What are the methods for reconstructing the lower lip?

From the Guidelines

Lower lip reconstruction can be achieved through various methods, including direct closure, wedge excision, local flaps, and regional flaps, with the choice of method depending on the size and location of the defect. When considering the reconstruction of the lower lip, several factors must be taken into account, including the size and location of the defect, as well as the patient's overall health and aesthetic goals. The goal of reconstruction is to restore both function (oral competence, speech, eating) and aesthetics while preserving sensation and minimizing microstomia. Some of the methods for reconstructing the lower lip include:

• Direct closure or wedge excision with primary closure for small defects (less than one-third of the lip)
• Local flaps such as Karapandzic, Abbe, or Estlander flaps for medium-sized defects (one-third to two-thirds of the lip)
• Regional flaps like the submental flap, facial artery musculomucosal flap, or free tissue transfer for large defects (greater than two-thirds of the lip) 1. It is essential to note that the choice of reconstruction method may also depend on the underlying condition being treated, such as hidradenitis suppurativa or infantile hemangioma, and the potential for recurrence or complications 1. Postoperative care is crucial to ensure proper healing and minimize the risk of complications, and may include oral antibiotics, pain management, and meticulous oral hygiene 1. Ultimately, the choice of reconstruction method should be individualized to each patient's unique needs and circumstances, taking into account the potential benefits and drawbacks of each approach 1.

From the Research

Methods for Reconstructing the Lower Lip

The methods for reconstructing the lower lip include:

• One-stage total lower lip reconstruction using bilateral inferiorly based nasolabial flaps and a bucket-handle mucomuscular flap from the upper lip 2
• Transverse lip advancement flap for lateral lower lip defects, which minimizes incisions and scar, and maximizes sensation and function 3
• Skin-mucosa Abbe-Estlander flap after squamous cell carcinoma excision, which provides a satisfactory final outcome 4
• Modified O-Z flap for small defects of the lower vermilion adjacent to the white roll, which results in successful aesthetic reconstruction 5
• Advancement flap technique, combination of advancement flap technique with a reverse Abbé-Estlander flap, and bringing two arterialized island flaps from the nasolabial region to reconstruct the lower lip 6

Characteristics of Each Method

Each method has its own characteristics, such as:

• The use of nasolabial flaps and a mucomuscular flap from the upper lip allows for a competent oral sphincter and satisfactory aesthetic outcome 2
• The transverse lip advancement flap provides dynamic reconstruction with superior results in terms of lip appearance and function 3
• The skin-mucosa Abbe-Estlander flap is used for large defects with low risk of necrosis due to the abundant blood supply of the lips 4
• The modified O-Z flap is used for small defects and results in successful aesthetic reconstruction 5
• The advancement flap technique and other methods described in 6 enable immediate and satisfactory repair of defects of the lower lip

Advantages and Outcomes

The advantages and outcomes of each method include:

• Minimal morbidity and preservation of the vascular pedicle and innervation 2
• Satisfactory functional, aesthetical, and sensational results 3
• Satisfactory final outcome with low risk of necrosis 4
• Successful aesthetic reconstruction with minimal distortion and color mismatch 5
• Immediate and satisfactory repair of defects of the lower lip with superior esthetics and function compared to traditional methods 6