title: Staged sequential reconstruction of a total lower lip, chin, and anterior mandibular defect.
abstract: The combination of a total lower lip, chin, and anterior mandibular defect following cancer resection is an extremely complex problem that requires a sequence of operations to optimize functional and aesthetic results. One patient is presented in whom the defect was reconstructed with a free fibular flap followed by a series of ancillary procedures using both modern and traditional techniques. At the time of tumor ablation, the through-and-through oromandibular defect was reconstructed with a fibular osteocutaneous flap. The lower lip and gingivolabial sulcus was reconstructed later with a tongue flap. Tissue expansion was subsequently used to replace the fibular skin with expanded submental hair-bearing skin. A polyethylene implant was added later to the fibular bone for chin augmentation. Subsequently the lower lip was supported with a tendinous graft suspended to the anterior masseter bilaterally. Lastly, the vermilion border was elevated by removing a rim of the tongue flap and covering the secondary wound with a full-thickness skin graft. At the end of the reconstructive procedures, lip seal and oral aperture were good with no drooling and excellent speech.
authors.affiliation: Department of Surgery, University of Arkansas for Medical Sciences, Little Rock 72205-7199, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Yuen
authors.forename: A
authors.initials: A
authors.lastname: Zhou
authors.forename: K
authors.initials: K
authors.lastname: Shewmake
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002680:Chin / Q000601:surgery; D006801:Humans; D008048:Lip Neoplasms / Q000601:surgery*; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D019930:Mandibular Prosthesis Implantation; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D015626:Tissue Expansion