Incomplete midline cleft of the lower lip

Summary Midline clefts of the lower lip and mandible, and incomplete midline clefts of the lower lip are uncommon anomalies, with the latter being very rare. A case of incomplete midline lower lip cleft with a corresponding orbicularis oris muscle defect is present.     

口轮匝肌肌黏膜瓣推进修复下唇缺损

目的　探索下唇缺损修复的新方法。方法　对下唇肿瘤切除后缺损超过全长 2 3以上的患者 ,设计下唇矩形口轮匝肌肌黏膜瓣推进转移修复肿瘤切除后缺损。结果　 2 0 0 0年 1月以来我们对 6例下唇肿瘤患者进行治疗 ,随访 6个月～ 3年 ,无肿瘤复发 ,下唇形态及闭合功能良好。结论　本手术方法设计合理 ,操作简单 ,术后形态功能良好 ,是下唇缺损修复的良好方法之一。     

The application of von Bruns' technique in lower lip reconstruction

Summary The superiorly based nasolabial flaps described first by von Bruns in 1857 are presented here in ten cases of carcinoma of the lower lip. The direct approximation technique with the additional modification of preserving the neurovascular bundle provides esthetic benefits without additional functional compromise. This technique allows resection of almost all of the lower lip with a minimal degree of resultant microstoma and lip distortion. Its use is suggested in preference to other direct approximation methods.     

Modified gate flap for lower lip reconstruction

Summary One of the latest techniques advocated for total lower lip reconstruction is thegate flap described by Fujimori in 1980 [3]. This technique has been modified and used in two patients. With this modification, it is no longer necessary for the lateral margins of resection to extend beyond the commissure for technical purposes, and the shape of the resection does not have to be rectangular. Thus, unnecessary resection of normal tissue and macrostomia are prevented. Widely used reconstruction techniques for large lower lip defects were compared and an attempt was made to explain how to choose the proper technique for a given defect.     

A new technique for one-stage total lower lip reconstruction: Achieving the perfect balance

BACKGROUND:

Reconstruction of extensive lower lip defects is difficult. The authors describe a new technique of one-stage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome.

METHODS:

The authors applied their new reconstructive technique in a patient with extensive lower lip defect following excision of squamous cell carcinoma. Bilateral inferiorly based nasolabial flaps were used for reconstruction of lower lip. For vermillion reconstruction, a bucket-handle mucomuscular flap from upper lip was designed primarily using the pars marginalis portion of orbicularis oris. Compared with previously described techniques, this procedure is unique with respect to the alignment of the nasolabial flaps in relation to one another. Furthermore, this technique of vermillion reconstruction is a one-stage procedure with minimal morbidity, enables preservation of the vascular pedicle and innervation and maintains the orientation of orbicularis oris, thus providing a competent oral sphincter. To the authors’ knowledge, this mucomuscular upper lip flap has not been described earlier and has definite advantages over the commonly used methods of vermillion reconstruction.

RESULTS:

The functional and aesthetic outcomes are satisfactory on follow-up, with normal lip movements and sensation, adequate mouth opening and oral competence, good colour and texture match with adjacent tissues, and excellent volume and quality of the vermillion. No subsequent corrective surgery is required.

CONCLUSIONS:

This technique is simple and achieves the main goals of total lower lip reconstruction in a single stage with minimal morbidity.     

Gracilis free muscle transfer for morpho-functional reconstruction of the lower lip

BACKGROUND: Large full-thickness defects of the lower lip need free tissue transfer. The free forearm flap is the more widespread technique for free flap lower lip reconstruction, but it results in a static lip. The authors describe a technique of morphodynamic sensate reconstruction of the lower lip with a free gracilis flap and a musculomucosal flap. METHODS: Three patients underwent reconstruction with an innervated free muscular gracilis flap, an innervated musculo-mucosal flap for the vermillion (2 cases), and a full-thickness skin graft. RESULTS: No significant complications were observed. Static function and vermillion sensitivity were immediately restored. The skin color match was excellent. After 9 months, contraction of the transferred muscle was evident. CONCLUSION: The lip is a dynamic unit. The innervated gracilis muscle seems ideal for lip reconstruction in that it correctly replaces all the lip layers and compensates for the lost function much better than a static technique.     

Reconstruction of the lower lip with the myocutaneous platysma flap

Summary A case of an ulcerated exophytic squamous cell carcinoma of the lower lip and part of the upper lip in an 86-year-old female is reported. Tumor excision and primary reconstruction were performed with the myocutaneous platysma transposition flap. There was no tumor recurrence or metastasis two years after surgery. Anatomical studies of the flap were performed.     

颏神经血管蒂V-Y岛状推进瓣功能性修复下唇部分缺损

目的 探讨下唇部分缺损的功能修复方法.方法 对7例下唇癌患者做手术切除,形成的唇全厚缺损(缺损长度为下唇1/3至2/3)用颏神经血管束为蒂的颏部V-Y岛状推进瓣修复.结果 颏神经血管蒂V-Y岛状推进瓣全部成活,术后3个月至1年随访,无肿瘤复发,唇外观良好,修复的下唇肌功能和感觉正常.结论 颏神经血管蒂V-Y岛状推进瓣是下唇部分缺损功能性修复的理想方法.     

Reanimation of lower lip reconstructed by flaps

This paper describes a technique of reanimating the reconstructed lower lip. For this the complete masseter on both sides has been used in order to obviate the danger of damaging the motor nerve supply to the muscle. The technique has been suitably modified to use the remaining musculature of the lips (i.e. orbicularis and the levators of the angle and upper lip) to improve the overall efficiency of the remaining upper lip function.     

Upper and lower lip reconstruction using the step technique

The step technique for lip reconstruction is a simple, flexible, one-stage operation that allows reconstruction of full-thickness defects spanning up to two-thirds of the lower lip and, in our experience, one-half of the upper lip without violating the opposite lip or using distant advancement flaps. Twelve patients, ranging in age from 24 to 86 years, underwent full-thickness lip excisions for squamous cell and deeply invading basal cell carcinomas. Reconstruction was achieved by advancing the remaining lateral lip elements to close the defects in a stepwise fashion without violating the remaining orbicularis oris muscle. All patients had a symmetrical, mobile, oral sphincter with intact commissures, adequate buccal sulcus, no symptomatic microstomia, and normal sensation at the completion of the procedure. There have been no recurrences in a nine-month to four-year follow-up, and satisfactory aesthetic results were achieved.     

A new method for reconstruction of the lower lip after tumor resection

A new operative technique is described for the reconstruction of a defect of the lower lip following carcinoma resection. This method combines the advantages of reconstruction using both rotation and advancement flaps. The technique is suitable for a half or subtotal defect and has been performed on 12 patients, yielding successful results in form and function.     

Reconstruction of large lower lip defects: a new method.

Lower lip defects may be due to some congenital or acquired problems, such as congenital naevi, hemangiomas, tumors, traumas, or infectious disease. The degree of substance loss may be skin, muscle, or mucoso, or a combination of one or all layers. In large defects of the lower lip, the challenge is to accomplish a result that meets the criteria of successful reconstruction. We present 3 patients with large defects of the lower lip from tumor ablation who underwent satisfactory reconstruction with a new method not previously described in the English-language literature.     

A new method for reconstruction of the lower lip after tumor resection

Summary A new operative technique is described for the reconstruction of a defect of the lower lip following carcinoma resection. This method combines the advantages of reconstruction using both rotation and advancement flaps. The technique is suitable for a half or subtotal defect and has been performed on 12 patients, yielding successful results in form and function.     

Arterial anatomy of the lower lip.

The arterial anatomy of the lower lip was investigated in 12 sides of six fresh cadavers that had been injected systemically with a lead oxide and gelatin mixture. We found that the blood supply of the lower lip was derived from the facial artery and three dominant labial arteries: the inferior labial artery, the horizontal labiomental artery, and the vertical labiomental artery. The inferior labial artery was derived from the facial artery or superior labial artery, and ran through the submucous tissue horizontally. The horizontal labiomental artery arising from the facial artery was located between the depressor labii inferioris muscle and orbicularis oris muscle. The vertical labiomental artery arose from the submental artery. These three arteries provided small vessels that traversed vertically. These small vessels and the small branches of the facial artery, that run superficial and deep to the orbicularis oris muscle, formed a vascular network in subcutaneous and submucous tissues and minute vessels branched off to the skin, mucosa, and muscles.     

One-stage reconstruction of a large defect of the lower lip and oral commissure.

Large lower lip defects including the oral commissure are very difficult to reconstruct and obtain an aesthetic appearance and an acceptable function. We report two patients who had a large defect in the lower lip including oral commissure and were treated using free radial forearm flap and temporal muscle transfer in one-stage. For the cutaneous defects, in one a local flap was elevated from the adjacent cheek and in the other a turned over area of the forearm flap was used. In each case, the reconstructed lower lip could maintain adequate elevation of oral the commissure using the temporal muscle was worked. The first case which used a local flap externally could avoid sialorrhea and had good sensation, and could close the mouth firmly soon after surgery. The appearance was acceptable. In the other case, leakage of oral contact and air occurred at the oral commissure because of the thickness of the forearm flap but improved after minor correction some 8 months after the surgery.     

New way to raise the V-Y advancement flap for reconstruction of the lower lip: Bipedicled orbicularis oris musculocutaneous flap technique

Abstract

We describe a new way to raise the V-Y advancement flap, which is useful for reconstruction of the lower lip. Various other methods have been reported in the past, but it has been necessary to choose the most suitable method for each particular case. A V-Y advancement flap from the submandibular region is one of the useful techniques to reconstruct the lower lip, and it is suitable for a wide horizontal defect. However, the conventional V-Y flap is insufficiently mobile and the reconstructed vermilion is thin because of the limitation of the pedicle. In such a case, the reconstructed lip may sag or cause an embarrassing defect. We developed a new way to raise the flap to obviate these problems. We use the V-Y advancement flap from the inferior margin of the defect in a conventional way after excision of the tumour, and use a mucosal flap to reconstruct the vermilion border. The skin side of the V-Y flap is undermined, and the orbicularis oris muscles are preserved on both sides as pedicles. The flap is then raised as a bipedicled musculocutaneous flap, which has adequate movement. After the flap has been sutured, the superior margin of the flap is de-epithelialised, and used to create the volume of the vermilion border. Functionally and cosmetically good results were achieved.     

下眼袋整形术常见并发症及防治

下眼袋整形术并发下睑外翻的主要原因是去除皮肤过多或切除眼轮匝肌过多所致。预防要点在于术中掌握好去除皮肤及眼轮匝肌的尺度，应恰到好处。严重外翻者需再次手术修复纠正。下睑凹陷主要是由于去除眶隔脂肪过多所致，故应掌握好去脂的量，术中如发现脂肪去除过多，可将去除的脂肪部分回植，若术后发生凹陷，可行脂肪充填术予以弥补。眼袋部分存留主要是对多余皮肤和脂肪去除的量过于保守所致。两侧不对称，是因术前两侧眼袋大小不一，而去除的皮肤及脂肪量却相同，或是因术前两侧眼袋大小相同，而去除的量不一致所造成，故术中要仔细观察，进行对照，如发现不对称则予调整纠正。血肿系止血不彻底而引起，球后血肿虽然少见但却是严重的并发症，应予以高度重视。去除眶隔脂肪时止血必须彻底，一旦发生球后血肿应及时再次手术止血。此外，作者还对切口线靠下、睫毛脱落、复视、外眦眼裂变小、感染等并发症的发生原因作了分析，提出防治方法。     

A rare perioral lesion: cutaneous horn of the lower lip

Cutaneous horns are uncommon lesions consisting of keratotic material; they resemble mini animal horns. They typically occur in sun-exposed areas, particularly the face, ear, nose, forearms, and dorsum of the hands. A case of cutaneous horn of the lower lip is presented as an extremely rare perioral pathology. The purpose of this paper is to highlight the need for a careful management of such lesions due to the high incidence of malignant or premalignant change.     

Reconstruction of chin and lower lip using bilateral segmental pectoralis major myocutaneous flap with functional support

Summary A 21-year-old man sustained an extensive high voltage electrical injury to his lower face, lower lip, chin, mandibular symphysis and floor of mouth. He lost all soft tissue as well as the outer cortex of the mandibular symphysis and lower teeth at the entry site. This soft tissue and skin loss was replaced by a left segmental pectoralis major myocutaneous flap [3] for lining of floor of the mouth and a right segmental pectoralis major myocutaneous flap augmentation of the chin and lower lip. The function of muscles and modiolus and orbicularis oris was reasonably regained by using bilateral temporalis muscle functional support [7]. The soft tissue on the left lower face was replaced by expanding the skin and soft tissue on the left submandibular area.     

Muscle transposition and skin grafting for salvage of below-knee amputation level after bilateral lower extremity thermal injury

Thermal injury to the lower extremity sometimes necessitates amputation around the knee joint. Knee function is so critical to prosthetic rehabilitation that every attempt should be made to salvage the knee joint. This report presents an unusual case of bilateral lower extremity flame burn requiring amputations. While the distal two-thirds of the legs and both feet were totally necrotic, the thermal damage was limited to skin and subcutaneous tissue sparing muscle and bone in the proximal one-third of the legs and posterior thighs. The below-knee amputation level was salvaged by muscle transposition over the anterior tibia and resurfacing of muscle cuffs with thick split-thickness skin grafts. The post-operative period was uneventful. Amputation stumps tolerated the below-knee prosthesis well and the patient attained independent functional prosthetic ambulation at the post-operative fourth month. It is known from the reconstruction of the plantar foot that skin-grafted muscle tissue tolerates weight bearing and shearing forces well. This principle can also be used for salvage aspects of the below-knee amputation level.