Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. This is more so when the resection is total and a complete lip has to be constructed. We present a case of lip reconstruction following a total resection of the upper lip. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal graft lining. We believe that this provides an alternative method of total upper lip reconstruction with minimal disruption of the facial aesthesis

A E Fadare

M O Majaro

O G Oseni

P B Olaitan

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Case Report
Total Reconstruction of the Upper Lip Using Bilateral
Nasolabial Flaps, Submental Flap, and Mucosa Graft following
Complete Resection for Squamous Cell Carcinoma
O. G. Oseni, A. E. Fadare, M. O. Majaro, and P. B. Olaitan
Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun 230105, Nigeria
Correspondence should be addressed to O. G. Oseni; osenioyediran@yahoo.co.uk
Received 10 June 2015; Accepted 28 October 2015
Academic Editor: Christophoros Foroulis
Copyright © 2015 O. G. Oseni et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. This is more so when the
resection is total and a complete lip has to be constructed. We present a case of lip reconstruction following a total resection of the
upper lip. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal
graft lining. We believe that this provides an alternative method of total upper lip reconstruction with minimal disruption of the
facial aesthesis.
1. Introduction
The perioral area is a focal point of both spoken and
nonspoken communication and an area of great aesthetic
importance. Its mobile nature and varied contours make it a
reconstructive challenge. The lips are a focus of facial beauty,
and their central location does not permit concealment
of unsightly scars or asymmetrical results. Both lips, but
especially the lower lip, are at risk for cutaneous malignancy
because of their prominent location [1]. The reconstruction
of composite defects of the upper lip following oncological
resection is challenging from both functional and aesthetic
perspectives [2]. Structural restoration of the lip must take
into consideration internal lining and external skin cover as
well as the functional goals of oral competence, the ability to
eat and drink, and intelligible speech. Aesthetically, there are
numerous subtle, but very important, variations in contour,
color, and texture. With no underlying bony or cartilagi-
nous framework, they are extremely sensitive to distortion
[3].
We present a case of complete reconstruction of the upper
lip following resection for extensive squamous cell carcinoma
with bilateral nasolabial flaps, submental flap in addition to
mucosa graft for lining. We belief this should be added to
the options of treating such a large defect especially where
microvascular procedures are not feasible.
2. Case Report
A. G was a 56-year-old farmer who presented with extensive
upper lip ulcer of about 3-year duration. Ulcer on the upper
lip had started with a small nodular swelling on the upper
lip which subsequently extended to involve the whole of
the upper lip. There was associated purulent discharge with
offensive odour which caused a social embarrassment to the
man. He had attempted suicide but was counseled and later
brought to the hospital.There was no previous burn injury or
scar on the lip prior to the swelling.
The main finding on examination was an extensive
exophytic ulcer on the whole of the upper lip extending
almost to the commissures bilaterally and just about 1 cm
short of the root of the columella (Figure 1).
He had a total resection of the lesion with a complete
resection of the upper lip laterally on either side to the
commissures and up to the root of the columela superiorly
(Figure 2).
Bilateral inferiorly based nasolabial flaps were raised and
brought to interdigitate with each other over the exposed
teeth (Figure 3(a)). A bipedicled submental flap was raised
with a 2.5 cm pedicle from either side of the cheeks with
the origin of the flap from the areas of the mastoid bones
(Figure 3(b)). The submental part of the flap was not raised
until about two weeks later (Figure 4).
Hindawi Publishing Corporation
Case Reports in Surgery
Volume 2015, Article ID 782151, 4 pages
http://dx.doi.org/10.1155/2015/782151
2 Case Reports in Surgery
Figure 1: Extensive exophytic ulcer on the upper lip.
Figure 2: Postexcision of the tumor and marking for nasolabial flaps.
(a) (b)
Figure 3: Insertion of bilateral nasolabial flaps and elevation of bipedicled mental flap.
At the second stage of the surgery, the nasolabial flaps
were observed to have done well and about 1.0 cm inferior
margin of the flapswas deepithelialised to accept the submen-
tal flap. A bipedicled submental flap of about 3.5 cm wide by
3.5 cm was raised and the inferior 2.5 cm portion of the flaps
lined with mucosa obtained from the cheek (Figure 4).
The flap was then sutured onto the deepithelialised por-
tion of the nasolabial flaps, thus allowing some free margin of
the lip that is not adherent with the soft tissue over the teeth
of the upper lip.
The pedicles were divided on the fourth and eight days,
respectively, following the second stage of the procedure.
He had topical application of 5-fluorouracil postopera-
tively. Patient was quite satisfied with the result with good
aesthetic and functional outcome (Figures 5 and 6).
3. Discussion
The perioral area is a focal point of both spoken and
nonspoken communication and an area of great aesthetic
importance. Its mobile nature and varied contours make
it a reconstructive challenge. Surgical resection of the lip
for malignancies brings a full-thickness defect of lip tissues,
and management of the resulting lip defect needs a surgical
Case Reports in Surgery 3
Figure 4: Submental flap lined with mucosal graft.
Figure 5: Postoperative picture views.
Figure 6: Postoperative picture: whistling and mouth opening.
technique that maximizes functional and cosmetic outcomes
[4].
Although the use of local tissue flaps forms the basic
concept of lip reconstruction, these are often limited when
an extensive part of the lip is to be reconstructed. Coupled
with this is the need to minimize facial defects and scarring
especially in the black patients who are prone to severe
hypertophic scars and keloids.
Full-thickness lip repair poses some challenges. This
challenge is more pronounced when a total reconstruction
is contemplated with minimal distortion of the structures of
the face. Aesthetic considerations also dictate that the recon-
struction should attempt to minimize or at least camouflage
the extent of disfigurement resulting from such extensive
surgery. Few published reports have addressed the issues
related to upper lip reconstruction [5]. Upper lip defects less
than one-fourth of total upper lip length are typically closed
directly, but larger defects require reconstruction.
The combined dorsalis pedis cutaneous, extensor hallucis,
and digitorum brevis muscle conjoined free flap is useful for
a moderate or subtotal defect of the full-thickness lip when
local or regional flaps are not applicable [6]. Full-thickness
reconstruction of the subtotal upper lip defect and the
restoration of the function and appearance of the columella
has been done using modified bilateral nasolabial flaps [7].
The use of the bilateral nasolabial flaps with bipedicled
submental flap and cheekmucosa is an addition to the options
for consideration where a total upper lip reconstruction is
4 Case Reports in Surgery
needed with an advantage of no microvascular involvement.
This means that the procedure is possible with any surgeon
wherever he is with minimal facilities. This method could
reconstruct anatomical features and function of the lip
precisely.
Facial scarring is also reduced as scar from the submental
flap is well hidden and the flap can provide hair on the upper
lip, thereby masking the reconstruction and absence of the
philtral dimple as well as other philtral prominences like the
cupid bow and the columns.This is therefore an option when
considering reconstruction of total upper lip loss.
Conflict of Interests
The authors declare that there is no conflict of interests
regarding the publication of this paper.
References
[1] L. E. Ishii and P. J. Byrne, “Lip reconstruction,” Facial Plastic
Surgery Clinics of North America, vol. 17, no. 3, pp. 445–453,
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[2] M. L. Urken, H. Weinberg, C. Vickery, D. Buchbinder, W.
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[3] F.-C. Wei, B.-K. Tan, I.-H. Chen, S.-P. Hau, and C.-T. Liau,
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[4] C. Matteini, N. Mazzone, G. Rendine, and E. Belli, “Lip
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[6] S. J. Oh and C. H. Chung, “Upper-lip reconstruction using a
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Total Reconstruction of the Upper Lip Using Bilateral Nasolabial Flaps, Submental Flap, and Mucosa Graft following Complete Resection for Squamous Cell Carcinoma

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Total Reconstruction of the Upper Lip Using Bilateral Nasolabial Flaps, Submental Flap, and Mucosa Graft following Complete Resection for Squamous Cell Carcinoma

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