Functional and esthetic reconstruction of composite lower lip defects with a motor-innervated chimeric facial artery buccinator myomucosal-submental island flap

OBJECTIVE

This study aimed to assess the functional and esthetic outcomes of a chimeric innervated buccinator myomucosal-submental island flap (BMM-SIF) for large composite lower lip reconstruction.

METHODS

This retrospective study included five patients who underwent lower lip tumor resection and BMM-SIF reconstruction at the Hospital of Stomatology, Sun Yat-sen University, between August 2021 and February 2023. Lip function was evaluated using water leakage, cheek puffing tests, and superficial electromyography. Lip appearance was observed using photographs and evaluated through subjective interviews. Donor-site conditions, including facial symmetry and mouth opening, were monitored.

RESULTS

All the BMM-SIFs survived. Drooling was the main complication observed shortly after surgery. The water leakage test showed complete oral competence for liquid holding in the 7th month; however, moderate air leakage was present in two patients. Electromyography revealed myoelectric signals from the innervated buccinator at the recipient site. Facial expression and food intake were typically managed. The shape and projection of the vermilion were harmonious and satisfactory for each patient. Neither microstomia nor mouth opening limitation was observed, with an average inter-incisor distance of 37.25±4.4 mm.

CONCLUSION

Chimeric motor-innervated BMM-SIF effectively reconstructed large full-thickness lower-lip defects with satisfactory functional and esthetic outcomes.

Mucomuscular Elastic Flap for Lower Lip Vermilion Reconstruction: Experience in a Series of Cases in Pediatric Patients

ABSTRACT

The mucocutaneous line and the lip vermilion are important structures from an esthetic standpoint but also in relation to the functionality of the mouth. In the literature, several types of flaps have been described for reparation of labial defects in adults. In this study, the authors analyze results of surgical reconstruction of the lower lip in the pediatric population using unilateral or bilateral mucomuscular elastic flaps for labial reconstruction. A retrospective analysis of 10 patients operated between 2003 and 2018 at our institution was made. The following demographic and clinical data were collected: age, sex, diagnosis, type of flap, follow-up, results, and complications. The Strasser scale was chosen for assessment of postoperative photographic results. Average age was 8.1 years (range 3-18). The most frequent etiology was arteriovenous malformation seen in 60% of cases. All cases corresponded to a defect of the lower lip. The average percentage of lip compromised was 44% and the largest length of compromise observed was 60% of the lip. Follow-up was on average 2.4 years. Esthetic results according to the Strasser method were as follows: 1 patient presented an excellent esthetic result, 5 good, 4 regular, and 0 poor.Considering the esthetic outcomes and low incidence of complications of the mucomuscular elastic flap, it is an acceptable and recommended technique of choice for lip vermilion reconstruction.

Use of lower vermilion cross-lip flap for correction of whistle deformity in clinical practice and anatomic study for the secondary cleft lip repair

BACKGROUND

The lower vermilion cross-lip flap is usually indicated for large upper-lip vermilion defects. This article points out the importance of the donor site incision and reveals the significance of incorporation of inferior labial artery in this flap.

MATERIALS AND METHODS

The cadaveric study was designed to measure the vertical distance between the upper most parts of the inferior labial artery to vermilion surface in 22 fresh male cadavers. Tissue specimens were taken from the lower lip at the midline in the sagital plane. Moreover, the histologic sections were stained with hematoxylin-eosin, and the measurements were done under light microscope. Alternatively, the divided-pedicle group study consists of 6 patients with lower vermilion cross-lip flap, in which the pedicles were sent to the laboratory for histologic examination after pedicle division.

RESULTS

The distance between the inferior labial artery and the upper most part of the vermilion border was 2.42 ± 1.67 mm. In 77.27% of cases, the artery was found in the submucosal layer. The histologic examination of the pedicles in 6 patients showed the presence of inferior labial artery, in hematoxylin-eosin staining, in the serial cross sections of 5 pedicles.

CONCLUSIONS

Four-millimeter-deep incision of the lower lip's vermilion will embody the inferior labial artery in lower vermilion cross-lip flap in most of the cases. Moreover, the histologic study of the pedicles revealed that the incorporation of the inferior labial artery in flap pedicle will ensure flap perfusion.

Technical details concerning myomucosal advancement method in the repair of large lower lip defects

The most important decision that a surgeon has to make in large lower lip defect reconstruction is whether to use a free flap or local flap. Despite efficient transplantation, serious cosmetic problems can occur in total or in near-total lower lip reconstruction with a free flap. On the other hand, better cosmetic results can be brought about in reconstructions with local flaps when a repair is made in tissues with similar properties in terms of color, thickness, or pilosity. However, functional problems such as microstomy can be encountered when inefficient transplantation is carried out during local flap repairs. If a repair technique with local flap that enables efficient transplantation can be applied, satisfactory cosmetic as well as functional results can be provided. In this text, the technical details of the myomucosal advancement flap method, which is a successful functional local flap application with good cosmetic results, were reported and explained with the help of schematic drawings.