title: Total and near-total lower lip reconstruction: 20 years experience.
abstract: BACKGROUND
  Reconstruction of total and near-total lower lip defects presents a formidable challenge for the reconstructive plastic surgeon. Many methods have been described, and each has its own advantages and disadvantages. The aim of this article is to discuss the selection of techniques and report our experience of total or near-total lower lip reconstruction.
  
  
  METHODS
  Over a 20-year period from January 1993 to December 2013, a total of 87 patients underwent total or near-total lower lip reconstruction. Bilateral Yu's flaps were used in 61 patients, double mental neurovascular V-Y island advancement flaps in 16 patients, bilateral Mutaf's techniques in 4 patients, and reconstruction with free radial forearm flaps in 6 other patients. Drooling Rating Scale (DRS) and Patient and Observer Scar Assessment Scale (POSAS) were used to evaluate oral competency and esthetic outcomes.
  
  
  RESULTS
  All patients underwent single-stage total or near-total lower lip reconstruction successfully. There were no flap failures. Only 1 patient who accepted the bilateral Yu's flaps developed microstomia, having difficulty in wearing her dentures postoperatively. Oral competencies were well preserved in other patients, and esthetic results were satisfactory.
  
  
  CONCLUSIONS
  Based on our experience, we recommend using the bilateral local techniques or free flap introduced in this article, according to the extent of defects and the patient's general condition, to achieve a personalized ideal reconstruction of the lower lip.
authors.affiliation: Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China; Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China. Electronic address: cmubaishuang@hotmail.com.
authors.forename: Shuang
authors.initials: S
authors.lastname: Bai
authors.affiliation: Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China; Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China.
authors.forename: Rui-Wu
authors.initials: RW
authors.lastname: Li
authors.affiliation: Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China; Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China.
authors.forename: Zhong-Fei
authors.initials: ZF
authors.lastname: Xu
authors.affiliation: Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China; Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China.
authors.forename: Wei-Yi
authors.initials: WY
authors.lastname: Duan
authors.affiliation: Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China; Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China.
authors.forename: Fa-Yu
authors.initials: FY
authors.lastname: Liu
authors.affiliation: Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China; Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China. Electronic address: changfusun@hotmail.com.
authors.forename: Chang-Fu
authors.initials: CF
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003528:Carcinoma, Adenoid Cystic / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002921:Cicatrix / Q000209:etiology; D004954:Esthetics; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation; D006801:Humans; D008046:Lip / Q000502:physiology / Q000601:surgery*; D008048:Lip Neoplasms / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008865:Microstomia / Q000209:etiology; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012798:Sialorrhea / Q000209:etiology; D013524:Surgical Flaps / Q000145:classification / Q000637:transplantation
keywords: Algorithm; Functional outcome; Lip reconstruction