Functional and aesthetic objectives in the reconstruction of lip defects

The reconstruction of lip defects presents a challenge to the surgeon. Apart from attaining a good aesthetic result, preserving the function of the oral sphincter is an essential objective. A variety of techniques and modifications of procedures for reconstructing lip defects have been reported in the literature. It is up to the surgeon to select the reconstruction procedure ensuring optimum functional and cosmetic results, depending on the location, size, and depth of the defect. The division of the lips into aesthetic subunits can prove very beneficial in designing lip reconstruction procedures. The upper lip is divided into three aesthetic subunits: two lateral subunits and a median subunit, the philtrum. The lower lip constitutes a single subunit. In this study established reconstruction techniques are discussed, and a concept serving to facilitate the appropriate choice of technique is introduced. This concept differentiates between vermilion defects on the one hand and partial-thickness and full-thickness lip defects on the other hand. For the lower lip the full-thickness defects are classified as defects involving one third and one third to two thirds of the lower lip width and between two thirds and complete loss of lip tissue. For the upper lip a distinction is made between isolated defects of the central and lateral subunits and combined defects of the central and lateral subunits. Important principles of surgery and the advantages and disadvantages of different reconstruction techniques are discussed.