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At least 721 records · Page 40Linked to original sources
PubMed2003

Squamous cell carcinoma of the lip: is there a role for adjuvant radiotherapy in improving local control following incomplete or inadequate excision?

BACKGROUND: The treatment of squamous cell carcinoma of the lip with surgery is usually curative but incomplete/inadequate excision may be associated with recurrence and poor outcome. There is no consensus in the literature on the definition of an adequate excision margin. METHODS: Patients treated for squamous cell carcinoma of the lip at Westmead Hospital, Sydney, between 1980 and 2000 were eligible for inclusion. Polytomous logistic regression analysis was undertaken to assess for predictors of recurrence. Recurrence-free and overall survival were calculated using Kaplan-Meier survival curves. RESULTS: A total of 130 patients was identified. Median age at diagnosis was 64 years (23-97 years). Most lesions (90%) were located on the lower lip in 96 (74%) male patients. Median follow-up duration was 54 months (0-189 months). Most patients -presented with T1 lesions (75%). Initial treatment was surgery (39%), radiotherapy (48%) or both (13%). Twenty-seven per cent of excised lesions had a close (< or =2 mm) or positive margin. A total of 40 patients (31%) had recurrence (18% lymph nodes, 11% lip and 2% both). In the surgery group recurrence was significantly more likely with close or positive margins (P = 0.05). The 2 year -recurrence-free survival was 82% and 54% for radiotherapy and surgery, respectively (P < 0.001). The 2 year overall survival was similar (90% radiotherapy vs 100% surgery; P = 0.58). CONCLUSION: Incomplete or inadequate excision of some lip cancers results in local recurrence. If re-excision is not feasible -surgeons should consider the role of adjuvant radiotherapy in improving local control.

Adult↗
PubMed2001

Basal cell carcinoma arising in a cleft lip repair scar.

BACKGROUND: A case of basal cell carcinoma (BCC) developing in the repair scar of a cleft lip is presented. OBJECTIVE: Primary BCCs arising in surgical scars are very rare and no known reported cases exist of a BCC developing in a surgically repaired cleft lip scar. METHODS: A 69-year-old white man presented with a 5 mm primary BCC on his upper lip at the site of his cleft lip repair scar. The diagnosis was made by a tangential biopsy that showed an ulcerated BCC. RESULTS: Review of the medical literature indicates that a scar may be an independent risk factor for developing BCC. CONCLUSION: BCC may rarely arise in a cleft lip repair scar.

Aged↗
PubMed2001

Total lower lip reconstruction with innervated muscle-bearing flaps: a modification of the Webster flap.

BACKGROUND: Mohs surgery and other surgical techniques are used for the removal of squamous cell carcinoma of the lower lip and may leave a large defect in the vermilion and underlying tissue. When nearly the entire lower lip is excised, reconstruction of this defect is a challenge. Repair requires the matching of vermilion color, maintenance of oral sphincter function and mouth opening size, and retention of sensation. Several techniques have been suggested. We present a modification of the Webster flap for total lower lip reconstruction using innervated muscle-bearing flaps. OBJECTIVE: To present a surgical technique for the reconstruction of total lower lip defects after excision of squamous cell carcinoma. METHODS: Innervated muscle-bearing flaps are used and demonstrated in one case. The surgical technique is discussed in detail. RESULTS: The reconstructive results were excellent. There were no postoperative complications. CONCLUSION: The use of innervated muscle-bearing flaps is a useful and effective option for the reconstruction of total lower lip defects.

Carcinoma, Squamous Cell↗
PubMed2001

Modified labial tissue sliding flaps for repairing large lower lip defects.

PURPOSE: Common flap techniques for reconstructing large defects in the lower lip are often destructive and complex and result in unsatisfactory function and appearance. This article describes a modified technique that uses sliding labial tissue flaps to avoid these problems. PATIENTS AND METHODS: Eight patients with lower lip carcinomas had defects ranging from one third to four fifths of the length of the lower lip after tumor resection. The defects were closed with sliding labial tissue flaps, taking advantage of the elasticity of soft tissue to reduce the loss of normal tissue. Patients were followed for 2 to 12 years. RESULTS: The functional and cosmetic results were good, and there were no intra- or postoperative complications. Some patients experienced tightness of the lower lip that disappeared within 6 months. Carcinoma did not recur in any patient after a median follow-up period of more than 5 years. CONCLUSIONS: This modified labial tissue sliding flap technique is simple, safe, functionally and aesthetically satisfactory, sacrifices little healthy tissue, heals rapidly, and requires no further revision. The technique is effective for repairing defects covering one third to four fifths of the lower lip.

Aged↗
PubMed1994

Cleft lip and hemangioma: a patient with Wolf-Hirschhorn syndrome.

A patient with Wolf-Hirschhorn syndrome had multiple congenital anomalies and a right cleft lip. Hemangioma involved the full thickness of the upper medial lip segment at the age of 2 months, which caused lip repair to be very difficult. The first attempt at adhesion cheiloplasty resulted in complete separation. The tumor did not respond to steroid treatment. A subsequent trial of lip repair with the assistance of a tension-relieving suture tied to the nasal septum was successful. This type of tension suture is helpful to prevent dehiscence when security of lip closure is questionable or cannot be achieved.

Abnormalities, Multiple↗
PubMed1996

Free composite graft for lip reconstruction after tumor excision.

This paper represents 10 patients for whom lip defects following excision of malignant tumors were reconstructed by the free composite graft technique using the opposite side of the lip. Usually, for upper lip reconstruction, a switch flap or Zisser-Madden method is commonly used. For lower lip reconstruction, the methods of the double cross-lip flaps or the rotation flap are most frequently used. However, we recommend the free composite graft technique for selective patients, since this method is simpler than the other techniques and the results are excellent both cosmetically and functionally.

Aged↗
PubMed2000

Utilization of the depressor anguli oris musculocutaneous flap for lip reconstruction.

The authors describe the anatomic aspects and surgical technique of the depressor anguli oris musculocutaneous flap for reconstruction of the upper and lower lips. Twenty patients were submitted to surgical treatment, 19 for carcinoma and for upper lip scar deformity. In all patients the repair was performed with the depressor anguli oris musculocutaneous island flap. At the follow-up, lip function was satisfactory in 19 patients and unsatisfactory in 1 patient. The aesthetic results were considered satisfactory in all patients. The depressor anguli oris musculocutaneous island flap is safe for upper and lower lip reconstruction, with good functional and aesthetic results, and can be added as a new flap for lip reconstruction.

Adult↗
PubMed2003

Unilateral cleft lip-nose repair: a 33-year experience.

A 33-year experience with a proven method of repair for primary unilateral cleft lip-nose is presented. The technique used by the authors has been improved by modifications that have led to better symmetry and balance with less scarring. The technique involves ignoring the abnormal skeletal base, use of perisurgical passive orthopedics, and primary surgical correction of the nose and lip. Improved results can consistently be achieved by approaching the nose laterally through an inferior turbinate incision, freeing completely the lip and nose components so they can be translocated to match the normal side. Accurate positioning and symmetry of the alar base and sill is aided by limiting the transverse incision in the lip. This results in less scarring and improved sill reconstruction. The technique for floor-of-the-nose reconstruction avoids a small nostril without discarding any tissue. It is important to leave tissue in the floor to compensate for the skeletal deficiency. The senior author has performed this procedure in more than 750 patients. Approximately 35% have or will require minor secondary reconstruction at age 5 years. An aesthetic rhinoplasty is performed on most patients after growth is complete. Self-esteem is enhanced by early nasal reconstruction and has become the authors' standard of care for rehabilitation of the unilateral cleft lip and palate. Many surgeons remain reluctant to perform primary nasal repair. With careful proper technique, any experienced cleft surgeon can learn this procedure. For the beginner, conservatism is recommended.

Adolescent↗
PubMed1983

Hair-bearing neck flap for upper-lip reconstruction in the male.

Reconstruction of the upper lip resulting in a hair-bearing area and a non-hair-bearing lining is described in two cases of full-thickness lip defects. A unipedicled neck flap was used in one case and a bipedicled neck flap in the other, both comprised of hair-bearing and adjacent non-hair-bearing areas. The neck flap has the advantages of providing the two layers of the lip, and the reconstructed lip is not too thick and is mobile and pliable, and the hair resembles lip hair in color, density, and quality. The multiple operative procedures can be performed under local anesthetic.

Adult↗
PubMed1984

Reconstruction of vermilion in unilateral and bilateral cleft lips.

The white skin roll is a useful term to describe the cutaneo-vermilion border of the lip. The muco-vermilion border line parallels the white skin roll and is described as the red line. The lip vermilion should be constructed so that these lines are parallel and widest at the base of the philtral column. It is suggested that the triangular lateral lip vermilion flap be used in unilateral cleft lips. In bilateral cleft lips, a white skin roll vermilion-mucosal muscle flap is used for reconstruction of vermilion.

Cleft Lip↗
PubMed1986

Aesthetic restoration of one-half the upper lip.

Aesthetic units of the face have been previously described. The lip itself may be divided into smaller topographic subunits. The lateral subunit is bordered by philtrum column, nostril sill, alar base, and nasolabial crease, while the medial topographic subunit is one-half the philtrum. When a large part of a subunit has been lost, replacing the entire subunit rather than simply patching the defect often gives a superior result. The only tissue suitable for the aesthetic restoration of moderate-sized defects of the upper lip is lower lip. An exact pattern is outlined and an Abbé flap is taken from the midline of the lower lip and transferred in two stages. Like tissue is replaced in kind, border scars are positioned aesthetically, and the orbicularis sphincter is reconstituted with an intact symmetrical commissure, muscular modiolus, and upper and lower lip symmetry. Spontaneous reinnervation by appropriate segmental facial branches occurs within 1 year. Four patients are presented.

Adult↗
PubMed1987

Unilateral cleft lip repair.

The marking of the medial lip segment of the Millard rotation advancement procedure for repair of the unilateral cleft lip has been altered in the uppermost portion by utilizing tissue from the columellar base. Once adequate length has been obtained, cutback is utilized at approximately 90 degrees. With adequate full-thickness release of this medial lip segment and subsequent rotation into the proper position, the C flap is advanced into the donor defect of the columellar base and is also used to lengthen the shortened columella on the cleft side. This results in placement of a scar that will closely simulate the "mirror image" of the noninvolved philtral column. Fifty-seven patients with unilateral cleft lip have been repaired utilizing this technique during the past 14 years. Several of these children have required secondary surgeries because of mucosal irregularities or residual nasal deformities, but none has required additional surgery because of inadequate rotation of the medial lip segment or for correction of any donor-site defect at the base of the columella.

Child↗
PubMed1997

The mental V-Y island advancement flap in functional lower lip reconstruction.

Various flap procedures for the reconstruction of lower lip defects have been described to achieve the basic requirements of a functional repair, namely muscle function and sensation. Flaps elevated from the upper lip or the adjacent cheek may provide a solution, but for larger lower lip defects, preservation of function is difficult. In this article, a new functional lower lip reconstruction technique that includes the transfer of a myocutaneous flap based on the mental neurovascular bundle and on the branches of the facial artery is described. The principle of this reconstructive procedure is to advance the tissues from both sides of the chin as myocutaneous flaps upward to the lip defect, reorienting the muscles of the flap for sphincteric function, and preserving the mental nerve for sensation. The depressor anguli oris and remnants of the orbicularis muscle together with their motor nerve branches are included in the V-Y advancement flap.

Aged↗
PubMed1999

Functional reconstruction using a depressor anguli oris musculocutaneous flap for large lower lip defects, especially for elderly patients.

Described here is a new technique to reconstruct large lower lip defects using one or two musculocutaneous island flaps, which includes an innervated depressor anguli oris muscle and has a facial artery in its pedicle. Vermilion is simultaneously reconstructed using a mucosal transposition flap. Three patients who had a total lower lip defect and five patients who had a defect larger than one-half of the lower lip were treated by our procedure. All the flaps survived completely without any signs of vascular stasis. In six patients, sphincter function and sensation appeared within 3 months after surgery. In one patient who needed a total lower lip reconstruction, the depressor anguli oris muscle was atrophic and the motor nerve could not be found. This patient could not regain motion. One other patient complained of a sialorrhea accompanied by sensory loss; however, his sensation improved within 6 months after surgery. All of the reconstructed lower lips were large enough to enable the patient to wear dentures and were of a cosmetically acceptable appearance 1 year after surgery.

Aged↗
PubMed2001

Histologic, histochemical, and ultrastructural analysis of soft tissues from cleft and normal lips.

The cause of cleft lip remains speculative. The nature and extent of pathophysiologic changes in cleft lip muscle are controversial. This study was undertaken to better understand the developmental processes at work. There were two groups of patients. In group 1, 40 fresh tissue specimens were taken from 22 patients who were 2 to 5 months old-their age at the time of their primary cleft lip repair. In group 2, eight control specimens were collected from six children who were seen in the emergency department with lip lacerations. Fresh specimens fixed in neutral buffered formalin were evaluated by the use of hematoxylin and eosin with Luxol fast blue, Bielschowsky, and Masson trichrome stains. Fresh frozen tissue was histochemically assessed by the use of hematoxylin and eosin, modified Gomori trichrome, and adenosine triphosphatase. Ultrastructural analysis was performed on fine sections of glutaraldehyde-fixed tissue. Histologic examination revealed increased endomysial and perimysial collagen in cleft specimens with evidence of muscle-bundle size variation and nonneurogenic atrophy. Insignificant differences were observed between cleft-side and noncleft-side specimens when the means of 200 counts of neural-tissue bundles in the subdermis were compared (p = 0.093). Histochemical examination revealed no typical checkerboard pattern, but a preponderance of type 2 fiber was seen. By means of electron microscopy, increased numbers of subsarcolemmal mitochondria were found in cleft, noncleft, and control specimens. Increased absolute numbers of mitochondria and variations in size, shape, and crystal arrangement were identified. In conclusion, there is no evidence of deficient neural supply in the cleft lip. There is also no evidence of neurogenic muscle atrophy or a metabolic abnormality. There are characteristic myopathic changes. These, in concert with the observed interstitial fibrosis, may have far-reaching implications for growth and function.

Adolescent↗
PubMed2004

Current concepts in lip reconstruction.

PURPOSE OF REVIEW: Approximately 25% of all oral cavity carcinomas involve the lips, and the primary management of these lesions is complete surgical resection. The management of the resulting lip defect remains a significant reconstructive challenge, requiring meticulous preoperative planning and surgical technique to optimize the functional and cosmetic outcome. Reviewed here are the accepted techniques of lip reconstruction, as well newer techniques that have been reported. RECENT FINDINGS: There have been no major advances in lip reconstruction; rather, continued improvement on accepted techniques. The main goals of reconstruction remain the restoration of oral competence, maintenance of oral opening, and the restoration of normal anatomic relations such that both the active (smile) and passive (form) cosmetic outcome is acceptable. The reconstruction should be tailored to the individual needs of the patient and should take into account the patient's condition, local tissue characteristics, previous treatment(s), and functional needs (eg, denture use), in addition to the size and location of the defect. SUMMARY: The lips play a key role in facial expression, speech, and eating. This requires meticulous attention to preoperative planning and surgical technique to maximize the functional and cosmetic outcome. It is important to assess local tissue characteristics (skin laxity) and previous treatment (surgery and/or irradiation) before the surgical plan is made final. Local tissue should be used whenever possible to provide the least donor site morbidity and the best overall tissue color and texture match. Whenever possible, dynamic reconstruction should be attempted. Careful preoperative assessment and planning will allow the surgeon to reach an acceptable balance between form and function with the reconstruction.

Carcinoma↗
PubMed2005

Visual and statistical modeling of facial movement in patients with cleft lip and palate.

OBJECTIVE: To analyze and display facial movement data from noncleft subjects and from patients with cleft lip and palate by using a new dynamic approach. The hypothesis was that there are differences in facial movement between the patients with cleft lip and palate and the noncleft subjects. SETTING: Subjects were recruited from the University of North Carolina School of Dentistry Orthodontic and Craniofacial Clinics. PATIENTS, PARTICIPANTS: Sixteen patients with cleft lip and palate and eight noncleft "control" subjects. INTERVENTIONS: Video recordings and measurements in three dimensions of facial movement. MAIN OUTCOME MEASURES: Principal component (PC) scores for each of six animations or movements and dynamic modeling of mean animations. STATISTICS: Multivariate statistics were used to test for significant differences in the PC mean scores between the patient groups and the noncleft groups. RESULTS: No statistically significant differences were found in PC mean scores between the patient groups and the noncleft groups; however, the variability of the effect of clefting on the soft tissues during animation was noted when the noncleft data were used to establish a "normal" scale of movement. Compensatory movements were seen in some of the patients with cleft lip and palate, and the compensation was not unidirectional. CONCLUSION: Measures of mean movement differences as summarized by PC scores between patients with cleft lip and palate and noncleft subjects may be misleading because of extreme variations about the mean in the patient group that may neutralize group differences. It may be more appropriate to compare patients to a noncleft normal scale of movement.

Adolescent↗
PubMed1994

Effect of presurgical infant orthopedics on facial esthetics in complete bilateral cleft lip and palate.

A sample of 40 teenage individuals with repaired complete bilateral cleft lip and palate, 20 of whom had received presurgical infant orthopedics, was obtained to test the effects of presurgical infant orthopedics on facial esthetics. All subjects had surgery by the same surgeon. The age and sex distribution was approximately equal between the two groups. A panel of five judges evaluated the lip and nose esthetics from full face and profile slides and a mean panel score for each subject was derived for six individual features and three total scores. No difference in the esthetic scores between the two groups could be detected. No differences were found in the number of revisionary surgical procedures required to the lip or nose. The findings indicate that conservative presurgical orthopedics for infants with complete bilateral cleft lip and palate has no lasting effect on the esthetics of the lip and nose, and does not alter the need for subsequent revisionary surgery.

Adolescent↗