Lip reconstruction: an anthropometric and functional analysis of surgical outcomes

Myomucosal Lip Island Flap for Reconstruction of Small to Medium Lower Lip Defects

Importance: Reconstruction of small to medium lower lip defects commonly includes mucosal advancement and wedge excision with primary closure, resulting in aesthetic complications such as lip flattening, shortening, and loss of the vermilion roll. The myomucosal lip island flap offers an alternative that preserves lower lip appearance and function.

Objective: To describe the lateral myomucosal lip island flap and its indications for the reconstruction of small to medium lower lip defects.

Design, Setting, and Participants: A retrospective chart analysis of patients from 2014 to 2019 was done. Participants include all consecutive patients of the senior author who had the myomucosal lip island flap employed in the lower lip from 2014 when the senior author began employing this technique, including 20 patients. Patient demographics, surgical indications, surgical defect bridging distances, flap advancing distances, functional complications, and aesthetic outcomes were reported. IRB approval was obtained from St. Joseph Health Center for Clinical Research and surgeries were performed at a private tertiary referral center—Skin Cancer and Reconstructive Surgery Center—by the senior author in a multispecialty practice.

Main Outcomes and Measures: Location and flaps utilized to reconstruct the defect were reported. Lateral advancing distance and overall bridging distance were measured. Functional complications, if any, were reported. Appearance rating after the first stage was assessed.

Results: This case series included 20 patients with lower lip defects reconstructed with myomucosal lip island flaps. The average bridging distance (width of defect) was 1.7 cm (minimum 1.0 cm, maximum 2.8 cm). Of 18 patients with available postoperative photographs, 4 cases (22%) had mild vermilion inferior retraction, 1 case (6%) had mild contour irregularity, and 1 case (6%) had visible white scar in the red lip.

Conclusions and Relevance: The myomucosal lip island flap is a reliable technique for reconstruction of small to medium lower lip defects, preserving lip fullness and the vermilion roll.

A New Modification of Fan Flap for Large Lower Lip Defects

BACKGROUND AND AIMS

The reconstruction of the lower lip defects which may result from malignancy, trauma, and burn is necessary for mastication, oral competence, salivary retain, articulation, and aesthetic appearance of the face. While small (30% of the lower lip) and medium (30%-80% of the lower lip) size defects are reconstructed using primary repair and local flaps, reconstruction of the large defects including total and near-total of the lower lip is very challenging entity. We introduce a new modification of the fan flap named extended fan flap for reconstruction of the total and near-total lower lip defects.

MATERIAL AND METHODS

The extended fan flap was used for 12 patients with defects involving more than 80% of the lower lip due to squamous cell carcinoma excision. Most of the patients were males (80.9%) with an average age of 66.8 years (range, 47-82 years).

RESULTS

No major complication is observed in the postoperative period. The functional and aesthetic results were satisfactory. The sphincter function for normal mastication, eating, and salivary retain was reestablished. No microstomy was seen and insertion of artificial dentition was possible for patients.

CONCLUSION

We believe that the unilateral extended fan flap is a reliable and safe option with satisfactory functional and aesthetic results for total and near-total (more than 80%) lower lip defects.

Two-Thirds Lip Defects: A New Combined Reconstructive Technique for Patients With Epithelial Cancer

BACKGROUND

The lips are a common site prone to squamous cell carcinomas, which arise in the facial region. There are different techniques to reconstruct the excised lip region, according to dimensions, area, and position of the tumor. The authors describe a new technique of lip reconstruction born from a combination between a nasolabial flap and adipose tissue transplant.

METHODS

The study was lead in the Plastic and Reconstructive Surgery Department of the University of Catanzaro. It includes 10 patients with squamous and basal cell carcinomas that interested lower or upper lip. The authors used a nasolabial flap to reconstruct two-thirds of the excised lip. All patients were staged and resulted free of disease. As a result of surgery, deformities and depressions persisted in 5 patients. This induced the authors to subject them to transplantation of adipose tissue to maximize results. Aesthetic and functional evaluation was performed with the Patient and Observer Scar Assessment Scale v 2.0 and drooling rating scale questionnaires. Moreover, an anthropometric analysis was performed in patients treated with fat transplant. Data were analyzed using Wilcoxon signed-rank test.

RESULTS

All patients had an acceptable aesthetic and functional outcome. Oral competence, sensation, and movements of the area were adequate and aesthetic was good. Adipose tissue transplant compared with surgery alone, determine a real modification of various parameters, that was statistically significant (P = 0.043) to our analysis.

CONCLUSIONS

The inverted nasolabial flap is versatile and simple. This technique allows to repair large lip defects by maintaining the eurythmia of the face. Autologous fat transplant is a favorable filler. Our data show that surgery alone is unable to restore face eurythmia after a tumor excision. Adipose tissue transplant allows to reach this goal. These 2 techniques, together, may significantly modify the functional and aesthetic result of the lip reconstruction, ensuring an optimal long-term result.

Variation trends of the postoperative outcomes for unilateral cleft lip patients by modified Mohler and Tennison-Randall cheiloplasties

PURPOSE

To evaluate postoperative variation trends of unilateral cleft lip by stages, and to analyze influential factors of nasolabial symmetry.

MATERIALS AND METHODS

A total of 145 patients with unilateral cleft lip were treated by the modified Mohler or Tennison-Randall technique, and received routine anti-scarring treatment postoperatively. Photogrammetry was applied to respectively measure 5 indices by stages preoperatively, the first week (1 w), the third month (3 m), the sixth month (6 m), and the first year (1 y) postoperatively. Then we calculated the symmetry ratio and drew line charts. Student t tests were used for any group differences; linear regression analysis was used to examine which postoperative stage correlated best with the preoperative stage; cluster analysis was used to classify the severity of the cleft according to preoperative SRsn-cphi, which was used to predict the operative difficulty and to select an appropriate technique.

RESULTS

The Mohler technique yielded a more symmetric result. With the Tennison-Randall technique, the alar base was more lateral and downward, and the lip height on cleft side seemed longer. A stable effect emerged around 1 year after surgery with both techniques. Conspicuous scars appeared at 3 months, most scars gradually fade at 6 months, and the total evolution took around 1 year. Scars from the Mohler technique fluctuated across a larger range. Preoperative SRsn-cphi of the two techniques had statistical significance and was adopted as the basis for cluster analysis. The critical value was 0.670. The Mohler technique attained an almost identical effect in each interval, whereas the Tennison-Randall technique was better in the interval that SRsn-cphi <0.670.

CONCLUSIONS

Preoperative SRsn-cphi can be the evaluation index of severity; the modified Mohler technique is more broadly applicable to differences in severity than is the Tennison-Randall technique.

Wearing complete dental prostheses - Effects on perioral morphology

Background

To adequately perform rehabilitation of edentulous patients by a complete removable dental prosthesis (CRDP) is from basic interest to dentists to understand the morphologic changes caused by re-establishment of a physiologic jaw relationship. Anthropometric analyses of standardized frontal view and profile photographs may help elucidate such changes.

Material and Methods

Photographs of 31 edentulous patients were compared in relaxed lip closure and after insertion of a CRDP in stable occlusion. 2232 anthropometric distances were raised. Eighteen anthropometric indices reflecting the perioral morphology and its integration in the vertical facial harmony were investigated.

Results

The intercanthal – mouth width index (p<.001), medial - lateral cutaneous upper lip height index (p=.007), lower vermilion contour index (p=.022), vermilion - total upper lip height index (p=.018), cutaneous - total upper lip height index (p=.023), upper lip - nose height index (p=.001), nose - upper face height index (p=.002), chin - mandible height index (p=.013), upper lip - mandible height index (p=.045), nose - lower face height index (p=.018), and nose - face height index (p=.029) showed significant pre- to post-treatment changes.

Conclusions

The investigated anthropometric indices presented reproducible results related to an increase in occlusal vertical dimension. Their application may be helpful in assessment, planning, and explanation of morphologic effects of CRDPs on the perioral and overall facial morphology, which may helps to improve the aesthetic outcome.

Key words:Dentures, removable dentures, anthropometry, perioral morphology.

Unilateral one stage nasolabial flap for reconstruction of the lips

BACKGROUND

Nasolabial flap (NLF) is one of the oldest described soft tissue flaps. Despite the great advances in maxillofacial reconstruction it still has a stable location in the reconstructive ladder of the face and oral cavity. Reconstruction of the lips, which are important structures that connect the oral cavity to the facial skin, with this flap is the interest of the surgeons.

PATIENTS AND METHODS

Experience of the authors for reconstruction of the upper lip philtrum, correction of lower lip contracture and subtotal reconstruction of the lower lip with emphasis on simultaneous correction of the red lip (volume and color) is explained in five cases.

RESULTS

Satisfactory functional and aesthetic results were obtained. Iatrogenic epidermoid cyst occurred in one patient.

CONCLUSION

One stage reconstruction of lateral lower lip defects with/without commissural involvement in full or partial thickness defects is possible by NLF. Supplementary flaps are needed when the vermilion needs simultaneous reconstruction.

A 3D anthropometric analysis of the orolabial region in Chinese young adults

The orolabial region undergoes considerable changes after orthognathic surgery or orthodontic treatment. Ethnicity, age, and sex-specific norms are needed during the planning of interventions in this region. In 2008 the Br J Oral Maxillofac Surg published anthropometric measurements of the lips of Chinese children, but to our knowledge such reference data for young Chinese adults are not currently available. We therefore used digital anthropometry on 3-dimensional craniofacial images acquired from 103 healthy young Chinese adults with Class I skeletal pattern. Anthropometric landmarks were identified, which provided linear and angular measurements. All orolabial measurements were significantly larger in men than women, with the exception of the labiomental angle. In contrast, there were no sex differences in the anthropometric proportions. We therefore provide what we think are the first cross-sectional norms available for young Chinese adults. These norms can be used to evaluate the morphology of the lips objectively for preoperative diagnosis, planning of treatment, and assessment of postoperative outcomes.