Resection of upper lip adenoid cystic carcinoma and reconstruction with reverse Yu flap: Report of three cases and a literature review

Abstract

Abstract. The present study aimed to describe the techniques that were used, and the results obtained, with the reverse Yu flap to reconstruct medium-sized upper lip defects following resection for adenoid cystic carcinoma (ACC). Data concerning the clinical and pathological characteristics of tumours, the size and location of the defects, surgical resection and the reconstructive procedure used were evaluated in three patients, as well as postoperative complications and outcomes. In all cases, a complete surgical removal of ACC was achieved with clear margins of at least 1 cm. Histopathological features revealed two cases with a predominant solid growth pattern, and one case of cribriform. Following tumour excision, the average size of the upper lip defect was 35.7x30 mm. The reverse Yu flap was raised simultaneously with tumour resection in all cases. No flap failed, and both excellent aesthetic and functional results were obtained. All the patients had a satisfactory oral competence, without microstomia, after a median of 20 months follow-up (range, 12-30 months). Adjuvant radiation therapy was not necessary in any case. On the basis of the present case study and literature review, reverse Yu flap is revealed to be a simple and reliable technique for the reconstruction of defects ranging from one-third to two-thirds of the total upper lip length, involving the commissure, nasolabial fold and philtrum, with minimal donor morbidity and a good functional and aesthetic outcome. This flap appears to be a valid surgical option for reconstruction of medium-sized upper lip defects, which may be considered following radical excision of ACC.

Adenoid cystic carcinoma – A case of an aggressive ulcerated lesion of the upper lip

“…[ 2 ] Literature suggests that the solid form of ACC is associated with worst prognosis compared with other histological types. [ 5 10 11 ] Histologically, our case presents mixed pattern of tumor cell proliferation with areas of hyalinization.…”

“…The very first case of ACC involving the upper lip was reported by Pizer and Dubois in 1985, but initially, it was described by Robin and Laboulbene in 1853. [ 2 4 5 ] Primary site of occurrence is the palate comprising all malignant palatal tumors,[ 4 5 ] but this can show a rare presence involving minor salivary glands of lower lip, retromolar tonsillar pillar region, sublingual gland, buccal mucosa, and floor of the mouth. [ 5 ] Gorlin et al .…”

“…[ 2 4 5 ] Primary site of occurrence is the palate comprising all malignant palatal tumors,[ 4 5 ] but this can show a rare presence involving minor salivary glands of lower lip, retromolar tonsillar pillar region, sublingual gland, buccal mucosa, and floor of the mouth. [ 5 ] Gorlin et al . pointed out that the incidence of ACC in the upper lip was ~3%.…”

“…[ 6 ] Very few cases have been reported involving the minor salivary glands of the upper lip. [ 5 ] ACC can be circumscribed or infiltrative in nature, comprise multiple cell types (ductal and myoepithelial), and may exhibit a variety of architectural patterns (solid, cribriform, and tubular). [ 7 ] In our present study, we have observed a mixed type of pattern, involving all the three architectural patterns.…”