The staircase technique for treatment of cancer of the lower lip: a report of 36 cases

Surgical management of squamous cell carcinoma of the lower lip: an experience of 109 cases

Objectives: We are presenting our experience collected from a series of 109 cases with SCC of the lower lip focusing on clinical features of patients and surgical approach. Study Design: We retrospectively analyzed medical records of patients diagnosed with Squamous Cell Carcinoma (SCC) of the lower lip at the Oral and Maxillofacial surgery at Xi’an Jiaotong University during a period between 1999 and 2008. Results: A total of 109 patients with lip cancer were included in the study. When no frozen-section test was performed, the neoplasia was removed with a margin of at least 6 mm. Different surgical techniques were used for lip reconstruction after tumor excision. Neck dissection was performed in all patients with clinically palpable lymph nodes. Median follow-up was 38 months. During follow-up, recurrence occurred in 5 patients, 3 patients developed neck metastases, distant metastases developed in 1 patient. Five patients died during observation period. Conclusions: The patient-related and defect-related issues must be taken into consideration during reconstruction for surgical defect. For N0 patients, we recommend wait-and-see policy. Early detection, careful follow-up and prompt neck is essential for the successful treatment.

Key words:Lip cancer, surgical management, reconstruction.

Yu's flap for lower lip and reverse Yu's flap for upper lip reconstruction: 20 years experience

Reconstruction of defects of the lip caused by cancer with its requirements of a complicated anatomical structure, important physiological function, and acceptable cosmetic result, is a challenge for oral and maxillofacial and plastic surgeons. A method that combines rotation and advancement flaps was described by Yu in 1989 for the reconstruction of defects of the lower lip. In our department between January 1992 and December 2012, 8 patients had reverse Yu flaps for the reconstruction of upper lip defects and 56 patients had classic Yu flaps for lower lip defects. Patients with defects located laterally to the upper lips, ranging from ⅓ to ½, had unilateral reverse Yu flaps, and bilateral procedures were done for defects of less than ⅔ of the lips. However, if the defects were located in the centre of the upper lips, between ⅓ and ½, they were treated with bilateral reverse Yu flaps. Patients with defects between ⅓ and ⅔ of lower lips had unilateral Yu flaps, and if the defects were wider than ⅔ of the lower lips, the procedure was bilateral. No flap failed and desirable functional and aesthetic outcomes were recorded in all cases. Here we report our experience with the Yu flap for the benefit of other surgeons.

Wave technique for treatment of lower lip cancer

PURPOSE

This article reports the authors' experience with treatment of lower lip cancer using the wave technique.

PATIENTS AND METHODS

Twenty-one patients (16 males, 5 females) were treated using the wave technique between September 2009 and October 2010. Patients undergoing the procedure had tumors that were classified as either T1N0M0 or T2N0M0. Lateral defects less than 2 cm in size are generally treated with unilateral flaps, and median defects are closed with bilateral symmetric flaps. If the defect is paramedian and greater than 2 cm in width, two asymmetric flaps are used.

RESULTS

No recurrence was observed during a 6- to 32 months follow-up (mean 19 months). All patients showed excellent esthetic results with no microstomia.

CONCLUSIONS

We modified the straight lines of the staircase technique into round lines of the wave technique, resulting in an esthetic improvement. The goal of the broken lines and round lines is to create less visible scars. The wave technique can be used to close defects of up to two-thirds of the lower lip.

Flap designs for lower lip reconstruction

Lower lip reconstruction is ideally achieved with innervated flaps that supply mucosa, functional muscle, and skin. These flaps should be capable of being used when vermilionectomy is necessary. The size and shape of the defect determine the optimal flap. This article illustrates the flaps used by the authors for particular reconstructive problems.

Reconstruction of the lower lip: rationale to preserve the aesthetic units of the face

BACKGROUND

The boundaries of the aesthetic units of the face are often crossed after lower lip cancer surgery. The aim of this study was to compare the aesthetic and functional outcome after use of different operative techniques based on the concept of the aesthetic units of the face.

MATERIALS

Sixty-three patients were evaluated after lower lip reconstruction. The aesthetic outcome was recorded by standard photography evaluating the disruption of the boundaries of the aesthetic units of the face, lip projection, and the resulting facial expression. The functional outcome consisted of the evaluation of mouth opening, pouting, and lips at rest for the evaluation of mouth continence. Three techniques were used: wedge excision, the Webster-Fries method, and the step technique. The step technique was combined with an Abbé or an Estlander flap in defects involving more than two-thirds of the lip.

RESULTS

In defects involving up to one-third of the lip, the aesthetic outcome was better for the step technique than for wedge excision (a statistical trend was observed, p = 0.088). In defects involving two-thirds of the lip, the aesthetic and functional outcome was better using the step technique than the Webster-Fries method (p = 0.002), because the boundaries of the aesthetic units are respected. In defects involving more than two-thirds of the lip, the result was better using the step technique combined with the Abbé flap.

CONCLUSION

The authors have shown that the step technique alone or combined with a flap of the opposite lip is a rational approach for preserving the aesthetic units of the face and its function.

Treatment of lower lip cancer: an experience of 48 cases

The article reports results obtained in 48 cases of lower lip cancer. Tumor classified as T1 or T2, requiring a resection up to 60% of the lower lip, were treated with the stair-case technique. Nine patients were treated with the bilateral symmetrical stair-case technique since their lesions were located medially, while 23 were treated with the bilateral method using two asymmetrical flaps because their lesions were in paramedian position but larger than 2 cm. Ten patients required a unilateral flap. The cases classified as T3, in which the lesion required resection of more than 60% of the lip, were treated with the Bernard-Freeman-Fries technique.