Grimm 1966 and Fries 1971

(Fig. 6.46; unilateral or bilateral)

Bernard (1852) described an operation, repeatedly modified during the past century, for unilateral or bilateral reconstruction of the lower lip. Placing the incisions and Burow's triangles in the lines of the esthetic units yields a very good cosmetic result with acceptable mobility and width of the reconstructed lip. A turnover flap of cheek mucosa (S) is raised to restore the vermilion on the opposing de-epithelial-ized portion of the reconstruction flap (D) (Fig. 6.46a-c). Cutting along the nasolabial folds can give the mouth a froglike appearance, however, and so we prefer to cut from the angle of the mouth to the alar groove (Fig. 6.46c, d; see also Fig. 6.40). Meyer (1962) described a modification of the technique (Fig. 6.47a, b).

Estlander Flap

Fig. 6.44 Modified Estlander flap (Brown 1928; Kazanjian and Converse 1974).

a Large median defect of the lower lip. The lateral lower lip is incised through all three layers. Note the outline of the Estlander flap, which is incised just to the mucosa inferiorly, where a small mucosal flap (S) is raised. b The lateral lip segment is slid medially into the primary defect and sutured in three layers (see Fig. 6.38). D = defect (new vermillion)

Fig. 6.44 Modified Estlander flap (Brown 1928; Kazanjian and Converse 1974).

a Large median defect of the lower lip. The lateral lower lip is incised through all three layers. Note the outline of the Estlander flap, which is incised just to the mucosa inferiorly, where a small mucosal flap (S) is raised. b The lateral lip segment is slid medially into the primary defect and sutured in three layers (see Fig. 6.38). D = defect (new vermillion)

c The lateral lip defect is closed with the Estlander flap (see Fig. 6.41), which is rotated into place. The small vermilion defect is covered with the mucosal flap

(S), d All defects are closed.

e, f Modification preserving the angle of the mouth (left side; Weerda and Härle 1981).

Large Estlander Flap

Fig. 6.45 Unilateral or bilateral Gillies fan flap (1957). a The fan flap is basically a large two-layered Estlander flap that is rotated around the orbicularis oris muscle, if possible maintaining its neurovascular supply (see Fig. 6.29). A large Z-plasty (1 + 2) extends the reach of the flap. If necessary, Burow's triangles are excised to help close the defects. b Appearance after flap transposition and closure of all defects (see Fig. 6.28).

Fig. 6.46 Lower lip reconstruction by the universal method of Bernard (1852), Grimm (1963), and Fries (1971). a For a subtotal defect of the lower lip, the lateral cheek is mobilized by incising the commissure and excising two-layer Burow's triangles lateral to the commissures. A portion of the cheek U-flap is de-epithelialized (D) and resurfaced with a mucosal flap (S) from the cheek. b The tumor has been resected. The cheek U-advancement flap has been raised, on the left side the mucosal flap (S) is raised, and on the right side it has been sutured into place. c The right side has been closed and the left side mobilized. d The completed repair. V

Upper Lip ReconstructionRestore Cheeks Cut

Fig. 6.47 Meyer's modification a The triangles are cut lateral to the upper lip, and the cheek mucosa is incised and mobilized to cover the upper lip defects. Burow's triangles are excised in the cheek skin, turnover flaps of the cheek mucosa (S) are incised to restore the lateral vermilion defects. b The completed repair.

Burow Triangle

Fig. 6.48 Lateral lip reconstruction by the method of Burow and Zisser.

a Burow's triangle after tumor excision. The flap is transposed by cutting a three-layer Burow's triangle lateral to the lower lip. D = depepithelialized area b As in previous reconstructions, a flap of cheek mucosa (S) is used to resurface the de-epithelialized area.

Fig. 6.47 Meyer's modification a The triangles are cut lateral to the upper lip, and the cheek mucosa is incised and mobilized to cover the upper lip defects. Burow's triangles are excised in the cheek skin, turnover flaps of the cheek mucosa (S) are incised to restore the lateral vermilion defects. b The completed repair.

Fig. 6.48 Lateral lip reconstruction by the method of Burow and Zisser.

a Burow's triangle after tumor excision. The flap is transposed by cutting a three-layer Burow's triangle lateral to the lower lip. D = depepithelialized area b As in previous reconstructions, a flap of cheek mucosa (S) is used to resurface the de-epithelialized area.

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