Classic Lower Lip Reconstructions

Approximately 90% of all lip tumors occur in the lower lip. It is important, therefore, to obtain a good esthetic and functional result when repairing small and large defects of the lower lip.

Angle The Lip
Fig. 6.37a, b Z-plasty used to raise the angle of the mouth.

Fig. 6.38a Heart-shaped wedge excision from the lower lip (up to one-third). b The mucosa is closed first.

c Then the muscle edges are approximated with absorbable sutures (M).

A coapting suture is placed at the skin-vermilion border (A).

Wedge Excision Lip
Fig. 6.39a, b Modifications of the wedge excision.
Estlander Plasty

Fig. 6.40 Mobilization of the lip stumps (see Fig. 6.47). The stumps are mobilized by excising Burow's triangles lateral to the upper lip and chin.

Estlander Flap Lip Reconstruction

Fig. 6.41 Lateral lower lip reconstruction of Estlander (1872). a A three-layer triangular flap is outlined in the upper lip down to the vermilion border, preserving the superior labial artery of the other side. The medial limb of the flap is convexly curved. The lateral limb extends to the commissure roughly along the nasolabial fold. b The Estlander flap is rotated into the defect, bringing the lateral vermilion downward, and sutured in three layers (see Fig. 6.38). Revision of the rounded commissure may be necessary as a secondary procedure (see Figs. 6.24, 6.556.58).

Fig. 6.40 Mobilization of the lip stumps (see Fig. 6.47). The stumps are mobilized by excising Burow's triangles lateral to the upper lip and chin.

Fig. 6.41 Lateral lower lip reconstruction of Estlander (1872). a A three-layer triangular flap is outlined in the upper lip down to the vermilion border, preserving the superior labial artery of the other side. The medial limb of the flap is convexly curved. The lateral limb extends to the commissure roughly along the nasolabial fold. b The Estlander flap is rotated into the defect, bringing the lateral vermilion downward, and sutured in three layers (see Fig. 6.38). Revision of the rounded commissure may be necessary as a secondary procedure (see Figs. 6.24, 6.556.58).

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