2. Lip Reconstruction
• Lips provide important aesthetic (ie. Mick
Jagger) and functional role (both sphincteric
and fine motor movements)
• The vermilion is highly sensitive to
temperature, touch and pain
• Aims of reconstruction are to restore
function, maintain sensation and avoid
cosmetic deformity
7. Lip Reconstruction
• Traumatic injury to the lips is more challenging
• Meticulous cleansing with minimal debridement to
preserve as much tissue as possible usually allows
for primary closure
• Critical landmarks (vermilion border, philtrum,
commissures) are realigned first
• Closure proceeds: muscle layer, mucosa, skin
• Flaps may be needed for closure or revision, but
are usually done as a delayed procedure
8. • Injury to Marginal Mandibular Nerve?
• Which side is injured?
• Right side is higher than left at rest.
9. Lip Anatomy
• the facial artery
supplies the superior
and inferior labial
arteries, which
anastamose to provide
a dual blood supply to
each lip
• the arteries lie
between the
orbicularis oris and
the oral mucosa
16. • 3 layers of muscles
• Group I: Orbicularis oris, buccinator, levator
anguli oris, depressor anguli oris,
zygomaticus major, risorius
• Group II: Levator labii superioris, levator
labii superioris alaeque nasi, zygomaticus
minor
• Group III: Depressor labii inferiorius,
mentalis, platysma
17. Lip Anatomy
• orbicularis oris is solely
responsible for lip closure,
oral competence
• The orbicularis is
manipulated by superior
elevator muscles and
inferior depressor muscles:
coordinate fine motor
movement
• Modiolus is area of muscle
integration at each
commissure
19. • Palpate infraorbital foramen
• Draw line down vertically from pupil to
infraorbital ridge
• 4-7 mm below orbital rim perpendicular
from medial limbus of iris
20. Mental Nerve
• Located between 2 second mandibular
bicuspid with 6-10mm of lateral visibility
• Frequently visible
21. Lip Anatomy
• Motor innervation to the orbicularis oris is
via the buccal branch of CN VII
• The marginal mandibular nerve supplies the
depressor muscles
• These nerves run deep to the muscles
• The trigeminal nerve supplies sensation to
the upper lip via the superior labial nerve, a
branch of the infraorbital nerve, and the
lower lip via the mental nerve
22. Lip
• Vermillion- Border between skin of face and
lip
• Wet lip (mucous membrane)-nonkertanized
• Dry lip (exterior lip)-kertanized
• Red lip
• White lip
23. Lip Anatomy
• The most important
aesthetic landmark is
the white roll
• For optimal cosmesis,
the nasolabial and
labiomental creases
should not be violated
24. Lip Anatomy
• The upper lip is
divided into aesthetic
subunits which should
be considered in
reconstructive
planning
• The lower lip has only
one subunit
31. Vermilion Reconstruction
• The vermilion can be
reconstructed with a
buccal mucosal
advancement flap
32. Vermilion Reconstruction
• advancement of a
musculovermilion
flap, raised deep to the
labial artery
• for defects of lower lip
up to 1/3 (maybe 1/2)
of lip
33. Vermilion Reconstruction
• A V-Y advancement
flap of muscle and
mucosa can restore
volume in a notch
deformity
35. Wedge excisions with primary
closure
• wedge resections
should not
violate nasolabial
or nasomental
crease
• Burow’s
triangles will
allow for medial
lip advancement
36. Medium Lower Lip Defects
• Abbe flap converts
medium defect to a small
one
• not for commissure
defects
• 2-stage (2-3 weeks)
• no new lip tissue (must be
enough remaining to
prevent microstomia
• flap can be based on either
side
37. Abbe Flap
• Flap ½ size of defect taken full thickness
• Leave Pedicled at Vermillion Border
• 2nd stage at 3 weeks
40. Medium Lower Lip Defects
• Estlander Flap can be
used for commissure
defects
• No new lip tissue
created
• Single stage
• Rounded commissure
• Good oral competence
43. Medium Lower Lip Defects
• Karapandzic Flap does not
bring in new lip tissue
• good for medial or lesions
with commissure
involvement
• preserves neurovascular
supply
• microstomia more
problematic with patients
who wear dentures
46. Medium Lower Lip Defects
• Bernard-Burow’s
procedure generated new
lip tissue to prevent
microstomia
• The advanced tissue lacks
sensation and sphincteric
function
• Burow’s triangles are skin
and subq tissue only
• buccal mucosa advanced
for vermilion
48. Large Lower Lip Defects
• Karapandzic flap may be used in lesions up
to 80% of lip, may cause microstomia
• Bernard-Burow’s procedure provides new
lip tissue, but sensation and competence
problems can lead to drooling
• Free flap may be needed in massive defects
or those with insufficient lip or cheek tissue
for reconstruction
49. • Best to address each subunit individually for
large lip defects
52. Upper Lip Reconstruction
• Special considerations include presence of
central structures (cupid’s bow, philtrum)
• In men, facial hair aids in hiding scars
• In men, nonhair-bearing flaps brought into
hear-bearing areas can be noticeable
• The upper lip is less important in oral
competence
• more lower lip tissue can be “borrowed” for
upper lip reconstruction
53. Small upper lip defects
• lateral defects can be
closed primarily
• taper incision into
nasolabial fold
54. Small Upper Lip Defects
• Perialar crescentric
excisions can be used
for central defects
• Loss of Cupid’s bow,
philtrum can be
disguised with
mustache
55. Small upper lip defects
• A nasolabial flap can
be used in upper lip
defects that spare the
vermilion
• The flap contains skin
and subQ tissue
• The donor site is
closed along the
nasolabial fold
56. Medium Upper Lip Defects
• When centrally
located, a combined
Abbe flap with
perialar crescentric
excisions
57. Medium Upper Lip Defects
• Karapandzic or Estlander
flaps can also be used
depending on commissure
involvement
58. Large Upper Lip Defects
• Unilateral Gilles flap
can bring in new lip
tissue
• Motor and sensory
function may not be
restored
59. Large Upper Lip Defects
• Upper lip Bernard-
Burow’s procedure brings
in new lip tissue
• Sensation and motor
function may not be
restored
• rarely, total upper lip
reconstruction will require
a distant or free flap
60. Commissureoplasty
• Can correct
microstomia or
asymmetry of the
commissures
• orbicularis oris
deficiency can result
leading to oral
incompetence
61. Microstomia
• Electrical
• Early ointment
• Early debridement not advised due to
necrosis of muscle and soft tissue which
extends beyond which is visible
64. Lips
• Injectable fillers
• Soft lip injection
• Lasts 4-6 months
• Fat transfer offers longer lasting results in
some patients but some unpredictability
65. How to make your lips fuller
without a procedure?
• Lip plumpers
• Drink a lot of water
66. Do Lip Plumpers Work?
• Study by Dr. Most at U of Washington
• Used Lip Explosion
• 14 patients used for three months
• No measurable difference
• Only one patient thought would use the
product again