title: The hinged mucosal flap. A contour-saving approach to submucosal lesions of the lip.
abstract: BACKGROUND
  A variety of approaches have been described for the removal of lip lesions, but approaches to submucosal lesions are not generally explored as a separate category of problem. A new adaptation of hinged tissue elevation occurred when vermilion mucosa was elevated, a small mucous membrane flap created, and then reapplied over a submucosal lip mass defect.
  
  
  OBJECTIVE
  Presentation of a new application of hinged flaps, using lip mucosa as the flap tissue to be raised and reapplied to the underlying muscularis. The purpose of the technique was to preserve all tissue above the mass, while successfully removing the submucosal lesion.
  
  
  RESULTS
  Application of the hinged mucosal flap concept to the lower lip resulted in complete preservation of the lip contour without invasion of the infravermilion shelf or subjacent chin areas, and without any anterior vermilion invasion.
  
  
  METHODS
  The surgical technique of evolving a hinged mucosal lip flap is described, with multiple photographs demonstrating the serial maneuvers carried out. Surgical intervention resulted in complete obliteration of the benign lesion with essentially no visible scarring and no change in lip contour.
  
  
  CONCLUSIONS
  Utilization of a hinged mucosal flap on the lip for removal of smaller submucosal lesions results in complete preservation of the delicate lip contours without sacrifice of subjacent lip tissue or visible scar beyond the vermilion junction. Further extension of the hinged flap principle to subepidermal exploration and extirpation elsewhere logically follows. Applying the principles of hinged flaps to lip submucosal lesions results in virtually undetectable surgical sequellae.
authors.affiliation: Department of Dermatology (Dermatologic Surgery), University of California, San Francisco, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Field
authors.forename: D
authors.initials: D
authors.lastname: Dassiou-Plakida
mesh_terms: D006801:Humans; D008046:Lip / Q000601:surgery*; D013524:Surgical Flaps / Q000379:methods*