Upper Lip Anatomy, Mechanics of Local Flaps, and Considerations for Reconstruction

Boson, Alexis L.; Boukovalas, Stefanos; Hays, Joshua P.; Hammel, Josh A.; Cole, Eric L.; Wagner, Richard F.

doi:10.12788/cutis.0205

Cited by 8 publications

(17 citation statements)

References 13 publications

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“…However, none of the available surgical approaches can restore the complex 3-layer lip component precisely, thus leading to a poor esthetic outcome and functional compromise. 3 Currently, it is popular to try to reconstruct the lower lip based on microsurgical techniques. 1,6 This type of reconstruction allows for a single-stage procedure, minimizing the risk of microstomia and maintaining oral competence.…”

Section: Discussionmentioning

confidence: 99%

“…This dynamic organ has an important functional role in speech articulation and oral competence maintenance. [1][2][3] Moreover, due to its central location, the lip has significant esthetic features of the lower face. 1 Throughout history, many solutions have been proposed to reconstruct different lip defects.…”

Section: Introductionmentioning

confidence: 99%

“…1 Throughout history, many solutions have been proposed to reconstruct different lip defects. [1][2][3] However, many of the current techniques work well for small to moderate lip defects. There is no ultimate reconstructive approach for total or near total lip defects.…”

Section: Introductionmentioning

confidence: 99%

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Near Total/Total Lower Lip Reconstruction—Chin Rotation Advancement Flap

Abu-Jabal

Joachim

Bitterman

et al. 2022

Craniomaxillofacial Research & Innovation

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Summary: Total lower lip reconstruction is a challenging reconstruction procedure. Its main role is to restore lip function, maintain the proper relationship between the upper and lower lips and optimize cosmesis. Various techniques ranging from local flaps to free tissue transfer have been developed. For patients who are not candidates for microsurgical techniques or for those who do not want complex procedures, the local flap technique is a good solution. Most of the reported techniques, based on cheek advancement and nasolabial flaps, lead to scars located in the midface and therefore to unaesthetic results. We hereby present a novel technique for total lower lip reconstruction using a rotation advancement flap based on the excess tissue of the lower face. To our knowledge, this method has not been described previously in the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Near Total/Total Lower Lip Reconstruction—Chin Rotation Advancement Flap

Abu-Jabal

Joachim

Bitterman

et al. 2022

Craniomaxillofacial Research & Innovation

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“…Operations are commonly performed on the upper lip for reconstruction after cancer resection 17,18 or traumatic injury. 19 Morphologic restoration is the initial goal of such reconstructive operations on an expressionless face, but functional restoration is a vital goal because the upper lip is crucially involved in facial movements during eating, speaking, and smiling.…”

Section: Discussionmentioning

confidence: 99%

Are there other muscle fibers on the orbicularis oris muscle in the upper lip?

Park

Rho

Lee

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: The elevator muscles of the upper lip are the levator labii superioris alaeque nasi, levator labii superioris, and zygomaticus minor muscles, which function by means of their insertions into the skin of the upper lip. However, many textbooks and journal articles state that no muscle fibers are present on the orbicularis oris muscle in the upper lip. The authors attempted to determine whether there is a superficial muscle layer in addition to the orbicularis oris muscle in the upper lip. Methods: The authors performed gross dissections of 10 formalin-fixed cadavers and applied micro–computed tomography to six formalin-fixed cadavers. The fine dissection of the upper lip was performed in a layer-by-layer manner that elucidated its muscle layers. The entire layer of the upper lip was separated and pretreated with phosphotungstic acid for micro–computed tomography. The samples used for micro–computed tomography were repurposed for use in histologic analysis. An ultrasonography study was also performed. Results: The presence of a muscle layer on the orbicularis oris muscle was confirmed in all samples. The elevator muscle fibers of the upper lip formed a layer by combining with connective tissue. Micro–computed tomography indicated lower terminal insertions of the elevator muscles throughout the upper lip. All parts of the upper lip skin were inserted into the orbicularis oris muscle. The histologic findings were similar to those of micro–computed tomography. Conclusion: The authors’ findings could be used to improve aesthetic and surgical procedures performed on the upper lip, such as correction of gummy smile and transverse upper labial crease, or postresection reconstruction of the upper lip.

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“…The mobility of the lip during the session imposes large safety margins, leading to more bone and soft tissue toxicities. A wedge surgical excision can be used in infiltrative tumors, but lip function may be impaired [14,15]. Reconstructive surgery could provide good results, but the periorificial location may be challenging to preserve lip function [16].…”

Section: Discussionmentioning

confidence: 99%

Pulsed Dose Rate Brachytherapy of Lip Carcinoma: Clinical Outcome and Quality of Life Analysis

Ayachy

Sun

et al. 2021

Cancers

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Purpose: Lip carcinoma represents one of the most common types of head and neck cancer. Brachytherapy is a highly effective therapeutic option for all stages of lip cancers. We report our experience of pulsed dose rate brachytherapy (PDR) as treatment of lip carcinoma. Methods and Materials: this retrospective single center study included all consecutive patients treated for a lip PDR brachytherapy in our institution from 2010 to 2019. The toxicities and outcomes of the patients were reported, and a retrospective quality of life assessment was conducted by phone interviews (FACT H&N). Results: From October 2010 to December 2019, 38 patients were treated in our institution for a lip carcinoma by PDR brachytherapy. The median age was 73, and the majority of patients presented T1-T2 tumors (79%). The median total dose was 70.14 Gy (range: 60–85 Gy). With a mean follow-up of 35.4 months, two patients (5.6%) presented local failure, and seven patients (19%) had lymph node progression. The Kaplan–Meier estimated probability of local failure was 7.2% (95% CI: 0.84–1) at two and four years. All patients encountered radiomucitis grade II or higher. The rate of late toxicities was low: three patients (8.3%) had grade II fibrosis, and one patient had grade II chronic pain. All patients would highly recommend the treatment. The median FACT H&N total score was 127 out of 148, and the median FACT H&N Trial Outcome Index was 84. Conclusions: This study confirms that an excellent local control rate is achieved with PDR brachytherapy as treatment of lip carcinoma, with very limited late side effects and satisfactory functional outcomes. A multimodal approach should help to improve regional control.

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Upper Lip Anatomy, Mechanics of Local Flaps, and Considerations for Reconstruction

Cited by 8 publications

References 13 publications

Near Total/Total Lower Lip Reconstruction—Chin Rotation Advancement Flap

Near Total/Total Lower Lip Reconstruction—Chin Rotation Advancement Flap

Are there other muscle fibers on the orbicularis oris muscle in the upper lip?

Pulsed Dose Rate Brachytherapy of Lip Carcinoma: Clinical Outcome and Quality of Life Analysis

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