Lip reconstruction may be required after trauma or excision surgery. Lips are considered the beginning of the oral cavity and are the most common sites of oral cancer. Each lips reconstruction should include both functional and cosmetic considerations. Lips are needed for talking, facial expressions, and eating. Because of its prominent location on the face, even small abnormalities can be seen.
Video Lip reconstruction
Relevant anatomy
Superficial
The upper and lower lips include the vermilion border. This is the meeting point between the lighter skin and the red tissue (vermilion) we used to call the lips. This tissue is red because of thin skin and is based on a large number of capillaries. Vermilion differs both from oral mucosa and from ordinary skin, as it includes stratum corollary cornified and has no salivary glands, unlike oral mucosa, but is thinner and more vascularized than ordinary skin, and lacks both hair follicles and sweat glands.
The vermilion border pattern defines the lip area:
- Philtrum-two vertical lines extending from the base of the nose to the border of the vermilion center, forming a central upper lip arc;
- Komisura-where the upper and lower lips meet laterally;
- Lateral upper lip between philtrum and commissure.
Away
The main muscle under the lips is the orbicularis oris. This circular muscle underlies the upper and lower lips. Muscles contract the lips to allow expression, speech, chewing and swallowing. It also maintains the tone to prevent objects from falling out of the mouth (referred to as oral competence). Disorders of the circular nature of these muscles can have a significant effect on oral function.
In addition, there are other muscles above and below the lips attached either to the orbicularis or to the fibrous band extending from the commissure.
Supply of nerves
Muscles are supplied by two cranial nerves, facial nerves and trigeminal nerves.
The upper lip receives sensitivity from the infraorbital nerve, which is the branch of the trigeminal nerve maxillary division. The infraorbita nerve provides a sensation to the upper lip, cheeks, ala, and nasal sidewalls. The sensory innervation of the lower lip is given by the mental nerves. The mental nerve is the terminal branch of the inferior alveolar nerve, which in turn is a branch of the division of the trigeminal nerve mandibula.
Blood supply
The muscles and skin on it are supplied by branches of the external carotid artery (the superior artery and the superior labial artery).
Lymph drainage
Submandibular/submental-Below the chin
Maps Lip reconstruction
Principles of Reconstruction
- Preserve lips sensation
- Maintain oral competencies
- Continuity of vermilion limit
- Adequate oral access (not too small, microstomas)
- Adequate lip appearance
Disabled types
Lip defects are classified by depth and size. Superficial defects involve the skin and vermilion, and leave the underlying muscles, nerves and arteries undisturbed. Deeply thickness defects include the underlying muscles, especially the orbicularis oris. The nerves and blood supply can also be affected if the disability is large. Regardless of depth or size, successful lip reconstruction considers the five principles and effects of reconstruction on the surrounding tissue.
Superficial top lip reconstruction
Successful reconstruction of the upper lip seeks to maintain an anatomical relationship of philtrum (the center of the upper lip) and the base of the nose. No distortion of commissure is also desirable for upper lip reconstruction.
Center lip
- The straight-line cover-can cause withdrawal from the vermilion border while healing
- The progress of this flaps-pulls the skin off the side and best heals when the defect is the full height of the upper lip, can come from one or both sides (single or double progress)
Lateral lips
- The straight line cover
- A-T closure - extends the defect to the philtrum or to the vermilion border to make the scar less visible.
- Single Advancements along the vermilion border to pull the network from the lateral aspect
- Rotation of flaps-rotate in tissue from cheeks
Superficial bottom lip reconstruction
Anatomical requirements do not limit the lower lip because the surrounding anatomy is less complex. Considerations include maintaining an undistorted vermillion border, hiding incisions in the horizontal folds of the chin, and not distorting commissures.
Vermilion only
- Closure A-T
- Single or double progress
Under vermilion
- Single or double progress
- A-T Closure
Deep thickness of lips inside/full
Deeper and larger defects of the lips posed greater reconstruction challenges, as they compromised the integrity of the orbicularis oris, nerves and blood supply. Thus, there is a shift of emphasis on the functional outcome of reconstruction, and less focus on lip appearance. All the flaps described below can be used on the upper or lower lip.
Main closure
Small flaws on the upper and lower lip can be closed primarily. For the upper lip, defects of up to 1/4 (25%) of the lips may be covered mostly. For the lower lip, defects of up to 1/3 of the lips may be covered mostly. This means the flawed ends are sewn together in three layers: the mucosa of the mouth, muscles, and skin. This closure has the best results because it reestablishes the continuity of orbicularis oris, which allows for oral competence, maximum lips preservation, vermilion border continuity, and adequate clearance.
Abbe lip changer
If the defect between 1/3 and 2/3 the length of the lip can be closed by the Abbe flap. The flap was developed by American plastic surgeon Robert Abbe. It is based on the main artery of the orbicularis oris, the labial artery. Some of the uninvolved lips (either up or down) are rotated in the mouth and into the involved lips defects while maintaining the blood supply from the labial artery. After 10-14 days, the blood supply from the flap has been set to the point where the artery can be divided. Abbe Flats have excellent cosmetic results when used to replace the entire philtrum of the upper lip. This technique can also be used when defects involve commissure. This is called the Abbe-Estlander flap. This repair requires two operations and requires good planning to ensure the continuity of the vermilion border.
Gillies fan flap
This flap borrows tissue from the cheeks and lips from the side of the lips that are not involved with the defect. This restores lips continuity in a one-step procedure, but has several disadvantages, including adverse effects on sensation, small mouth size, and difficulty in matching the vermilion edge of the central lip with lateral lips.
Flap Karapandzic
This flap borrows the network from the sides of the defect, like a Gilles flap. The difference is that it maintains the nerves and orbicularis oris blood supply. The fins come from both directions to meet in the middle of the handicap. This is a one-step procedure that maintains oral sensation and competence. The main problem with this reconstruction is that it can create very small mouthpieces.
Total lip reconstruction
The whole lips are reconstructed is a challenge. Tissue can be rotated from the nasolabial or cheek region bilaterally, but the result is limited by a lack of sensation, small size, poor mouth capacity, and less optimal appearance.
For Postoperative Lips Large deltopectoral defects may be useful: tube pedicle flikung to cover the lower jaw. After 6 weeks lips reconstruction is done
Complications of reconstruction
- Bad cosmetic results
- Lack of oral competency
- Small mouth size
- Reduced lip or mouth sensation
- Recurrent illness
See also
- Plastic Surgery
References
External links
- Emedicine Lip Reconstruction Articles
- Lip reconstruction
Source of the article : Wikipedia
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