Lip Cancer: Treatment & Reconstruction
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1 Lip Cancer: Treatment & Reconstruction GBMC - Head & Neck Cancer Grand Rounds Elizabeth E. Redd, M.D. With the assistance of Ira Papel, M.D. Patrick Byrne, M.D.
2 Lip Cancer: Treatment & Reconstruction Anatomic considerations Pathology & Staging Behavior & Prognosis Resection & Reconstruction Techniques
3 Lip Cancer: Treatment & Reconstruction 56 male, caucasian, nonsmoker, carpenter Non-healing ulcer, 2 mos Steriod treatment T1N0M0 SCCa Excised 5mm margins 2.4cm specimen (7cm lip) Closed primarily
4 Anatomic Considerations Facial artery superior & inferior labial branches Cranial Nerve V Infraorbital and mental nerves
5 Anatomic Considerations Buccal & marginal branches of CNVII Sphincteric muscles & Dilator muscles
6 Anatomic Considerations Aesthetic Subunits, mental labial sulcus White line & vermilion Functional Oral competence Communication of emotion Deglutition Speech labial sounds: b, m, w, p Labial-dental sounds: f, v
7 Pathology Squamous Cell Carcinomas 95% on Red lip (95%) 90% on Lower lip versus 10% on Upper lip Exophytic more common than ulcerative Minor Salivary gland tumors Adenoid cystic, adenocarcinoma, mucoepidermoid Basal Cell Usually on cutaneous white upper lip
8 Staging Tx - Primary can not be assessed T0 - No evidence of primary Tis - Carcinoma in situ T1 - Tumor 2 cm or less in greatest dimension T2 - Tumor > 2cm but < 4cm in greatest dimension T3 - Tumor more than 4 cm in greatest dimension T4 - Tumor invades adjacent structures, e.g., cortical bone, tongue, skin of neck
9 Behavior & Prognosis Lips 25% of all oral cavity carcinomas 1.8/100,000 (upper lip 2-8%, commissure 1%) Cervical metastases initial presentation: lower lip 10% - submental nodes upper lip - preauricular, periparotid nodes commissure 20% - submandibular nodes Surgical treatment, 0.5 cm margins Favorable prognosis 85-90% 5 yr DFS Radiation Tx in patients with high surgical risk
10 Lower Lip Reconstruction
11 Wedge Excision & Primary Closure < 1/2 lip Upper or lower V-plasty M-plasty larger lesion wider inferior margin
12 Wedge Excision & Primary Closure Improve vermilion-cutaneous matching with angulation of lateral incision border
13 Wedge Excision & Primary Closure Simple full-thickness excision excellent oral opening Hint: Mark vermillion border
14 Karapandzic Flap 1/2 to 2/3 Central Lower lip
15 Karapandzic Flap - technique Incise skin and mucosa Preserve branches CN V & VII labial arteries muscles if possible
16 Karapandzic Flap - intra-op
17 Karapandzic Flap - post-op Mild microstomia, but acceptable results
18 Bernard-von Burrow Flap 2/3 of lip Adequate adjacent cheek tissue Midline defect
19 Bernard-von Burrow Flap Webster Modification Webster modification: mucosa is advanced to create new lower lip vermillion
20 Bernard-von Burrow Flap Webster Modification - intra-op 2/3 of lip 4 cm of lip removed on this patient
21 Bernard-von Burrow Flap Webster Modification - post-op
22 Nasolabial transpositional flaps 2/3 of lip Upper or lower lip Lateral defect Adequate adjacent cheek tissue Full or partial thickness
23 Gilles Fan Flap (Nasolabial transpositional flaps)
24 Nasolabial transpositional flaps 2/3 of lip
25 Nasolabial transpositional flaps
26 Upper Lip Reconstruction
27 Abbe Flap 1/2-2/3 of upper or lower lip Commissure not involved
28 Abbe Flap 1/2-2/3 of upper or lower lip
29 Abbe Flap 1/2-2/3 of upper or lower lip
30 Estlander Flap 1/2-2/3 of upper or lower lip Commissure involved
31 Modified Burrow Technique 2/3 of upper lip, midline defect Adequate adjacent cheek tissue
32 Modified Burrow Technique 2/3 of upper lip, midline defect Adequate adjacent cheek tissue
33 Modified Burrow Technique Mild microstomia Loss of cupid s bow
34 Thanks! Dr. Ira Papel, M.D. Faculty, Johns Hopkins University Otolaryngology-H&N Surgery Facial Plastics and Reconstructive Surgery Dr. Patrick Byrne, M.D. Assistant Professor, Johns Hopkins University Otolaryngology-H&N Surgery Facial Plastics and Reconstructive Surgery
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