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Lip and Cheek Reconstruction: BY DR Mohammad Akheel Omfs PG
Lip and Cheek Reconstruction: BY DR Mohammad Akheel Omfs PG
BY
DR MOHAMMAD AKHEEL
OMFS PG
Lip reconstruction
Lip function
Oral competence
Deglutition
Articulation
Expression of emotion
Symbol of beauty
Lip reconstruction
Anatomy
Topographic landmarks
Lip reconstruction
Anatomy
Muscles
Lip reconstruction
Anatomy
Motor Innervation
Facial nerve VII
Buccal
Elevators of commissures and orbicularis oris
Marginal mandibular
Lip depressors
Sensory innervation
Trigeminal nerve V
Mental nerve terminal branch of inferior alveolar nerve
Lower lip
Infraorbital nerve
Upper lip
Lip reconstruction
Anatomy
Muscles
Orbicularis oris
Closes the oral sphincter
Primarily horizontal fibers - compress lips
Originate lateral to the commissures
Mingle with cranial VII muscles at modiolus
Cross the lip
Decussate in the midline
Insert into opposite philtral column
Oblique fibers - evert lip
Arise from modiolus
Travel upward and medial
Insert at the anterior nasal spine, nasal septum, and anterior nasal
floor
Lip reconstruction
Anatomy
Muscles
Major elevators upper lip
Levator labii superioris (LLS)
Zygomaticus major
Crossover common
Lip reconstruction
Approach
Evaluate
Size and location of the defect
Etiology of the lesion
Patient age and gender
Lip reconstruction
Surgical goals
Flattening of lip
Lip reconstruction
Vermilion reconstruction
Buccal mucosal advancement flap
Relaxing incision on mucosa at deep buccal sulcus
Mucosa elevated deep to salivary glands and superficial to
orbicularis oris muscle
Lip reconstruction
Vermilion reconstruction
Tongue flaps
Two stage procedures
Tongue mucosa
Red with poor cosmetic match
Nose
Disadvantage
Effect of gravity on repair
Greater need for tone to prevent drooling and oral
incompetence
Lip reconstruction
Lower lip reconstruction
Primary closure
V or W wedge resection
Can provide inadequate margin at lower portion of resection
Grafts
Unreliable survival of composite grafts
Average width 1 cm
Lip reconstruction
Lower lip
reconstruction
Orbicularis oris flap
Rectangular excision of
lower lip lesion
V-Y advancement
Bipedicled orbicularis oris
Vermilion reconstruction
Labial mucosa
advancement flap
Preserves muscle integrity
and nerve supply
Lip reconstruction
Lower lip
reconstruction
Rectangular flaps
Lower lip rectangular
flaps
Labiomental region
Rotated medially
Vermilion
Bilateral buccal
mucosa flaps
Lip reconstruction
Lower lip
reconstruction
Step method
Horizontal component
of step excisions
½ width of defect
Vertical dimension
8-10 mm
2 to 4 steps are made
Can be used to close
defects up to 2/3 of lip
length
Lip reconstruction
Lower lip reconstruction
Abbe flap
Lip switch
Two stage procedure
Indications
Medium sized defects
Cooperative patients
EMG studies
Return of muscle function to flap at recipient site
Lip reconstruction
Lower lip reconstruction
Abbe flap
Flap design
Junction of middle and lateral 1/3s of upper lip
Distal flap
Rectangle
2 to 3 cm
Lip reconstruction
Lower lip reconstruction
Abbe flap
Flap elevation
White roll marked
Post operative
Liquid and soft diet
Antiseptic rinses
Advantages
Maintains continuity of orbicularis oris
Oral competence
Disadvantages
Poor commissure definition
Central
Disadvantages
Microstomia
Avoidance of microstomia
Advantages
Brings new tissue from cheek
Disadvantages
Incomplete recovery of sensation
Men
Hairbearing – nasolabial and cheek flaps obvious
Can disguise scars in a mustache
Nostral sill
Alar base
Nasolabial crease
Medial
One half of philtrum
Karapandzic
Lateral
Commissure not involved
Abbe flap
Commissure involved
Estlander flap
Lip reconstruction
Upper lip reconstruction
Large defects
Adequate cheek tissue
Inverted Bernard Burow’s procedure
Free flap
Lip reconstruction
Upper lip reconstruction
Hair bearing skin
Forehead flap
Scalp flap
Unipedicled submandibular flap
Bipedicled submental flap
Temporal island scalp flap
Temporoparietal fascia flap
Advanced or
transposed full
thickness flap
Buccal mucosa
Alternative
Lip reconstruction
Commissure reconstruction
Macrostomia
Congenital macrostomia
Lateral orofacial cleft between maxillary and mandibular
components 1st branchial arch
Incomplete orbicularis oris ring
Commissure positioning
Less contraction
Decreased edema
Start subcutaneous
Free flaps
Radial forearm
TFL
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