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ORIGINAL ARTICLE
Year : 2018  |  Volume : 37  |  Issue : 1  |  Page : 27-30

Evaluation of near total lower lip reconstruction using mcgregor musculomucocutaneous cheek rotational flap


Department of Plastic Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt

Date of Submission25-Jul-2017
Date of Acceptance27-Sep-2017
Date of Web Publication14-Feb-2018

Correspondence Address:
Waleed Aldabaany
Royal City Towers, Fayoum
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejs.ejs_85_17

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  Abstract 

Introduction The goals of lower lip reconstruction are maintenance of adequate oral stoma, restoration of oral competence, to maintain speech, to preserve sensation, to provide both skin cover and oral lining and to produce an aesthetically satisfying result. A number of local flaps are available for reconstruction of lip defects, although free flaps may also be used for more extensive defects. Local flaps achieve better aesthetic and functional results compared with free flaps. In this study, we evaluate the near total lower lip reconstruction using single-stage McGregor musculomucocutaneous cheek rotational flap.
Aim The aim of this study was to evaluate the near total lower lip reconstruction using McGregor musculomucocutaneous cheek rotational flap.
Patients and methods This prospective study was performed at the Plastic Surgery Unit, Fayoum University Hospital, in the period from October 2015 to April 2017. Eight patients with squamous cell carcinoma at the lower lip excised with safety margin ranging from 0.5 to 1 cm in each side, leaving defects more than 2/3 of the length of the lower lip, were included in this study. Reconstruction was done in all patients using McGregor musculomucocutaneous flap.
Results The mean age of the patients was 61.4 years (range: 55–70 years). Five patients were male and three patients were female. In all patients the angles of the mouth were symmetrical with preservation of the anatomic proportions of the lip, except in two patients there were some mucosal folds at the rotation point at the commissure. In all patients, the philtrum had a normal shape and position. The oral mobility was good in all patients, which was evaluated by facial expressions and sound formations.
Conclusion Although more number of cases are required to build up our conclusion, according to our results on this low number of patients McGregor musculomucocutaneous cheek rotational flap is considered a good option for near total lower lip reconstruction with good functional and aesthetic outcomes.

Keywords: lower lip, McGregor musculomucocutaneous, near total, rotational flap


How to cite this article:
Aldabaany W, Maher S, Abdelhamid AM. Evaluation of near total lower lip reconstruction using mcgregor musculomucocutaneous cheek rotational flap. Egypt J Surg 2018;37:27-30

How to cite this URL:
Aldabaany W, Maher S, Abdelhamid AM. Evaluation of near total lower lip reconstruction using mcgregor musculomucocutaneous cheek rotational flap. Egypt J Surg [serial online] 2018 [cited 2018 Sep 22];37:27-30. Available from: http://www.ejs.eg.net/text.asp?2018/37/1/27/225486




  Introduction Top


The insufficiency of the remained lip tissue causes great difficulty in reconstruction of extensive lower lip defects resulting from the excision of malignant lesions, especially squamous cell carcinoma.

The goals of lower lip reconstruction are maintenance of adequate oral stoma, restoration of oral competence, to maintain speech, to preserve sensation, to provide both skin cover and oral lining and to produce an aesthetically satisfying result [1].

A number of techniques have been described, and the choice depends on the extent of the defect in addition to the surgeon’s experience.

A number of local flaps are available for reconstruction of lip defects, although free flaps may also be used for more extensive defects.

Local flaps achieve better aesthetic and functional results compared with free flaps [2].

In this study, we evaluate the near total lower lip reconstruction using single-stage McGregor musculomucocutaneous cheek rotational flap.


  Patients and methods Top


This prospective study was performed at the Plastic Surgery Unit, Fayoum University Hospital, in the period from October 2015 to April 2017. Ethical approval and patients consents: Were obtained.

Eight patients with squamous cell carcinoma at the lower lip excised with safety margin ranging from 0.5 to 1 cm in each side, leaving defects more than 2/3 of the length of the lower lip, were included in this study.

Reconstruction was done in all patients using McGregor musculomucocutaneous cheek rotational flap, which was based on the superior labial artery running just deep into the mucosa.

Supraomohyoid block neck dissection was performed in five patients.

In all patients, preoperative incisional biopsy was performed to prove the diagnosis. Computed tomography scan neck, chest and abdomen were performed to exclude metastasis.

Surgical technique

The skin is marked in a rectangular fan shape that extends laterally from the defect and around the nasolabial fold where the arc of the fan is completed and back cut is designed.

The width of the rectangular flap is equal to the vertical height of the lip defect and the vertical length of the flap is equal to the width of the defect plus the width of the flap itself.

The flap is based on the superior labial artery running just deep into the mucosa.

From the bottom of the lip defect the incision extended laterally along the full thickness of the flap, upward vertically, medially and then the back cut downward vertically up to few millimetres of the vermilion border of the remaining upper lip. The flap was rotated into place and mucosa, muscle and skin were sutured separately.

The donor site was closed directly and the skin and mucosa of the flap were sutured together to create the new vermilion.

Follow-up periods ranged from 9 months up to 1 year postoperative.


  Results Top


The mean age of the patients was 61.4 years (range: 55–70 years). Five patients were male and three patients were female.

All eight patients had a squamous cell carcinoma at the lower lip excised with safety margin ranging from 0.5 to 1 cm on each side, leaving defects more than 2/3 of the length of the lower lip.

Reconstruction was done in all patients using McGregor musculomucocutaneous cheek rotational flap.

In all patients the flaps survived completely.

No recurrence of the tumour was noticed in the follow-up period in all patients.

The vermilion and vermilion–cutaneous white border were reconstructed and established in all patients with good satisfactory shape.

In all patients the angles of the mouth were symmetrical with preservation of the anatomic proportions of the lip, except in two patients there were some mucosal folds at the rotation point at the commissure.

In all patients the philtrum had a normal shape and position.

The oral mobility was good in all patients, which was evaluated by facial expressions and sound formations.

In all patients there was no microstomia with an adequate oral access.

The oral continence to food, fluids and air was good in all patients.

The patients’ satisfaction ranged from 60 to 100%: in three patients it was from 60 to 80%, and in five patients it was from 80 to 100% ([Figure 1] and [Figure 2]).
Figure 1 (a) Preoperative picture of squamous cell carcinoma at the lower lip; (b) intraoperative picture of the defect; (c) flap inset to the defect; (d) 6 months postoperative picture.

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Figure 2 (a) Preoperative picture of squamous cell carcinoma at the lower lip; (b) intraoperative picture of the defect; (c) 6 months postoperative picture; (d) 6 months postoperative picture.

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  Discussion Top


Many surgical techniques for reconstruction of the extensive lower lip defects have been described, each of them having its own advantages and disadvantages. Most of these techniques restore lip continuity, but compromise mouth opening (cause microstomia) or sphincter function, or cause significant perioral scarring and poor aesthetic outcome [3].

The local flaps that are used for extensive lower lip defects (>two-thirds) are mainly Karapandzic flap, the Gillies fan flap, McGregor and Nakajima flap and the Webster–Bernard flap.

The Karapandzic flap can achieve a functional lip with preserved competence and sensation, but results in narrowing of the mouth especially when reconstructing large defects and necessitating another setting of commissuroplasty [4].

The Gillies fan flap is another option to reconstruct massive lower lip defect, but the angle of the mouth is distorted and the lower lip is shortened [5].

The Webster–Bernard procedure can produce good lip reconstruction but involves a large amount of perioral tissue loss, resulting in a tight lower lip and significant perioral scarring with contour deformity [6].

The Fujimori nasolabial ‘gate flaps’ can achieve lip reconstruction with good functional and cosmetic results, but retouch operations are often necessary [7].Free flaps are suitable for reconstruction of the total lower lip owing to more soft tissue availability; however, there is risk of donor site morbidity, and the operative time is longer and the aesthetic appearance is less satisfactory because the flaps lack the harmony of the face. Furthermore, it is difficult to create a functional oral sphincter leading to oral incompetence [8].

In this study, we evaluated the functional and the aesthetic outcome of the McGregor musculomucocutaneous cheek rotational flap, which is a rectangular modification of the Gillis fan flap.

In all patients the flaps survived completely. The vermilion and vermilion–cutaneous white border were reconstructed and established in all patients with good satisfactory shape.

In all patients the angles of the mouth were symmetrical with preservation of the anatomic proportions of the lip, except in two patients there were some mucosal folds at the rotation point at the commissure.

In all patients the philtrum had a normal shape and position. The oral mobility was good in all patients, which was evaluated by facial expressions and sound formations.

In all patients there was no microstomia with an adequate oral access.

The oral continence to food, fluids and air was good in all patients.

The patient satisfaction ranged from 60 to 100%: for three patients it was from 60 to 80% and for five patients it was from 80 to 100%.


  Conclusion Top


Although more number of cases are required to build up our conclusion, according to our results on this low number of patients McGregor musculomucocutaneous cheek rotational flap is considered a good option for near total lower lip reconstruction with good functional and aesthetic outcome.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sandipan G, Debarati CH, Marang BM, Souradip G, Hari SS. A new technique for one-stage total lower lip reconstruction: achieving the perfect balance. Can J Plast Surg 2013; 21:57–61.  Back to cited text no. 1
    
2.
Gökçe T, Görkem E. The management, current treatment modalities and reconstruction techniques for lip cancer. Turk Arch Otolaryngol 2014; 52:22–32.  Back to cited text no. 2
    
3.
Uzunov NG, Trifonov M, Sarachev EL. Total and subtotal lower lip reconstruction using modified Webster’s cheek advancement flaps after cancer resection. Trakia J Sci 2008; 6:220–224.  Back to cited text no. 3
    
4.
Karapandzic M. Reconstruction of lip defects by local arterial flaps. Br J Plast Surg 1974; 27:93–97.  Back to cited text no. 4
    
5.
Jackson IT. Local flaps in head and neck reconstruction. St Louis: CV Mosby; 1985. 398.  Back to cited text no. 5
    
6.
Webster RC, Coffey RJ, Kelleher RE. Total and partial reconstruction of the lower lip with innervated muscle bearing flaps. Plast Reconstr Surg 1960; 25:360–371.  Back to cited text no. 6
    
7.
Shehab El-Din SA. Lower lip reconstruction with Fujimori gate flaps. Egypt J Plast Reconstr Surg 2003; 27:319–324.  Back to cited text no. 7
    
8.
Jeng SF, Kuo YR, Wei FC, Su CY, Chien CY. Total lower lip reconstruction with a composite radial forearm-palmarislongus tendon flap: a clinical series. Plast Reconstr Surg 2004; 113:19–23.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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Introduction
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