Guidelines for Complications of Cancer Treatment Vol VIII Part B

ManagementPrinciples The most important considerations areoAdequate gingivo-labial sulcus creation.o Tight oral commissure.o Bony support to lips (upper and lower alveolus).o Sufficient height of lower lip so that it touches theupper lip or vice – versa. Lower lip has no definitive central structure like philtralcolumn and therefore can donate larger amounts of tissuefor upper lip reconstruction. For the sake of oral continence, muscle restoration inthe upper lip is little less important than it is in the lowerlip because the upper lip functions more like a curtain,while the lower lip functions more like a dam. Surgical reconstruction may leave the lips with reducedsensation and elasticity. Reconstruction techniques thatuse full-thickness nasolabial tissue may also dennervatethe upper lip muscle to a great degree. Patients who havereduction of lip sensation in addition to poor sulcus depthhave tendency to drool. Injury to Sensory/motor innervation of lip- managementinvolves primary repair of the nerve and if required facialreanimation. Extensive resections of the cheek not involving lip –manage by forehead flap or free radial artery forearmflap to give adequate soft tissue replacement with specialconcern for adjusting the angle of the mouth on thediseased side at the same level as that of the normal side. Loss of bony support to lips (upper and lower alveolus)– free fibula osteocutaneous flap is the flap of choice asit provides bony support as well as soft tissue. As the154