Elegance in Upper Lip Reconstruction

Abstract

Summary: Restoration of the upper lip provides a reconstructive challenge because of its anatomical and aesthetic requirements. This article provides a “where is it on the lip” approach to reconstruct small to subtotal defects of the upper lip that are feasible to perform in the office setting. Emphasis is placed on adherence to core principles, attention to macroaesthetic and microaesthetic landmarks, and technical refinements of well-established reconstructive techniques. These tenets include algorithms for central and lateral defects, precise use of the Abbe flap, use of local tissue rearrangement and skin grafts, and appropriate management of scars. A strong understanding of the anatomical and aesthetic nuances of the upper lip will allow for enhancement of conventional reconstructive procedures to optimize functional and aesthetic outcomes.

Revisional Techniques for Secondary Cleft Lip Deformities

“…7,42 This flap is useful for correction of both unilateral and bilateral cleft lip secondary deformities, but it is mostly employed in the latter. 43 The flap is designed in the central lower lip, with a length intended to reconstruct the entire philtral unit. Its width is also designed narrower than the defect in anticipation of future widening after inset and to facilitate easier closure of the donor site.…”

“…Its width is also designed narrower than the defect in anticipation of future widening after inset and to facilitate easier closure of the donor site. 7,43,44 During flap dissection, effort should be made to preserve one side of the labial artery, which is found at the level of the white roll. However, it has been reported that ample mucosa alone (11 mm) can preserve the pedicled flap.…”

“…However, it has been reported that ample mucosa alone (11 mm) can preserve the pedicled flap. 42,43,45 For proper inset, continuity must be attained at the level of the skin, vermillion, muscle, and mucosa. The amount of wet vermillion used from the lower lip depends on the level of deficiency in the upper lip.…”

“…44 A winged Abbe flap may be used in cases with extremely deficient vermillion. 43 Neophiltral columns are reconstructed by the cutaneous scars after inset. Finally, closure of the donor site is performed in a straight-line fashion or a sublabial Z-plasty to avoid scar tethering.…”

Versatilidad del colgajo Estlander en reconstrucción de labio

“…Las columnas filtrares con frecuencia cuentan con depresor septal en la base medial. 9 El origen de la arteria labial superior se localiza al mismo nivel superior de la comisura labial y se origina de la arteria facial. 10 Los objetivos funcionales de la reconstrucción labial incluyen el mantenimiento de la competencia oral, el acceso oral suficiente y la preservación de la sensación labial.…”