Reconstruction of the lower face and lips

The first step in rehabilitation of massive lower face injuries is usually control of drooling by the Wilkie operation. When destruction is extensive, the floor of the mouth, chin, upper neck, and mandible should be first restored as a foundation on which the lower lip is independently reconstructed. Local tissue should be used as much as possible. All remnants of normal lip tissue should be conserved and utilized in the reconstruction. When both lips are damaged, upper lip segments are often best used to fill out the lower lip, with total reconstruction of the upper. Although many of the principles of treatment of these injuries are well established, there are still major unsolved problems. These include adequate support of the lower lip, maintenance of the flat shape of the lips, and determination of the end-point of surgery.