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Hung SY, Hanba C, Chang TNJ, Chen YL, Lu JCY. Delayed Commissuroplasty Increases Interincisal Distance in Buccogingival Cancer Patients Treated with Free Flap Reconstruction of the Oral Commissure. J Reconstr Microsurg 2024; 40:707-712. [PMID: 38499044 DOI: 10.1055/s-0044-1782659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Oral cavity cancers requiring excision of the oral commissure and free flap reconstruction often requires commissuroplasty to manage oral incontinence. We aimed to evaluate the implications of primary versus delayed commissuroplasty on drooling, and interincisal distance outcomes in this cohort. METHODS A retrospective query of head and neck cancer patients operated by a single surgeon from 2017 to 2020 was performed. Patients were included if they underwent free flap reconstruction of the oral commissure, had an immediate or delayed commissuroplasty, and had 2 years of follow-up data including Thomas-Stonell and Greenberg drooling rating scales and interincisal distance measurements. RESULTS Thirty-five patients were included in the review. Twelve patients received immediate commissuroplasty and 23 patients had delayed commissuroplasty. Interincisal distance was similar at baseline, although significantly varied between immediate and delayed commissuroplasty groups at 1 month and 2 years postoperative. Drooling scores were significantly elevated in the group treated with delayed commissuroplasty, but eventually normalized after staged surgery and follow-up. Patients treated with adjunct radiation therapy had lower interincisal distance than patients who did not have radiation. CONCLUSION Delayed commissuroplasty increased interincisal distance and normalize drooling in patients who required full-thickness excision of the buccal mucosa and oral commissure and free tissue reconstruction. The presented data can help to educate patients on expected postoperative outcomes and likely advocates for a second-stage procedure after completion of adjunct radiotherapy to achieve optimal commissural placement and oral competence.
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Affiliation(s)
- Shao Yu Hung
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Curtis Hanba
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tommy Nai-Jen Chang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yan-Lin Chen
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan
| | - Johnny Chuieng-Yi Lu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Reconstruction of Subtotal Defect of the Lower Lip: Combined Use of Karapandzic and Nasolabial Flap. Indian J Otolaryngol Head Neck Surg 2022; 74:116-120. [PMID: 35070933 PMCID: PMC8743317 DOI: 10.1007/s12070-020-02205-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022] Open
Abstract
Subtotal reconstruction of the lower lip after excision of the tumor is always a challenge for surgeons. It is because of the difficulty in regaining the function of the lip, including the oral competency and restoring the aesthetic subunit. A 46-year-old patient presented with an ulceroproliferative growth involving 70% of the lower lip, including the right commissure. After the confirmation to be a malignancy, patient underwent excision of the tumour and reconstruction of the lower lip using the left Karapandzic flap and right nasolabial flap. The patient was on regular follow-up in the postoperative period to assess the surgical outcomes. The combined use of Karapandzic flap and the nasolabial flap can be reliably used for subtotal reconstruction of the lower lip in advanced oral cavity malignancy, involving one of the commissures. Later can ensure good postoperative results in terms of aesthetic and functional lip reconstruction without any significant intraoperative or postoperative complications.
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Moon BM, Pae WS. Reconstruction of a large lower lip defect using a combination of Abbe and staircase flaps: a case report. Arch Craniofac Surg 2022; 22:324-328. [PMID: 34974688 PMCID: PMC8721431 DOI: 10.7181/acfs.2021.00493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/18/2021] [Indexed: 11/20/2022] Open
Abstract
Lip defects often occur following wide excision as a surgical treatment for squamous cell carcinoma of the oral cavity. Defects larger than one-half of the lip cannot be closed primarily and require flap surgery. Reconstruction of the oral sphincter function can be achieved by means of a local flap using the like tissue, rather than with a free flap utilizing different tissues. A defect of the lower lip requires reconstruction using different techniques, depending on its size and location. Herein, we present the case of a patient exhibiting a lip defect spanning more than two-thirds of the lower lip, after a wide resection due to squamous cell carcinoma. The defect was reconstructed using an Abbe flap and a staircase flap. Revision was performed after 16 days. The patient’s oral competencies were fully restored 3 months postoperatively, and the esthetic results were ideal. Based on our experience, a combination of the Abbe and staircase flaps can produce excellent functional and esthetic outcomes in the reconstruction of a lower lip with a large defect. It can serve as a reliable reconstruction option for defects spanning more than two-thirds of the lower lip, not including the oral commissures.
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Affiliation(s)
- Bo Min Moon
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woo Sik Pae
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Lidhar T, Sharma S, Ethunandan M. Split zygomaticus major muscle sling reconstruction for significant lower lip defects. Br J Oral Maxillofac Surg 2020; 59:106-108. [PMID: 32878716 DOI: 10.1016/j.bjoms.2020.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Abstract
Defects to the lower lip remain surgically challenging to reconstruct. Restoration of aesthetics and function are crucial, of which the aims include restoring the tissues of the lower lip, maintaining oral competence, speech articulation, and restoring lip height and the vermillion. Further surgical techniques continue to be explored, with local flap surgery being the generally preferred method. However, many reconstructions leave the patient with pronounced deformity and morbidity. In this case report, we describe a new technique for the reconstruction of an 80% lower lip defect with an ipsilateral split zygomaticus major muscle sling, nasolabial flap, and facial artery musculomucosal flap. The reconstruction provided good oral competence, speech articulation and aesthetics, in addition to maintaining the oral commissure and lower lip height/length. Iatrogenic microstomia was avoided and zygomaticus functioning was normal. We are confident this technique will be useful to reconstructive surgeons in select cases of significant lip defects.
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Affiliation(s)
- T Lidhar
- Oral and Maxillofacial Surgery Department, Southampton General Hospital, Southampton, England.
| | - S Sharma
- Oral and Maxillofacial Surgery Department, Southampton General Hospital, Southampton, England
| | - M Ethunandan
- Oral and Maxillofacial Surgery Department, Southampton General Hospital, Southampton, England
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Defect Repair After Lip Cancer Surgery. Plast Reconstr Surg 2018. [DOI: 10.1007/978-981-10-3400-8_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dewey EH, Roche AM, Lazarus CL, Urken ML. Total lower lip and chin reconstruction with radial forearm free flap: A novel approach. Am J Otolaryngol 2017; 38:618-625. [PMID: 28734457 DOI: 10.1016/j.amjoto.2017.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The management of large chin and lower lip defects is challenging due to this facial subunit's tremendous functional and aesthetic importance. Specific methods for total lower lip and mentum reconstruction are not well chronicled. Aesthetic and functional goals of this reconstruction include restoration of oral competence by maintaining lower lip height, vermilion reestablishment, color-matched skin introduction to the chin, sensation restoration, and ideally restoration of dynamic activity to the lower lip. METHODS Literature review performed. RESULTS Presentation of novel, two-stage technique for lower lip and chin reconstruction with a submental flap and a radial forearm free flap, suspension of the lower lip and chin with a tensor fascia lata graft, and vermilion reconstruction with a buccal mucosal flap. CONCLUSIONS This procedure meets all goals of total lower lip reconstruction with the exception of the introduction of dynamic tissue and represents a novel solution to a challenging reconstructive problem.
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Affiliation(s)
- Eliza H Dewey
- Thyroid, Head and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY, USA 10003.
| | - Ansley M Roche
- Otolaryngology Fellow, Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Cathy L Lazarus
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA
| | - Mark L Urken
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, 10 Union Square East, Suite 5B, New York, NY 10003, USA
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Dediol E, Čvrljević I, Dobranić M, Uglešić V. Extended Karapandzic Flap Technique for Reconstruction of Lower Lip and Chin Defect. J Oral Maxillofac Surg 2017; 76:213-220. [PMID: 28697350 DOI: 10.1016/j.joms.2017.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Near total defect of the lower lip adjacent to the chin remains a reconstructive challenge for surgeons in function and esthetics. The objective of this study was to present a modified extended Karapandzic technique for reconstruction of near total defects of the lower lip adjacent with the chin. MATERIALS AND METHODS From 2000 to 2013, patients with lip cancer or oral cavity cancer who required subtotal lower lip and chin resection and subsequently underwent reconstruction with an extended Karapandzic flap were included in this retrospective study. Patient demographics, histopathology, tumor stage, localization, tumor extension, method of reconstruction, and postoperative complications were extracted from patients' documentation. RESULTS Reconstruction of the lower lip and chin was performed in 21 patients using a combination of double local extended Karapandzic flaps with microvascular free flaps for intraoral and mandibular reconstruction. There was no flap necrosis; the main complications were fistula and exposure of the osteosynthesis plate. All lips were functional and the esthetic result was pleasing. All patients returned to a peroral diet, although a variable degree of microstomia was present. CONCLUSION The extended Karapandzic flap technique provides superior results for esthetic and functional lip reconstruction and chin reconstruction compared with any other regional or free flap. Free flaps should be reserved for oral cavity and mandibular reconstruction, if needed.
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Affiliation(s)
- Emil Dediol
- Assistant Professor, School of Medicine, University of Zagreb, Zagreb; Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia.
| | - Igor Čvrljević
- Resident, Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | | | - Vedran Uglešić
- Professor, Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb; Dental School, University of Zagreb, Zagreb, Croatia
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Denadai R, Raposo-Amaral CE, Buzzo CL, Raposo-Amaral CA. Functional lower lip reconstruction with the modified Bernard-Webster flap. J Plast Reconstr Aesthet Surg 2015; 68:1522-8. [PMID: 26243196 DOI: 10.1016/j.bjps.2015.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/06/2015] [Accepted: 07/12/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lower lip defects after squamous cell carcinoma (SCC) excisions have been repaired by several surgical techniques. However, the functional reconstruction of full-thickness defects of the lower lip remains a therapeutic challenge. We therefore evaluated functional results of the modified Bernard-Webster flap for the reconstruction of full-thickness lower lip defects after SCC excisions. METHODS A prospective study was performed on all patients with lower lip full-thickness defects after SCC excisions greater than 1/3 of the lip, reconstructed with the modified Bernard-Webster flap in 2011-2013. Functional (sphincter, motor, and sensory functions) postoperative results were evaluated according to criteria previously adopted. RESULTS Twelve lower lip defects were reconstructed without complications, except for two (16.7%) wound dehiscence successfully managed. Ten (83.3%) patients presented transient and permanent functional abnormalities in the recent and late postoperative assessments. Ten (83.3%) patients classified the late functional results as satisfactory. CONCLUSIONS The modified Bernard-Webster flap proved to be an excellent alternative to repair full-thickness lower lip defects with more than 1/3 of the lower lip length, as it allowed the use of similar neighboring tissues, could be performed in one stage, and was functionally effective.
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Affiliation(s)
- Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | | | - Celso Luiz Buzzo
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
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Okochi M, Ueda K, Okochi H. Hemi-Bernard method: straightforward reconstruction of lower lip after malignant tumor resection. J Oral Maxillofac Surg 2015; 73:1232.e1-8. [PMID: 25869747 DOI: 10.1016/j.joms.2014.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
The Bernard method is a straightforward method for reconstructing lower lip defects after tumor resection. However, this method is difficult to apply when the defect is located on the unilateral side of the lower lip. This report describes the reconstruction of unilateral lower lip defects using a modified Bernard method, which is referred to as the hemi-Bernard method. Three patients (2 male and 1 female; mean defect, 55%) underwent reconstruction using the hemi-Bernard method after lower lip malignant tumor resection. No infection or flap necrosis occurred, and none of the 3 patients had difficulty with oral ingestion. Movement of the orbicularis oris muscle was retained in all patients. The hemi-Bernard method is straightforward and has several advantages, including extension of lower lip length. This method could be useful for reconstructing full-thickness defects located on the unilateral side of the lower lip.
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Affiliation(s)
- Masayuki Okochi
- Associate Professor, Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima, Japan.
| | - Kazuki Ueda
- Professor, Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima, Japan
| | - Hiromi Okochi
- Research Associate, Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima, Japan
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Lower lip reconstruction using a combined technique of the Webster and Johanson methods. Ann Plast Surg 2014; 73:620. [PMID: 25310130 DOI: 10.1097/sap.0b013e3182a6ae4a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lower lip reconstruction using a combined technique of the Webster and Johanson methods: reply. Ann Plast Surg 2014; 73:620-1. [PMID: 25305188 DOI: 10.1097/sap.0000000000000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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