Use of Social Media and an Online Survey to Discuss Complex Reconstructive Surgery: A Case of Upper Lip Reconstruction with 402 Responses from International Microsurgeons.

BACKGROUND: The best reconstructive strategy for upper lip defects is still in debate. The purpose of this study was to analyze the decisions made by international microsurgeons, who were participated through online questionnaire, distributed by email and social media network. MATERIALS AND METHODS: A case of a two-thirds upper lip oncologic defect was presented via an online questionnaire and 402 microsurgeons replied their treatment options. The data were then analyzed according to the geographic area, microsurgical fellowship, seniority, and subspecialty. All the data were analyzed using SPSS 22. RESULTS: A total of 27.7% of microsurgeons chose a free flap, while 72.3% chose a local/pedicle flap as their preferred method for reconstruction. The most common choice of free and local/pedicle flaps was radial forearm (73.6%) and Abbé (36.2%), respectively. The microsurgeons in Europe preferred local/pedicle flaps than free flap when compared with Middle/South America, Asia-Pacific, Africa and South Asia/Middle East (11.6% versus 50%, 43.4%, 29.3% and 27.3%, respectively, multivariant p < 0.05). The microsurgeons with microsurgical fellowships preferred to use free flaps (32.9% versus 17.5%, multivariant p = 0.021). There was no difference for the seniority and specialty of the microsurgeons. CONCLUSIONS: The online questionnaire is valuable and feasible for obtaining experts' opinions. This study provides a current global overview of surgical preferences for this common complicated clinical scenario.

Disfiguring facial hemangioma compromising labial functionality: a case report.

Hemangiomas are proliferative lesions characterized by increased endothelial cell turnover. Lip hemangiomas can distort lip anatomy and are at increased risk of ulceration and/or bleeding, which lead to impaired function and disfigurement. Surgery can provide active treatment but it can be problematic because vermilion tissue is unique and not found elsewhere on the body. Since there is no similar tissue that can easily be used for reconstructing missing vermilion, its preservation is essential for a satisfactory cosmetic result. We present the case of a 74 year old woman suffering from a large hemangioma of the mid-face and particulary with an angiomatous ulcerated lesion at the level of the lower lip. We describe clinical management and surgical treatment of this pathology.

Functional and aesthetic results obtained by modified Bernard reconstruction technique after tumour excision in lower lip cancers.

BACKGROUND: In this study, we investigated the functional and aesthetic results in new lip formation using modified Bernard reconstruction technique after tumour excision in lower lip cancers. MATERIAL AND METHODS: The study included 47 patients. All were operated due to lower labial squamous cell carcinoma and underwent defect reconstruction using modified Bernard technique. The patients were separated into two groups as: 50-70% and 70% total defect occurring after surgical excision. The functional and aesthetic assessments were done after at least 1 year had passed, and the results were compared statistically with a control group. RESULTS: Of the 18 patients with 50-70% defect, sensibility was normal in 16 (89%) and complete competence was determined in all (100%). In 17 patients (94%), complete and symmetric pouting and mouth-opening movements were ensured. Normal mouth opening was noted in all patients. Nasolabial asymmetry was detected in one patient (6%) and apparent mentolabial scar tissue was detected in two patients (11%). The new vermilion was of equal width to the upper lip vermilion in 15 patients (83%). Of the 29 patients with 70% total defect, sensibility was normal in 21 (72%) and complete competence was detected in 27 patients (93%). Sialorrhoea on fluid intake was detected in one patient (3.5%) and sialorrhoea at rest in one patient (3.5%). In 22 patients (76%), complete and symmetric pouting and mouth-opening movements were ensured. Normal mouth opening was noted in 27 (93%) of the 29 patients. Asymmetry in nasolabial fold was detected in one patient (3.5%), apparent scar tissue in nasolabial fold in one patient (3.5%) and commissure asymmetry in one patient (3.5%). In 25 patients (86%), the new vermilion was of equal width to the upper lip vermilion. No statistically significant difference was found (p>0.05) among the two patient groups and the control group in terms of functional and aesthetic results. CONCLUSION: Modified Bernard technique provides a good degree of lip mobility and sensation after excision of lower lip malignant tumour and produces acceptable results.

[Upper lip plasty by Karapandzic: modifications of the method].

The study presents two modifications of the method of Karapandzic in the operative treatment of malignant tumors of the lower lip. The first modification is applicable in initial stages of the lower lip cancer, originating from preceding leukoplakia. The modification presents a different design of the flap from one of the sides, which gives a better mobilization of the tissues and a higher level of oncological radicality compared with the method of "lip shave". The second modification corresponds the excision of the triangle from the mucosa, after the von Burow method. That modification was performed routinely in our practice. The results were evaluated with the electrophysiological test (EMG) and a subjective judgment of the appearance and function. An altered questionnaire of Washington University was used to estimate the quality of life of the operated patients with cancer of head and neck region.

Density and migration of mast cells in lip squamous cell carcinoma and actinic cheilitis.

Mast cells (MCs) display a diversity of roles that may contribute to the stromal microenvironment alterations during tumor progression. The aim of this study was to investigate MC populations expressing tryptase and c-kit in lip squamous cell carcinoma (lip SCC) (n=37), actinic cheilitis (AC) (n=15) and normal lip mucosa (control) (n=6), as well as their relationship with microscopic parameters (collagen degeneration, elastin changes, angiogenesis and proliferative index). Tryptase, c-kit, CD31 and Ki-67 expressions were analyzed by means of immunohistochemistry and collagen and elastic fibers were visualized with Picrosirus and Verhoeff's stain, respectively. The numbers of tryptase+ MC were significantly higher in lip SCC when compared with control (P=0.01), while a similar density of these cells was observed in AC and lip SCC (P=0.09). The density of c-kit+ MC was similar in all groups examined (P=0.65). MC migration (c-kit+/Tryptase+ relationship) was 69% in lip SCC, 60% in AC and 100% in control. The number of CD31+ blood vessels was significantly higher in the lip SCC when compared with control and AC (P<0.01). The increase of MCs and angiogenesis in lip SCC may reflect an important modification in the tumor microenvironment during squamous photo-carcinogenesis.

Second intention healing for intermediate and large postsurgical defects of the lip.

BACKGROUND: The lip plays critical roles in both function and cosmesis. Many options exist for postsurgical reconstruction following excision or Mohs micrographic surgery on the lip. Second intention healing is generally reserved only for superficial and small postsurgical defects of the lip vermilion. METHODS: We sought to evaluate second intention healing of the lip for intermediate and large partial thickness, postsurgical defects through a retrospective review of medical charts in conjunction with telephone interviews. Complication rates, time to reepithelialization, and patient satisfaction were determined for 25 patients who underwent second intention healing on the lip following Mohs micrographic surgery for non-melanoma skin cancer. RESULTS: The majority of patients in the study demonstrated good to excellent cosmetic and functional results with minimal complications. Time to complete reepithelialization averaged 25 days. Patient satisfaction with both the healing process and final cosmetic result was very high. LIMITATIONS: The study is a small retrospective case series. Using patient satisfaction as a primary endpoint, a limiting factor may be recall bias. CONCLUSION: Second intention healing is an effective and satisfactory management strategy for intermediate and large postsurgical defects of the lip vermilion, including those with extension to cutaneous lip and underlying orbicularis muscle.

Free mucosa graft from the lateral tongue for reconstruction of intraoral buccal/lip mucosal defects after tumor resection.

OBJECTIVES: To develop a functional and morphologic reconstruction for intraoral buccal/lip mucosal defects after tumor resection. STUDY DESIGN: A prospective clinical series. METHODS: From November 2003 to July 2006, 32 patients underwent free tongue mucosa graft reconstruction after resection of buccal or lip tumors. Graft validity and acceptability, donor site morbidity, and postoperative articulation and swallowing functions were evaluated. RESULTS: Regular postoperative follow-up for at least 6 (mean, 18.5; range, 6-38) months revealed good functional outcomes and satisfactory cosmetic results of grafts at recipient sites in 29 of 32 (90.6%) patients. There were minimal to mild postoperative pain and minor complications at the donor sites. Mouth opening width was preserved, and all patients could tolerate either soft or regular diets. None of the patients had postoperative functional deficiencies involving articulation, swallowing, mastication, or sense of taste. CONCLUSION: This study demonstrated that free mucosa grafts from the lateral tongue are an excellent alternative for reconstruction of buccal/lip mucosal defects after tumor resection.

Functional lower lip reconstruction with a forearm flap combined with a free gracilis muscle transfer.

We applied a forearm flap combined with a gracilis muscle flap for total reconstruction of the lower lip. The motor nerve of the gracilis muscle was repaired to the buccal branch in the cheek. The patient obtained good sphincter function for eating and speaking, and he could inflate a balloon without air leakage.

Surgical treatment of erythroleukoplakia in lower lip with carbon dioxide laser radiation.

Erythroplakia is considered to represent a premalignant condition and is felt to be at high risk to progress to oral cancer development. When the lesion presents with red and white mucosal alterations concomitantly, the term erythroleukoplakia is used. However, in erythroleukoplakia lesions, the red or erythroplakia areas have been shown to be most likely to demonstrate dysplastic changes compared to the white hyperkeratotic areas. We present a case of patient with erythroleukoplakia involving the lower lip that was treating with carbon dioxide laser radiation (CO2) with 0.8 mm focus, 5 W, power density of 2.5 W/cm2 in continuous. After the surgery, the vaporized surface was protected with a fibrinolisine + chloramphenicol cream. To date, after 6 months, there has been no clinically evident recurrence on the vermilion area. The functional and esthetic results observed were judged to be excellent.

[Diagnosis and management of 49 cases of hemangiomas in infants and children].

OBJECTIVE: To observe the management results of hemangioma in infants and children. METHODS: Forty-nine cases of hemangioma in infants and children managed from 1986 to 2004 were reviewed. During the management period, the incidence and first visit age and sex were recorded. The location and volume of the lesions were photographed and followed up at an interval of 3 to 12 months until the complete involution of the tumor. The treatment modalities used included local injection of prednisone in 16 cases, surgery in 6 cases, and the remaining 33 cases were observed without treatment. RESULTS: Thirty-three cases receiving no treatment involuted naturally. The complete involution age was found from 9 months to 10 years with average age of 5.4 years. The cosmetic results after involution were good. CONCLUSIONS: Most hemangiomas do not need treatment and can involute naturally. However, in cases with severe complications such as expansion, destruction and obstructive or congestive heart failure, treatment is indicated.

Histological correlates of metastasis in primary invasive squamous cell carcinoma of the lip.

The histological features of 66 cases of squamous cell carcinoma of the lip were studied in an attempt to define prognostic parameters. Features that correlated with an increased risk of metastasis included histological grade of the tumour at the base and the surface, the tumour thickness, presence of stromal sclerosis, and the presence of muscle and perineural invasion.

Carcinoma of the lip.

Carcinoma of the lip represents the most common malignancy of the oral cavity with an incidence in the United States of approximately 1.8/100,000. Lip cancers represent 15% to 20% of all malignancies of the oral cavity. With increasing public awareness of the harmful effects of solar radiation, physicians need to be aware of the etiological factors as well as appropriate treatment plans to ensure that patients obtain the most favorable outcome possible.