Two-Piece Extraoral Prosthetic Rehabilitation to a Perineural Invasion Lip Cancer.

Lip cancers can severely affect a person in terms of function, esthetics, and psychological trauma. After surgical resection, lip defects require special rehabilitation. This clinical report describes a neck prosthesis of a male patient diagnosed with lower lip squamous cell carcinoma with perineural involvement. The neck prosthesis was connected to the mandibular complete denture with cobalt samarium magnets. Both prostheses improved the patient's mastication, deglutition, and esthetics.

Combination lower lip prosthesis retained by an intraoral component.

Patients who have had a partial or full surgical resection of the maxillary or mandibular lip experience difficulties with articulation of speech, swallowing, and salivary control. This is further complicated by significant alterations in facial esthetics and lowered self-esteem. This clinical treatment will describe the fabrication of a two-piece tooth-retained maxillofacial prosthesis. An intraoral retentive portion and an extraoral section restoring lip anatomy were attached by retentive elements. This prosthesis restored the patient's esthetics, oral function, and self-esteem.

[Karapandzic flap for reconstruction of extensive defects of the lower lip]. / Place du lambeau de Karapandzic pour la reconstruction des pertes de substance étendues de la lèvre inférieure.

OBJECTIVE: To discuss advantages and disadvantages of Karapandzic flap for reconstruction of extensive defects of the lower lip. METHODS: Two clinical observations and a review of the literature are presented. RESULTS: The Karapandzic flap requires only one operating time. The tissue used to reconstruct the lower lip is very close to the resected lip. The functional result is satisfactory, the lips being continent, allowing speech and feeding. The main advantage of this technique is the preservation of the labial sphincter, which is vascularized, mobile and sensitive. The aesthetic result is acceptable. This flap keeps the vermilion, but with rounded commissures that corrects spontaneously. The main disadvantage of this flap is the microstomia, requiring only rarely further surgery. CONCLUSION: The Karapandzic flap is a good option for reconstruction of extensive defects of the lower lip. It recreates the labial sphincter, while maintaining its vascularization and innervation. Functionality is maintained, with an aesthetically acceptable result despite the presence of residual microstomia proportional to the defect.

Upper lip reconstruction with the alar crescent flap: A new approach.

PURPOSE: The alar crescent advancement flap technique has been widely used for repair of large central defects of the upper lip and base of the nose because of its 1-stage procedural simplicity and good results. Several more complicated and multiple staged procedures that respect either structure or function, often compromising one to achieve the other, have become popular and have recently taken its place. However, these procedures are more complex and in many cases require a staged approach. In this study, we present a series of 33 patients who underwent reconstruction of large upper lip defects utilizing alar crescent flaps between 1992 and 2002. PATIENTS AND METHODS: A series of 20 patients underwent reconstruction of large upper lip defects using alar crescent flaps between 1992 and 2002. Malignant etiologies were responsible for the defect in all patients. Reconstruction was performed as a 1-staged procedure in 19 cases. In 1 patient with a total upper lip defect, bilateral alar crescent flaps were used in conjunction with a cross lip flap that was later divided in a second stage procedure. RESULTS: All patients tolerated the procedure well with no major complications. Minor complications not requiring surgical intervention occurred in 5 patients. During the 12- to 60-month follow-up, all patients were found to be satisfied with the functional result. However, 7 patients underwent minor surgical procedures for esthetic improvement. There was no recurrence of disease in the 20 patients who underwent resection of malignancy. CONCLUSIONS: In these 20 cases, we have shown the utility of the alar crescent flap for varying length partial and full-thickness reconstruction of upper lip defects. This simple and straightforward technique provided good functional and esthetic results. The disadvantage of this procedure is the loss of philtral anatomic detail. Its primary advantage is that it is a single-stage procedure with a relatively low morbidity and patient inconvenience. As a single-stage technique it satisfies concerns over cost containment over more complex and staged procedures while still providing a good functional and cosmetic result. Furthermore, for those same reasons, this procedure is a good first choice in the elderly.

Total lower lip reconstruction using sensate composite radial forearm flap.

In modern plastic and reconstructive surgery, shape and function must be considered together. These are the most important goals of any operation. There are a lot of techniques that have been reported for total lower lip reconstruction. It is believed that the radial forearm flap is the most suitable technique for lower lip and chin reconstruction after tumor excision so as to achieve better shape and functional results. The sensate radial forearm-palmaris longus free flap was used for total lower lip reconstruction in 17 patients with lower lip carcinoma with a mean age of 51 years. Two of the patients were female, and 15 were male. All the patients had squamous cell carcinoma. The patients were followed up for 1 to 3 years. Complications of these operations were partial superficial flap loss in 1 patient, partial graft loss in the donor areas of two flaps, and infection in only 1 patient. Wound dehiscence, fistula formation, suture abscesses, or sialocele was not seen in any patient. In this study, the aim was to demonstrate that the sensate radial forearm flap could produce acceptable esthetic results, good sphincteric function, and sensation in the early period after surgery.

A maxillary lip prosthesis retained by an obturator with attachments: A clinical report.

This article describes the prosthetic rehabilitation of small maxillary lip and maxilla defects with a lip prosthesis attached to an obturator. The definitive obturator prosthesis was designed with 3 plastic ball attachments on the labial surface that provided adequate retention for the lip prosthesis. The thin margin of the lip prosthesis ensured that it adapted well to functional movements.

The partial-thickness cross-lip flap for correction of postoncologic surgical defects.

PURPOSE: Abbe and Estlander cross-lip flaps have been described and designed as a full-thickness flap to reconstruct a full-thickness excisional defect. Some Mohs surgical excisions and other serial excisions leave partial-thickness defects. This article reviews a series of partial-thickness cross-lip flaps, which included some orbicularis oris muscle in the vermilion region but otherwise was a subcutaneous flap. PATIENTS AND METHODS: In the last 7 years, 110 patients with lip cancer had their postsurgical defects reconstructed 24 to 72 hours after the resection. In all cases, negative margins were established by histologic evaluation or Mohs micrographic surgery. Twenty of 29 patients had Abbe- and Estlander- (lip-switch) type flaps, which were composed of a musculomucosal pedicle of 1.25 to 1.50 cm and an attached skin/subcutaneous flap trimmed to fit the defect. The remainder had full-thickness lip-switch flaps. RESULTS: There were no vascular complications in either group. Four patients had notching or trapdoor- type bulking, which were revised after 3 to 6 months. CONCLUSION: The partial-thickness cross-lip flap has the same viability as the full-thickness flap within 1 cm from the inferior border of the mandible.

Regional approaches to the reconstruction of the lip region.

Surgical operations on the lips are characteristically required when dealing with epithelial tumors in dermatosurgery. Aside from precancerous stages, the definitive removal of basal cell carcinomas and squamous cell carcinomas is most common. The immediate reconstruction of lip defects proves successful, utilizing the histologic examination of the cut edge by cryotechnique. All operative techniques that reconstruct the circular musculature of the musculus orbicularis oris in its natural uniformity are appropriate. Of the large variety of reconstructive procedures, this article discusses those techniques that are used routinely.

Objective evaluation of function of the lower lip reconstructed with a myocutaneous advancement flap.

Many surgical methods have been developed for reconstruction of extensive defects resulting from resection of lower lip cancer, with the aim of achieving of normal appearance and function. However, observers' subjective evaluation, which is the method usually employed, makes comparison of the outcomes of appearance and function obtained from different techniques difficult. In this paper, a speech intelligibility test and electromyography were used as objective means of evaluating the motor function of the reconstructed lower lip.

Full-thickness reconstruction of cheek defect involving oral commissure with forearm tendinocutaneous flap.

An 82-year-old man underwent full-thickness reconstruction of the cheek for a defect of the oral commissure resulting from a T3N1M0 squamous cell carcinoma. He had previously had both radiotherapy and chemotherapy. A tendinocutaneous flap from the forearm incorporating palmaris longus was used for static reconstruction. The vermilion was then reconstructed with rotation flaps from the contralateral vermilion. Oral function was restored, and he had no problems with drooling or speech.

[Mutilation of the lower lip. Repair using the Karapandjic technic. Apropos of 2 cases]. / Les multilations de la lèvre inférieure. Réparation par la technique de Karapandjic. A propos de 2 cas.

Many processes of repairing concerning the mutilation of the lower lip were described with their advantages and drawbacks. The Karapandjic process which has been described since 1974 is simple to realize, leaving no after-effects provided the loss of the substance is not very important. This process is illustrated regarding two cases.

Reconstruction of total loss of upper lip with hair-bearing flaps.

Carcinoma of the lip is a relatively common problem in Papua New Guinea, accounting for some 12% of all malignant tumours in the oral cavity. The cancer is associated with chewing betelnut with slaked lime and smoking. Advanced squamous cell carcinoma of the upper lip is necessarily managed by primary surgery when radiotherapy facilities are not available. Adequate surgical treatment of these carcinomas usually requires full thickness excision of a portion or whole of the lip. The purpose of this paper is to demonstrate the role of hair-bearing scalp flap for reconstruction of total loss of the upper lip in male patients.

Total upper lip reconstruction using a free radial forearm flap incorporating the brachioradialis muscle: report of a case.

One-stage reconstruction of the upper lip using a free radial forearm flap was successfully performed with excellent functional and cosmetic results. The free radial forearm flap, including the vascularized and innervated brachioradialis muscle, has a very wide potential for reconstruction of the lip defects due to carcinoma.