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Head and Neck / CF > Lip Reconstruction > Flashcards

Lip Reconstruction Flashcards

1
Q

What are your options for reconstruction of a vermillion defect

A
  • V-Y mucosa advancement - V-Y vermilion advancement - vermillion switch - bipedicled mucosa advancement tongue flap - FAMM flap - Goldstein vermillion musculocutaneous flap
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2
Q

How do you classify lower lip defect

A

by subunit involved by size by component by thickness

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3
Q

What are your options for reconstruction of a lower lip defect

A

1’ closure with wedge and barrel/burrow triangle

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4
Q

What are your options for reconstruction of lower lip defect up to 1/2

A
  • step ladder advancement - reverse Abbe - Estlander - unilateral Gilles Fan flap - Karapandzic flap - DAO flap
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5
Q

What are your options for reconstruction of a lower lip 2/3 to total defect?

A
  • bilateral Gilles Fan flap - Webster Bernanrd burrow - Fujimori Gate flap (inferior NL flaps) - regional/free
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6
Q

How do you classify upper lip defects?

A

by subunit by size

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7
Q

What are your options for reconstruction of a lateral lip defect

A
  • 1’ closure - perialar crescentric advancement flap - nasolabial flap - A to T closure - Abbe - Reverse Estlander
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8
Q

What are your options for reconstruction of a philtral defect?

A
  • 1’ closure - STSG - Abbe
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9
Q

What are your options for reconstruction of a philtral and lateral defect

A
  • bilateral perialar crescentric flap +/- Abbe - Reverse Karapandzic
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10
Q

What are your options for reconstruction of a philtral and lateral defect >2/3

A
  • bilateral nasolabial fold +/- Abbe - upper lip Webster Bernard Burrow + bipedicled mucosal advancement buccal mucosa
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11
Q

What do you do to reconstruct the commissure

A

rhomboid mucosa flap

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12
Q

What muscles insert onto the modiolus

A

LAO, ZM, O.Oris, Buccinator, risorius Fx: all shift the lateral commisure

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13
Q

What muscles insert onto upper lip

A

LLS LLSan Zm Fx: elevate upper lip

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14
Q

What muscles insert onto lower lip

A

mentalis, DLI, plastysma Fx: depress lower lip, except mentalis ELEVATES lower lip

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15
Q

What is the lymphatic drainage of the upper and lower lips?

A

Upper lip and lateral lower lip -> submandibular Central lower lip: submental basin

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16
Q

What are your goals of lip reconstruction

A

Aesthetics -Skin, lining, vermilion reconstruction Function - sensation - stoma opening (denture) - competence - Buccal sulcus - speech

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17
Q

Describe the FAMM flap

A

facial artery musculomucosal flap Based on facial artey - raise mucosa, submucosa, buccinator, facial artery

18
Q

What are the subunits of the lower lip?

A

chin vermilion white lip

19
Q

Describe a step ladder advancement flap

A

suitable for defect of lower lip up tp 1/2 if width of defect is x, width and height of step is 1/2x Will need 2-4 steps If defect midline, use stairsteps bilateral, if defect lateral, use unilateral step ladder

20
Q

What are indications for a karapandzic flap?

A

Upper lip 1/2 defect Lower lip 2/3 defect

21
Q

Describe a karapandzic flap

A

From the defect, draw falps of equal height extending along NL folds or menton crease - except at commisure, go beyong NLfold/menton to ensure flap is equal width throughout. Width=Height Skin incision then dissect to release O.oris throuhg whole flap but leave mucosa in tact to preserve NV supply (labial arteries)

22
Q

Describe an Estlander flap

A

Used for defects which include commissure Actually a rotation flap, no dissection of pedicle as in Abbe - rotate commissure to meet defect vermilion.

23
Q

Describe a gilles fan flap

A

extension of estlander rotation advancement of white lip adjcant to NL fold No preservation of innervation

24
Q

Describe the DAO flap

A

skin DAO and buccal mucosa is rotated from commisure to midline need neovermilion

25
Q

Describe the bilateral gilles fan flap

A

indicated for 2/3 -total lower lip defect bilateral rotation flaps - no nerve supply to o.oris maintained

26
Q

Describe the webster Bernard Burow

A

Bilateral horizontal advancement flaps, burrow triangles in NL fold and paramental folds - skin and subcut eccision of burow triangles only.

27
Q

Describe the fujimori gate flaps

A

Inferiorly based nasolabial flaps

28
Q

Describe regional flap options for lower lip defect

A

pectoralis, SCM, deltopectoral, fasciocutaneous scalp/temporal flaps

29
Q

Describe free flap options for lower lip recon

A

USed if failed local, hx radiation, composite requiring bone, FOM RFFF +/- PL fibula scapula ALT +/- fascia lata

30
Q

Describe management options for upper lip defects (

A

primary closure A to T Perialar crescentric adv flap Nasolabial flap Abbe flap Reverse estlander

31
Q

Describe management for philtral defect

A

1’ closure STSG abbe

32
Q

Describe options for defects of lateral and philtral less than 2/3

A

bilateral crescentric perialar flaps reverse karapandzic

33
Q

Upper >2/3 defect options

A

need combination abbe and bilateral NL abbe and reverse karapandzic Upper lip webster bernard burrows

34
Q

Whata re reional flap options for recon of upper lip

A

TPF

35
Q

What are options for local flap reocn of cheek defect

A

rhomboid flap transposition flap bilobed flap nasolabial flap V-Y advancement sickle shaped flaps cheek advancement

36
Q

Describe an anteriorly based rotatationadvancement flap

A

Juri and juri flap (based on facial and trasnverse cervical) designed form teh superior edge of defect, along Z arch, preauricular rease, behind ear to follow occipital hairline If insufficient and include neck and chest bu going posterior to trapezius and lateral to AC joint then returnign to chest abouve NAC

37
Q

Describe posteriorly based rotation advancement flap

A

based on STA, perforators from TA and trapexius

38
Q

Describe pectoralis muscle flap

A

type 5 - based on TA pectoral br and perforators from IMA

39
Q

Describe regional flap options for cheek reconstruction

A

pectoralis Deltopectoral trasnverse forehead flap TPF platysma, SCM

40
Q

Describe an abbe flap

A

Based on inferior labial artery or superior labial artey, full thickness flap wedge -

wdith of flap is deisgned to be 1/2 width of defect and height is made to made (except for 2’cleft lip revision where width is designed to be equal

Pedicle should be at the midlin eof the defect when designing

41
Q

what % defect of upper lip and lower lip can you close primarily with a wedge?

A

upper lip 25%

lower lip 30%

Head and Neck / CF (27 decks)

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