Upper lip cancers are usually basal cell carcinomas that spare the vermilion. The central aesthetic subunit of the upper lip, the philtrum, makes upper lip reconstruction more challenging than lower lip reconstruction. Upper lip defects could be divided into partial-thickness and full-thickness defects.
Partial-thickness philtral defects could be allowed to heal by secondary intention or skin grafting. The triangular fossa skin-cartilage composite graft is well-described for reconstructing the philtrum in burn patients. Partial-thickness defects from the lateral subunits can be repaired by a variety of means. For larger lateral subunit defects, an inferiorly-based nasolabial flap might be employed (sometimes to change the whole lateral subunit).
Upper lip defects that are alongside the nasal ala can also be reconstructed using the nasolabial flap. This reconstructive method might not be ideal in men, however, because the nasolabial flap isn't hair-bearing. Primary closure might be achieved for males by advancing adjacent lip and cheek tissue.
For full-thickness defects, the choice of reconstructive option depends on the size the defect. Defects of one-quarter to one-third of the upper lip can be closed primarily. Larger defects of the upper lip require flaps in the lower lip or recruitment of adjacent cheek tissue. If these larger defects involve the central part of top of the lip, perialar crescentic excisions may provide additional mobility as needed.
Defects measuring one-third to two-thirds from the upper lip might be closed using the Abbe flap, the Karapandzic flap, or even the Estlander flap. The Abbe and Karapandzic flaps bring central defects whereas, the Estlander flap is used for lateral defects that involve the commissure. The Abbe flap may also be used for lateral defects that don't involve the commissure.
Defects greater than two-thirds of the upper lip can be closed using the Bernard-Burow's technique if sufficient cheek tissue is available. However, if sufficient cheek tissue is not available, most surgeons choose a free flap for reconstruction. Often, these methods may also be applied to closure of lower lip defects as well. Accordingly, for simplicity and easy explanation, reference is usually designed to lower lip reconstruction.
In contrast to the upper lip, lower lip reconstruction is commonly simpler. This advantage is a result of the higher laxity from the soft tissues and insufficient a separate central aesthetic unit. Since oral competence is principally mediated by the lower lip, function and sensation is commonly more important than aesthetics.
Partial-thickness defects of the lower lip are treated differently based on whether the defect involves skin and subcutaneous tissue or vermilion. Skin and subcutaneous defects of the lower lip subunit could be left to heal by secondary intention or skin grafted. More commonly, however, an area advancement flap, rotation flap or transposition flap is utilized for reconstruction. Careful planning and execution should allow the final scars to lie parallel towards the natural skin tension lines. The white roll should be realigned as closely as you possibly can.
Many of the reconstructive methods employed for upper lip reconstruction can also be used for lower lip reconstruction. As in the upper lip, reconstructive choices for full-thickness defects depend on the size of the defect. Defects up to one-third of the lower lip could be closed. Larger defects measuring one-third to two-thirds of the lower lip width may be closed using the Karapandzic, Abbe or Estlander flaps.
When the commissure is involved, both Karapandzic and Estlander flaps may be used; however, the Karapandzic is probably the better choice since it is better at maintaining oral competence. When the commissure isn't involved, the Karapandzic or even the Abbe flaps can be utilized. The Abbe flap is insensate; however it does provide a better cosmetic result.
Our website is not responsible for the information contained by this article. Webworldarticles.com is a free articles resource thus practically any visitor can submit an article. However if you notice any copyrighted material, please contact us and we will remove the article(s) in discussion right away.
This article was sent to us by:
Sean Barnes at
02142011
1. Chemoprotective effects of anthocyanin found in berries
All articles in this directory are property of their respective authors. Additionally, read our Privacy Policy
© 2010 WebWorldarticles.com - All Rights Reserved. Partners: Gunblade Saga