Sunday, April 7, 2019

ACUTE LIP LOSS - RECONSTRUCTION OUTCOME

LIP LOSS - MANAGEMENT PROTOCOL


ANATOMY OF LIP

The lip consists of four basic components: the skin and subcutaneous tissue, the muscle, the mucosa, and the vermilion. Each of these structures has unique characteristics that must be considered when planning the reconstruction.

FUNCTION

The sphincteric function of the lips allows for oral competence in eating and drinking, speech and sound production, forceful blowing, and kissing.

The muscular content of the lips allow for their tone. Without this muscular support, the tissue would simply lose its support and become ptotic, as seen in patients with facial palsy who inevitably develop lower-lip laxity and lowerincisor show.

 Similarly if the upper lip was without muscular
tone, the normal upper incisor–upper lip relationship would be lost.

ETIOLOGY

The etiology of most lip defects is tumors or trauma. Lip tumors are either congenital or acquired.

Congenital tumors are most often vascular malformations and hemangiomas. Acquired tumors
are usually basal cell carcinoma in the upper lip and squamous cell carcinoma in the more sun-exposed lower lip.


NERVE SUPPLY

The sensory innervation of the lip is provided by the mental and infraorbital nerves.


These two distinct nerves allow for local anesthesia to be easily and quickly established for lip procedures. Low volumes of solution, placed accurately, will give complete anesthesia.


Intraoral injections have the advantage of being less painful,  and simpler to achieve complete blockade as they are based on bony landmarks (teeth) and the entire path of the needle
parallels the bone. 



LOWER LIP DEFECT 1/3RD LOSS

This case had a trauma with lip loss in lower segement of 1/3 rd loss managed with muscle mucosal advancement flap.


When analyzing a lip defect, the most important assessment is the amount of remaining lip vermilion. Vermilion, if present, carries with it muscle that can be used to maintain the sphincteric
function of the lip.

All methods of vermilion reconstruction by using other tissues are suboptimal. Buccal mucosa and tongue look like buccal mucosa and tongue. They do not take
lipstick in the same way, have different light reflection, and have different color.

Remaining lip skin is also important, but in general, this tissue can be replaced more easily than vermilion.
When deciding on the operative plan, one must decide whether the lip can be reconstructed with lip tissue, which is preferable, or if the defect will require nonlip tissue. Lip tissue not only replaces “like with like,” but most lip reconstruction using lip tissue with orbicularis muscle will eventually have
some element of neurotization.

This will allow for functional reconstruction that provides a natural appearance both at rest and in conversation. It also allows for the replacement of precious
vermilion tissue. Direct lip closure, or closure with sliding lip tissue, is always the first choice.

Flaps such as the Abbe and reverse Abbe flap also satisfy
lower lip 1/3rd loss

outcome


Schuchardt procedure



 

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