Lip Reconstruction

Question 1

What are your options for reconstruction of a vermillion defect

Answer 1

• V-Y mucosa advancement - V-Y vermilion advancement - vermillion switch - bipedicled mucosa advancement tongue flap - FAMM flap - Goldstein vermillion musculocutaneous flap

Question 2

How do you classify lower lip defect

Answer 2

by subunit involved by size by component by thickness

Question 3

What are your options for reconstruction of a lower lip defect

Answer 3

1’ closure with wedge and barrel/burrow triangle

Question 4

What are your options for reconstruction of lower lip defect up to 1/2

Answer 4

• step ladder advancement - reverse Abbe - Estlander - unilateral Gilles Fan flap - Karapandzic flap - DAO flap

Question 5

What are your options for reconstruction of a lower lip 2/3 to total defect?

Answer 5

• bilateral Gilles Fan flap - Webster Bernanrd burrow - Fujimori Gate flap (inferior NL flaps) - regional/free

Question 6

How do you classify upper lip defects?

Answer 6

by subunit by size

Question 7

What are your options for reconstruction of a lateral lip defect

Answer 7

• 1’ closure - perialar crescentric advancement flap - nasolabial flap - A to T closure - Abbe - Reverse Estlander

Question 8

What are your options for reconstruction of a philtral defect?

Answer 8

• 1’ closure - STSG - Abbe

Question 9

What are your options for reconstruction of a philtral and lateral defect

Answer 9

• bilateral perialar crescentric flap +/- Abbe - Reverse Karapandzic

Question 10

What are your options for reconstruction of a philtral and lateral defect >2/3

Answer 10

• bilateral nasolabial fold +/- Abbe - upper lip Webster Bernard Burrow + bipedicled mucosal advancement buccal mucosa

Question 11

What do you do to reconstruct the commissure

Answer 11

rhomboid mucosa flap

Question 12

What muscles insert onto the modiolus

Answer 12

LAO, ZM, O.Oris, Buccinator, risorius Fx: all shift the lateral commisure

Question 13

What muscles insert onto upper lip

Answer 13

LLS LLSan Zm Fx: elevate upper lip

Question 14

What muscles insert onto lower lip

Answer 14

mentalis, DLI, plastysma Fx: depress lower lip, except mentalis ELEVATES lower lip

Question 15

What is the lymphatic drainage of the upper and lower lips?

Answer 15

Upper lip and lateral lower lip -> submandibular Central lower lip: submental basin

Question 16

What are your goals of lip reconstruction

Answer 16

Aesthetics -Skin, lining, vermilion reconstruction Function - sensation - stoma opening (denture) - competence - Buccal sulcus - speech

Question 17

Describe the FAMM flap

Answer 17

facial artery musculomucosal flap Based on facial artey - raise mucosa, submucosa, buccinator, facial artery

Question 18

What are the subunits of the lower lip?

Answer 18

chin vermilion white lip

Question 19

Describe a step ladder advancement flap

Answer 19

suitable for defect of lower lip up tp 1/2 if width of defect is x, width and height of step is 1/2x Will need 2-4 steps If defect midline, use stairsteps bilateral, if defect lateral, use unilateral step ladder

Question 20

What are indications for a karapandzic flap?

Answer 20

Upper lip 1/2 defect Lower lip 2/3 defect

Question 21

Describe a karapandzic flap

Answer 21

From the defect, draw falps of equal height extending along NL folds or menton crease - except at commisure, go beyong NLfold/menton to ensure flap is equal width throughout. Width=Height Skin incision then dissect to release O.oris throuhg whole flap but leave mucosa in tact to preserve NV supply (labial arteries)

Question 22

Describe an Estlander flap

Answer 22

Used for defects which include commissure Actually a rotation flap, no dissection of pedicle as in Abbe - rotate commissure to meet defect vermilion.

Question 23

Describe a gilles fan flap

Answer 23

extension of estlander rotation advancement of white lip adjcant to NL fold No preservation of innervation

Question 24

Describe the DAO flap

Answer 24

skin DAO and buccal mucosa is rotated from commisure to midline need neovermilion

Question 25

Describe the bilateral gilles fan flap

Answer 25

indicated for 2/3 -total lower lip defect bilateral rotation flaps - no nerve supply to o.oris maintained

Question 26

Describe the webster Bernard Burow

Answer 26

Bilateral horizontal advancement flaps, burrow triangles in NL fold and paramental folds - skin and subcut eccision of burow triangles only.

Question 27

Describe the fujimori gate flaps

Answer 27

Inferiorly based nasolabial flaps

Question 28

Describe regional flap options for lower lip defect

Answer 28

pectoralis, SCM, deltopectoral, fasciocutaneous scalp/temporal flaps

Question 29

Describe free flap options for lower lip recon

Answer 29

USed if failed local, hx radiation, composite requiring bone, FOM RFFF +/- PL fibula scapula ALT +/- fascia lata

Question 30

Describe management options for upper lip defects (

Answer 30

primary closure A to T Perialar crescentric adv flap Nasolabial flap Abbe flap Reverse estlander

Question 31

Describe management for philtral defect

Answer 31

1' closure STSG abbe

Question 32

Describe options for defects of lateral and philtral less than 2/3

Answer 32

bilateral crescentric perialar flaps reverse karapandzic

Question 33

Upper \>2/3 defect options

Answer 33

need combination abbe and bilateral NL abbe and reverse karapandzic Upper lip webster bernard burrows

Question 34

Whata re reional flap options for recon of upper lip

Answer 34

TPF

Question 35

What are options for local flap reocn of cheek defect

Answer 35

rhomboid flap transposition flap bilobed flap nasolabial flap V-Y advancement sickle shaped flaps cheek advancement

Question 36

Describe an anteriorly based rotatationadvancement flap

Answer 36

Juri and juri flap (based on facial and trasnverse cervical) designed form teh superior edge of defect, along Z arch, preauricular rease, behind ear to follow occipital hairline If insufficient and include neck and chest bu going posterior to trapezius and lateral to AC joint then returnign to chest abouve NAC

Question 37

Describe posteriorly based rotation advancement flap

Answer 37

based on STA, perforators from TA and trapexius

Question 38

Describe pectoralis muscle flap

Answer 38

type 5 - based on TA pectoral br and perforators from IMA

Question 39

Describe regional flap options for cheek reconstruction

Answer 39

pectoralis Deltopectoral trasnverse forehead flap TPF platysma, SCM

Question 40

Describe an abbe flap

Answer 40

Based on inferior labial artery or superior labial artey, full thickness flap wedge - wdith of flap is deisgned to be 1/2 width of defect and height is made to made (except for 2'cleft lip revision where width is designed to be equal Pedicle should be at the midlin eof the defect when designing

Question 41

what % defect of upper lip and lower lip can you close primarily with a wedge?

Answer 41

upper lip 25% lower lip 30%