Lip reconstruction surgery: Restoration of oral competence and contour

The lips are not only seen a significant aesthetic element of the face, but are important too for facial expression, speech and eating. Goals in lip reconstruction are to restore normal anatomy, oral competence and contour. These goals are often attained following repair of small lip defects. However, restoring these characteristics of the lips in large defects remains a more arduous task.

The surgical upper lip includes the entire area from one nasolabial fold towards the other, and all structures right down to the oral orifice. It extends intraorally to the upper gingivolabial sulcus. It is split into the vermilion, one central and two lateral aesthetic subunits. The low lip includes all structures superior to the labiomental fold such as the vermilion and continuing intraorally towards the inferior gingivolabial sulcus.

Extending from the nasal base are bilateral philtral columns flanking the located philtrum. The philtral columns extend downward to meet the vermilion-cutaneous junction (also known as the ‘white roll') of the upper lip. Cupid's bow may be the portion of the vermilion-cutaneous junction located in the lower philtrum.

The tubercle is the fleshy middle the main upper lip from which the vermilion extends bilaterally to satisfy the commissures. The vermilion from the lower lip is bisected through the central sulcus which is prominent in a lot of people. The lower lip is considered less anatomically complex compared to upper lip since it lacks a definitive central structure.

The vermilion consists of a modified mucosa with submucous tissue and orbicularis oris muscle underneath. The large number of sensory fibers per unit of vermilion is reflected in its comprising a disproportionately large part of the cerebral cortex. It features a high degree of sensitivity to temperature, light touch and pain. The natural lines of the vermilion are vertical, thus scars on the vermilion should be placed vertically if at all possible.

The primary muscle accountable for oral competence may be the orbicularis oris muscle. This muscle functions like a sphincter, puckering and compressing the lips. The fibers of the orbicularis oris muscle extend to both commissures and converge with other facial muscles just lateral towards the commissures in the modiolus. The major elevators of the upper lip are the levator labii superioris, levator anguli oris and the zygomaticus major.

The mentalis muscle elevates and protrudes the middle portion of the lower lip. The major depressors of the lips would be the depressor labii inferioris and depressor anguli oris. The risorius muscle pulls the commissures laterally.

The circulation towards the lips comes from the superior and inferior labial arteries, which in turn are branches of the facial arteries. The paired superior and inferior labial arteries form a rich network of collateral blood vessels, thus providing a dual blood supply to each lip.

These vessels lie between the orbicularis oris and also the buccal mucosa close to the transition from vermilion to buccal mucosa. There aren't any specific veins; instead there are several draining tributaries that eventually coalesce to the facial veins. The lymphatic channels from the upper lip and lateral lower lip drain to the submandibular nodes; whereas, the central lower lip lymphatics drain into the submental nodes.

Motor innervation from the perioral muscles is from facial nerve branches. The buccal branches of the nerve supply motor input to the lip elevators; whereas, the marginal mandibular branches give you the lip depressors. The motor nerve enters each individual muscle on its posterior surface. Sensory supply towards the upper lip comes from the infraorbital nerve (second trigeminal branch) and the lower lip comes by the mental nerve.

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Lip reconstruction surgery: Restoration of oral competence and contour

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