Transoral Cross-Lip (Abbé-Estlander) Flap as a Viable and Effective Reconstructive Option in Middle Lower Lip Defect Reconstruction

Abstract

The Abbé-Estlander flap surgery is a cross-lip procedure that is valuable in repairing a defect on the lower lip using a full-thickness flap, consisting of the skin, muscle and mucosa, from the upper lip. As usefulness and practicality of the flap in reconstruction of lower lip surgical defects in Asian ethnicity have not been documented, the authors present a case of successful lower lip reconstruction with a staged, Abbé-Estlander lip switching flap with commissuroplasty as an illustrative example. A 71-year-old male has presented with an ulcerating lip nodule in the middle one third of the lower lip, measuring about 1.5×2 cm across its long and short axes. Wide excision of the tumor was followed by delineation of the triangular Abbé-Estlander flap from the upper lip, in which the medial hinge point of the base was chosen as the pedicle. Then, the flap elevation was carried out from the lateral commissure and then was transferred into the lower lip defect. Three weeks later, commissuroplasty was performed to correct the rounding at the new commissure. The patient is currently performing his daily activities with no apparent compromise in orbicularis oris strength or oral continence. Given the size of the primary defect and the flap-to-defect ratio of size, the degree of microstomia was acceptable. Even with other myriad of reconstructive options at surgeons' disposal, the Abbé-Estlander lip-switching flap is a reliable, and less morbid method of lower lip reconstruction for Asian surgical candidates. The authors illustrate an exemplary case in which a relatively large lower lip defect was successfully repaired using an upper lip flap of a significantly smaller size in an Asian subject of advanced age, without any remarkable long term sequelae which have traditionally been associated with the trans-oral lip switching flap technique.

Anthropometric labial analysis of Han Chinese young adults

“…This region also has highly characterized facial expression function in addition to functions of speaking, eating, and breathing. Labial surgery is performed for reconstruction of congenital malformations, external trauma or tumour resection, and facial aesthetic improvement . Therefore, evaluation of labial morphology has become the basis for both reconstruction and cosmetic surgery.…”

Mucomuscular Elastic Flap for Lower Lip Vermilion Reconstruction: Experience in a Series of Cases in Pediatric Patients

“…Several techniques have been developed over time for labial defect reconstruction, in which the objective is functional and esthetic conservation; however, they often have poor results and present with limitations in oral opening. [3][4][5] Although multistage procedures, such as the Abbe ´-Estlander Flap, have reported good results, 6 patients often prefer 1-time procedures because it reduces the feeling of anxiety regarding the final esthetic result.…”

Lip Repair after Mohs Surgery for Squamous Cell Carcinoma by Bilateral Tissue Expanding Vermillion Myocutaneous Flap (Goldstein Technique Modified by Sawada)

“…Various techniques have been developed over time to improve functionality and esthetics [ 8 ][ 9 ][ 10 ][ 11 ][ 12 ][ 13 ][ 14 ][ 15 ][ 16 ][ 17 ]. Although multiple-step procedures such as the Abbé - Estlander flap can yield good results [ 13 ], single step procedures are favoured by patients. The Karapandzic flap [ 14 ] and the Bernard–Burrow–Webster procedure [ 15 ][ 16 ] are two long-established surgical techniques for lower lip reconstruction.…”