Lower lip reconstruction after tumor resection; a single author's experience with various methods

Squamous cell carcinoma is the most frequently seen malignant tumor of the lower lip. The more tissue is lost from the lip after tumor resection, the more challenging is the reconstruction. Many methods have been described, but each has its own advantages and its disadvantages. The author presents through his own clinical experience with lower lip reconstruction at the NCI, an evaluation of the commonly practiced techniques.

Over a 3 year period from May 2002 till May 2005, 17 cases presented at the National Cancer Institute, Cairo University, with lower lip squamous cell carcinoma. The lesions involved various regions of the lower lip excluding the commissures. Following resection, the resulting defects ranged from 1 /3 of lip to total lip loss. The age of the patients ranged from 28 to 67 years and they were 13 males and 4 females. With regards to the reconstructive procedures used, Karapandzic technique (orbicularis oris myocutaneous flaps) was used in 7 patients, 3 of whom underwent secondary lower lip augmentation with upper lip switch flaps. Primary Abbe (Lip switch) flap reconstruction was used in two patients, while 2 other patients were reconstructed with bilateral fan flaps with vermilion reconstruction by mucosal advancement in one case and tongue flap in the other. The radial forearm free flap was used only in 2 cases, and direct wound closure was achieved in three cases. All patients were evaluated for early postoperative results emphasizing on flap viability and wound problems and for late results emphasizing on oral continence, microstomia, and aesthetic outcome, in addition to the usual oncological follow-up.

All flaps used in this study survived completely including the 2 free flaps. In the early postoperative period, minor wound breakdown occurred in all three cases reconstructed by utilizing adjacent cheek skin flaps, but all wounds healed spontaneously. The latter three cases involved defects greater than 2 /3 of lower lip and one of them was previously irradiated. Those patients then suffered from occasional drooling of saliva. The best results in terms of oral continence and cosmetic outcome were achieved in those cases reconstructed with flaps utilizing residual lower lip or upper lip tissues (i.e; the Karapandzic technique (orbicularis oris myocutaneous flaps, and the Abbe (upper lip switch flaps). Nevertheless, microstomia developed in four patients primarily reconstructed with the Karapandzic technique in which defects were greater than one half of the lip. Only one of those patients tolerated her microstomia and required no further treatment. The remaining three patients showed marked improvement after augmenting the lower lip with bilateral paraphiltral lip switch flaps from upper lip in a second stage. The follow-up period ranged from 6 months to three years during which no patient had developed local recurrence or distant metastasis.

Lower lip reconstruction aims to restore function and appearance with the best results obtained by utilizing residual normal lip tissues incorporating potentially innervated muscle fibers. With larger defects, reconstruction is less than optimal, but every effort should be taken to obtain an adequate sphincter function and lip continence to saliva, both of which are the most important goals to achieve in lip reconstruction.