upper lip takes the form of a double-curved Cupid bow, the bilateral apices of which correspond to the lower end of each philtral ridge. Commissure involved. Aesthetically, the lips are the focal point for verbal expression and are fundamental to the overall appearance of the face. Previously, the oral fissure was assumed to be surrounded by a series of complete ellipses of muscle resulting in a sphincter compression of the lip margins. The lips contribute to chewing, speech, facial expressions, and oral competence. Careful preoperative assessment and planning will allow the surgeon to reach an acceptable balance between form and function with the reconstruction. The mental nerves inferiorly and the supraorbital nerves superiorly provide sensation. Karapandzic introduced the myoneurovascular pedicled advancement flap, and Harii and Ohmori performed the microvascular free tissue transfer for lip reconstructions in 1974.[1]. Approximately 25% of all oral cavity carcinomas involve the lips, and the primary management of these lesions is complete surgical resection. Skin cancer on the lip is painful and the surgery to remove it often leaves significant, unsightly scars. Recent findings: Reconstruction of acquired lip defects: Ten-year experience at a tertiary care center. 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. Epub 2020 Sep 30. Hautarzt. Lip reconstruction is not a new concept. Abstract. The management of the resulting lip defect remains a significant reconstructive challenge, requiring meticulous preoperative planning and surgical technique to optimize the functional and cosmetic outcome. Accessory muscles of the orbicularis oris complex exist and mainly consist of superior and inferior tractors. Cleft Lip and Palate Foundation of Smiles Inc. is a Public Charity Organization 501© 3 # 45-2230155. Because prior surgery in the area may have compromised some of the reconstructive options, these algorithms clearly serve only as guidelines. Lip defects can be classified according to thickness of the defect (ie, skin or mucosa only, full-thickness) and overall size of the defect. sumeryadav2004@gmail.comsumeryadav2004@gmail.com. 2020 Oct-Dec;10(4):698-704. doi: 10.1016/j.jobcr.2020.09.007. It can be thought of as an extension of the Estlander flap. Large Lower Lip Defects • Karapandzic flap may be used in lesions up to 80% of lip, may cause microstomia • Bernard-Burow’s procedure provides new lip tissue, but sensation and competence problems can lead to drooling • Free flap may be needed in massive defects or those with insufficient lip or cheek tissue for reconstruction HHS Would you like email updates of new search results? Lip Reconstruction In Depth Modified Burrow Technique. NLM The main goals of reconstruction remain the restoration of oral competence, maintenance of oral opening, and the restoration of normal … Breast Reconstruction Case 10850 Breast Reconstruction. Lip Reconstruction. Lip reconstruction for defects which involve the commissure remains a significant challenge to the facial plastic surgeon. The nasolabial flap, while a common flap for the repair of other facial defects, is an under-recognized option for the reconstruction of the lower lip. Though the choices of flaps abound, perhaps understanding the principles of a few flaps is best. The inferior division is divided simply at the vermillion border. Lip reduction surgery is a lip correction technique for larger lips or lips deformed by fillers such as permanent silicone injections. This site needs JavaScript to work properly. The main goals of reconstruction remain the restoration of oral competence, maintenance of oral opening, and the restoration of normal anatomic relations such that both the active (smile) and passive (form) cosmetic outcome is acceptable. It is nourished by a narrow superiorly-based pedicle of the superior labial artery. Click Here to … Complete Philtrum Reconstruction on the Partial-Thickness Cross-Lip Flap by Nasolabial Muscle Tension Line Group Reconstruction in the Same Stage of Flap Transfer. 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. The superolateral boundaries orient from around the alar sulci to the modioli. Superficial defects involve the skin and vermilion, and leave the underlying muscles, nerves and arteries undisturbed. Although many techniques use hair-bearing flaps to repair large upper lip defects in men, few preserve orbicularis sphincter function. Superiorly, these tractors are the zygomaticus minor, the levator labii superioris, and the levator labii superioris alaeque nasi. Read about how medications can play a role in causing birth defects. 2008 Jan;24(1):92-104. doi: 10.1055/s-2007-1021892. Facial Plast Surg. It is important to assess local tissue characteristics (skin laxity) and previous treatment (surgery and/or irradiation) before the surgical plan is made final. Due to these com - plex functions, the reconstruction of lip defects can pose The blood supply is derived from superior and inferior labial arteries, which branch from the facial artery superomedially. Techniques popularized by Karapandzic and Hari and Ohmori highlight the ability to more effectively address the largest lip defects. What is lip reconstruction surgery? Reconstruction of massive lower lip defect with the composite radial forearm-palmaris longus free flap: empowered static and partial dynamic reconstruction. A novel technique has been described by Manafi et al as Mutual cross lip musculomucosal flaps for correction of major vermillion defects which is very helpful in cases of lip hemangioma. The goals of lip … Techniques popularized by Karapandzic and Hari and Ohmori highlight the ability to more effectively address the largest lip defects. The last century is considered to be one of refinement of the above-mentioned principles. Prevention and treatment information (HHS). 16 The major disadvantage of these flaps is that the reconstruction must be staged, with pedicle division occurring 2 or more weeks after initial flap positioning. Curr Opin Otolaryngol Head Neck Surg. Nonetheless, in the case of a long lip deformity, multiple studies have shown that superficially excising tissue from the alar base in an effort to elevate the cleft side is insufficient in redressing the issue. We have, in an earlier issue of this journal, described the modiolus perforator flap, a versatile and reliable flap for perioral reconstruction. Dr. Spence is a leader in his field, and he uses the most advanced surgical techniques available during lip reconstructions. The Gillies Fan flap is a single-stage composite rotational-advancement flap for reconstruction of medium to large full thickness lower lip defects. It is the site of almost 30% of all oral cavity malignancies. The hexagonal lip aesthetic subunit can be divided into upper and lower divisions. Reviewed here are the accepted techniques of lip reconstruction, as well newer techniques that have been reported.  |  With any surgical reconstruction, one must take into consideration many factors that affect overall satisfaction in terms of functional and aesthetic results. In general, entire subunits must be excised and reconstructed to conform to the aesthetic principles of scar camouflage. Individual patient factors, such as previous operations, underlying comorbidities, compliance, and mechanisms for the wound defect, may affect choices of reconstruction; therefore, several different options should be available for each defect. Motor innervation is derived from the facial nerve branches. Yin N, Wu D, Wang Y, Song T, Li H, Jiang C, Ma H, Zhao Z. JAMA Facial Plast Surg. The late 19th century was a time of the popular contributions of Abbe, Sabattini, and Estlander. Karapandzic Flap for Esthetic and Functional Reconstruction of Large Defect of Lower Lip. Soft tissues containing neoplastic cells may be undermined and relocated, ultimately confusing further excision. COVID-19 is an emerging, rapidly evolving situation. Proceeding with a complex closure prior to establishment of adequate margins can certainly compromise the ultimate result. 2011 May;62(5):368-74. doi: 10.1007/s00105-010-2088-3. Previous operations with possible compromise of labial vessels may be a contraindication to the use of a pedicled labial flap. Upon further functional inspection, independent quadrants clearly are apparent. Concepts for cleft lip reconstruction are discussed in the eMedicine article Cleft Lip. The inferolateral boundaries extend downward and medially from the modioli to the mentolabial sulcus. The glistening, pink, and moist appearance of the free red lip, or vermillion, is due to its covering with a specialized stratified squamous epithelium that is thinnest near the white skin and increases in thickness slightly as the mucosa is approached. Please enable it to take advantage of the complete set of features! doi: 10.1093/jscr/rjaa082. The Estlander flap is a hardy local flap which can be used to reconstruct defects of 1/3-2/3 of both the upper and lower lip. Dadhich A, Shah S, Nilesh K, Saluja H, Girhe V, Agarwal S, Mishra M. J Oral Biol Craniofac Res. Celsus method combined withCelsus method combined with an Abbe flapan Abbe flap Large defects of upper lip can be reduced by CelsusLarge defects of upper lip can be reduced by Celsus method and then closed by using Abbe flap.method and then closed by using Abbe flap. Functionally, the lips serve as borders of the oral commissure, providing adequate access to the oral cavity and contributing to oral competency. This result is 10 days after surgery (case # 15588). Their role in aesthetic balance, facial expression, speech, and deglutination is not replicated by any other tissue substitute. The reconstruction should be tailored to the individual needs of the patient and should take into account the patient's condition, local tissue characteristics, previous treatment(s), and functional needs (eg, denture use), in addition to the size and location of the defect. This is the first … Reviewed here are the accepted techniques of lip reconstruction, as well newer techniques that have been reported. The principles and techniques described are broadly applicable to other flap designs that are expected to meet both the aesthetic and functional results of a lip reconstruction procedure. 2017 Dec 1;19(6):496-501. doi: 10.1001/jamafacial.2017.0296. J Surg Case Rep. 2020 May 23;2020(5):rjaa082. Lip Reconstruction Case 15588 Repair of Lip Laceration. Deep/full thickness defects include the underlying muscles, primarily the orbicularis oris. Available techniques can also result in an unnatural appearance, because the entire upper lip is covered by a dense region of hair. RECONSTRUCTION OF LIP DEFECTS: ONE HALF TO TWO THIRDS OF LOWER LIP Defects larger than one half of the lip cannot be closed primarily without undue wound tension. Lip Deformity can adversly affect one's overall facial appearance and can be a great source of concern to the affected person. Raschke quantified that effect with cephalometric analysis. Before. While traumatic injury to the lips should be repaired immediately, lip reconstruction after a cleft lip repair in a baby should occur when the child is older and more developed. Epub 2020 Apr 6. Privacy Policy | Disclaimer | Sitemap. Summary: Lip Reconstruction Surgery. NIH 2017 Jul-Dec;7(2):300-303. doi: 10.4103/ams.ams_127_17. Although this is an excellent resource in considering potential options, knowledge of both the options and the related benefits and pitfalls of each flap is important. Lip reconstruction for traumatic, congenital, or cancer removal aims at restoring the function and appearance of the lips. Raise money for Cleft Lip and Palate Foundation of Smiles (Wyoming - MI) just by searching the web and shopping online! We do not give out medical advice or recommend any particular team, doctor, hospital, health care health care professional or course of treatment. Cleft Lip Repair; The timing of your cosmetic and reconstructive lip repair is dependent upon the cause and type of your lip defect. The depth of the skin–red lip junction of the lower lip varies greatly in individuals, but invariably some inferomedially directed convexity from the modioli is present. Lip Reconstruction. Regardless of the depth or size, a successful lip reconstruction considers the five principles and the effect that the reconstruction has on the sur… 2/3 of upper lip, midline defect. USA.gov. 1/2 - 2/3 of upper or lower lip. Dadhich AS, Shah S, Saluja H, Tandon P, More V. Ann Maxillofac Surg. Reconstructive Cases - Medial Canthal Nose / Eyelid… Superior Extended Nasal Myocutaneous Island Flap: An… Posted in Basal Cell Carcinoma , Intraoperative Photos , Reconstructive Techniques and tagged Intraoperative Lip Cases , Lip Reconstruction , Mohs excision , Mohs surgery , Recurrent BCC Lip reconstruction is driven by restoration or preservation of function and aesthetics. [ 2, 3] Functional considerations include oral continence, mobility that allows for … There have been no major advances in lip reconstruction; rather, continued improvement on accepted techniques. Summary: Restoration of the upper lip provides a reconstructive challenge because of its anatomical and aesthetic requirements. Craniofacial, Unilateral Cleft Lip Repair, Hearing and Behavior in the Child with Cleft Palate For Parents. Formally, the orbicularis oris muscle as a whole is composed of 8 segments, each representing a fan with its stem at the modiolus. Modified Burrow Technique. The nerve and blood supply may also be affected if the defect is large. The reconstruction of full-thickness eyelid defects is best approached using an algorithm of techniques based on defect size. The aim of this study is to evaluate McGregor flap reconstruction of large lower lip defects following excision of squamous cell carcinoma (SCC). We've collected research on medications that have been linked to craniofacial differences to give our families facts to discuss with treating doctors. The upper lip is further divided into 2 lateral subunits and a central philtral subunit. Horizontal lip shortening and vermilion line effacement are the primary negative consequences of traditional reconstructive techniques of the lower lip. Upper and lower lip defects are best described separately. J Craniofac Surg. 3 Herein, we describe a reconstructive method where we combined a large lip switch flap together with a composite advancement modiolus flap to reconstruct a whole lower lip and the donor defect of the upper lip all at once. It is a modification of the Gillies fan flap 3, which is best indicated for …
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