Laboratory Studies

The laboratory tests that are required for lip reconstruction are those that would be necessary in any type of surgical intervention. Evaluation of coagulation profile, blood counts, blood chemistry, electrocardiography, chest radiography, and other specialized cardiac and pulmonary tests are indicated as appropriate for the age and medical conditions of each patient.

Imaging Studies

See the list below:

Most cases of primary lip reconstruction do not require special imaging. If any possibility exists that the underlying mandible is involved with a lower lip neoplasm, CT scanning with bony windows is indicated.
Consider MRI in those patients who present with preoperative hypoesthesia of the upper or lower lip. In this case, suspicion of infraorbital or submental nerve infiltration may be warranted. Extent of infiltration can certainly have an impact on the choice of extirpative technique.

Diagnostic Procedures

Diagnostic confirmation of cancer is often prudent prior to any extensive resection. Various biopsy techniques are available.

Treatment & Management

Media Gallery

Large defect of the lateral upper lip side unit is addressed with a perialar crescentic cheek advancement flap. The muscular continuity is preserved, allowing for complete functional restoration.
The Abbe lip switch flap. Typically, the flap is half the width of the defect to allow for symmetric shortening of the upper and lower lip. A second stage is necessary to ligate the pedicle and finalize flap inset.
The Estlander lateral lip switch flap. Note that although complete inset is accomplished at the initial stage, a second stage is often warranted to allow for better definition of the oral commissure. As described by Converse, the modiolus is expanded followed by mucosal advancement flaps.
Near-total upper lip defects are best addressed by treating each subunit individually. The lateral subunits are formed by use of inferiorly based melolabial rotation flaps. The central subunit is created with lip switch. Mucosal advancement flaps are necessary to recreate the vermillion.
Near-total upper lip defects are best addressed by treating each subunit individually. The lateral subunits are formed by use of inferiorly based melolabial rotation flaps. The central subunit is created with lip switch. Mucosal advancement flaps are necessary to re-create the vermillion.
The Karapandzic flap is a suitable option for large lower lip defects. The neurovascular pedicles are preserved allowing for adequate sensation and motor function. Since no additional tissue is advanced, a limitation is microstomia.

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Author

Michael R Shohet, MD Assistant Clinical Professor, Department of Otolaryngology, Mount Sinai School of Medicine

Michael R Shohet, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, Minnesota Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Maurice M Khosh, MD, FACS Clinical Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons; Private Practice, Head and Neck Surgical Group; Attending Surgeon, Lenox Hill Hospital, Manhattan Eye, Ear and Throat Infirmary, Columbia Presbyterian Medical Center, St Luke's-Roosevelt Hospital Center, Beth Israel Medical Center

Maurice M Khosh, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Triological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Dominique Dorion, MD, MSc, FRCSC, FACS Dean, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Université de Sherbrooke, Canada

Dominique Dorion, MD, MSc, FRCSC, FACS is a member of the following medical societies: Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Paul S Nassif, MD FACS, Consulting Surgeon, Facial Plastic and Reconstructive Surgery, Spalding Drive Cosmetic Surgery and Dermatology

Paul S Nassif, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, California Medical Association, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

The authors would like to acknowledge the artwork of Tanya S. Penn for the illustrations.