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Lower lip defects are a major challenge from a reconstructive perspective. The lower lip is an anatomical region formed by different types of tissue, and it is essential to obtain adequate functional and aesthetic results. When local tissue is available to be a donor area, it becomes the best option to repair the defect. This article's purpose is to present our experience in reconstruction of partial or transfixing total defects of the lower lip with the musculocutaneous flap of the depressor anguli oris described by Yotsuyanagi.

The aim of this study is to investigate the association between hydrochlorothiazide (HCTZ) use and the risk of cutaneous and lip squamous cell carcinoma development.We performed a systematic review and meta-analysis of case-control studies. We searched the Cochrane Library, PubMed, Scopus, Web of Science and LILACS. This study was registered in PROSPERO under protocol CRD42019129710. The meta-analysis was performed using the software Stata (version 12.0).A total of 2181 published studies referring to the theme were identified, from which six were included in this systematic review. Men were more frequently affected by cutaneous and lip squamous cell carcinoma than women, with a 1.42:1 ratio. The mean age for cutaneous and lip squamous cell carcinoma development was 73.7 years. This meta-analysis demonstrated a chance of developing cutaneous and lip squamous cell carcinoma in any region of the body in hydrochlorothiazide users of 1.76-fold higher than in non-users. In addition, a risk factor of 1.80 higher (CI 95% = 1.71-1.89) of cutaneous squamous cell carcinoma in the head and neck region was observed in HCTZ users. Moreover, in the analysis of the dose used, the chance of developing squamous cell carcinoma was 3.37-fold lower when the concentration of HCTZ used was less than 50,000 mg.Our results confirm the association between the use of hydrochlorothiazide and the cutaneous and lip squamous cell carcinoma development.

New prevention strategies have been advocated to control the progression of HIV/AIDS, such as preexposure prophylaxis (PrEP). The aim of this study is to evaluate the potential changes in the oral and salivary conditions of HIV-uninfected subjects using PrEP. Subjects were evaluated before beginning the medication (T0), at the first follow-up (T1), and at the second follow-up (T2). Xerostomia, presence of untreated cavitated caries, oral hygiene habits, taste, gingival and plaque index, stimulated salivary flow rate (SSFR), and salivary concentrations of calcium, glucose, urea, and total proteins were evaluated. Data obtained were analyzed using statistical tests (p0.05), except for the salivary calcium concentration, that increased at T2 compared to T1 (p=0.02). There was significant difference between taste and xerostomia at T1 (p=0.017), and the need to drink to swallow at T2 (p=0.015). There was significant correlation between the reported amount of saliva and taste (p=0.039, r=-0.378) at T1. The prolonged use of PrEP seems to be associated with reports of dry mouth and worsening of taste, possibly associated with increased salivary calcium concentration.

BACKGROUND Total or near-total lip defects poses a serious challenge to a reconstructive surgeon with static procedures not providing desired functional and aesthetic outcomes. The dynamic lip reconstructive methods using functional muscles have become a current issue in recent years showing admirable results. This study present 3 cases of successful total and near-total lip reconstruction are presented using vastus lateralis muscle. METHODS This is a retrospective analysis of a consecutive series of 3 patients (2 men and 1 woman) aged 44 to 56 years (mean) who had resection of extensive squamous cell carcinoma 2 had both upper and lower lip involved and 1 had lower lip involvement only. After resection patients had near total full thickness lower lip defect and 40% upper lip defect. The innervated vastus lateralis muscle free flap was transferred to the lip and end-to-end vascular anastomosis on the facial artery and end-to-side to internal jaguar vein was performed. The marginal mandibular branch of the facial nerve was used for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a thick-split-thickness skin graft. Drooling rating scale and patient and observer scar assessment scale as well as electromyography were performed to evaluate oral competency and aesthetic outcome. RESULTS All patients underwent single stage near-total lower lip and 2 had part of upper lip reconstruction successfully and survived the surgical operation. One patient lost the skin graft and was managed consecutively and muscle granulated and healed. Two patients underwent radiation therapy and 1 died before starting radiation due to other unnatural causes. The 2 patients achieved perfect oral sphincter competence without drooling and at 9 months postoperative demonstrated successful reinnervation of the vastus lateralis muscle. CONCLUSIONS This study demonstrates that lip reconstruction using an innervated vastus lateralis muscle free flap is a reliable method, providing a functional lip.

Infantile hemangiomas are the most common benign childhood tumors and can occur on any part of the human body. Sclerosing agents are used in the early stage of treatment of infantile hemangioma. Sometimes a lip defect remains after sclerosing agent treatment. We developed a simple technique to repair lip defects. The authors performed transposition mucosal flap and autologous fat transplantation surgery on patients who had lip defects caused by sclerosing agents. The flap was transposed 90° from the intraoral labial mucosa to the vermilion defect. Autologous fat was transplanted to the white lip defect. If necessary, a secondary fat transplantation may be performed every half year. All patients were followed up to evaluate the effect of the operation. Patients were asked to rate their satisfaction with the surgery between 1 and 10. Digital three-dimensional evaluation was performed. Sixteen patients underwent the surgery successfully, and the flaps were all viable. No complications occurred after surgery (5 males, 11 females; age range, 5-27 years; 12 upper lip, 3 lower lip, and 1 median lip). The patients were satisfied with the aesthetic outcome of surgery (mean score, 9). Seven patients wanted to undergo a second fat transplantation, whereas 9 patients felt it was unnecessary to transplant fat again. Transposition mucosal flap combined with autologous fat transplantation is reliable and minimally invasive. It is an effective method for repairing moderate lip defects mainly involving vermilion caused by a sclerosing agent.

Mutation signatures represent unique sequence footprints of somatic mutations resulting from specific DNA mutagenic and repair processes; however, their causal associations and potential utility for genome research remain largely unknown. In this study, we performed PanCancer-scale correlative analyses to identify the genomic features associated with tumor mutation burdens (TMB) and individual mutation signatures. We observed that TMB was correlated with tumor purity, ploidy, and the level of aneuploidy, as well as with the expression of cell proliferation-related genes representing genomic covariates in evaluating TMB. Correlative analyses of mutation signature levels with genes belonging to DNA damage-repair processes revealed that deficiencies of NHEJ1 and ALKBH3 may elevate TMB levels in cancer genomes accompanying APOBEC overactivity and DNA mismatch repair deficiency, respectively. We further employed a strategy to identify feature-driven, de novo mutation signatures and demonstrated they can be reconstructed using known causal features such as APOBEC overexpression, MLH1 underexpression, POLE mutations, and the level of homologous recombination deficiency. We further demonstrated, that tumor hypoxia-related mutation signatures are similar to those associated with APOBEC suggesting that APOBEC-related mutagenic activity mediates hypoxia-related mutational consequences in cancer genomes, and also, that mutation signatures can be further used to predict hypoxic tumors. Taken together, our study advances mutation signature-level mechanistic insights in cancer genomes, extending categories of cancer-relevant mutation signatures and their potential biological implications.Author summaryMutation signature analysis is powerful in deciphering the causative mutagenic events and their contributions in individual cancer genomes, but the causal relationship of individual mutation signatures are still largely unknown. PanCancer-scaled correlative analysis revealed mutation resource candidates in cancer genomes such as NHEJ1 and ALKBH3 deficiencies that may facilitate the accumulation of mutations in the setting of APOBEC overactivity and DNA mismatch repair deficiency, respectively. A feature-driven mutation discovery approach was employed to identify the mutation signatures representing homologous recombination deficiency and tumor hypoxia, the extent of which may serve as mutation-based phenotypic measures, previously estimated by DNA copy number alterations and mRNA expression signatures, respectively. Our study advances our understanding into the mechanistic insights of mutation signatures and proposes a method to utilize somatic mutations as a molecular proxy in terms of mutation signatures.

Defects to the lower lip remain surgically challenging to reconstruct. Restoration of aesthetics and function are crucial, of which the aims include restoring the tissues of the lower lip, maintaining oral competence, speech articulation, and restoring lip height and the vermillion. Further surgical techniques continue to be explored, with local flap surgery being the generally preferred method. However, many reconstructions leave the patient with pronounced deformity and morbidity. In this case report, we describe a new technique for the reconstruction of an 80% lower lip defect with an ipsilateral split zygomaticus major muscle sling, nasolabial flap, and facial artery musculomucosal flap. The reconstruction provided good oral competence, speech articulation and aesthetics, in addition to maintaining the oral commissure and lower lip height/length. Iatrogenic microstomia was avoided and zygomaticus functioning was normal. We are confident this technique will be useful to reconstructive surgeons in select cases of significant lip defects.

Lower lip cancer is typically treated with surgical excision, and this frequently results in a large defect and severe aesthetic problems. Local flap reconstruction is suitable for restoring appearance and function, and it causes less surgical stress than a vascularized free flap. The Fusuma sliding flap is a local flap technique introduced by Kasai et al in 2008. Here, the authors report their use of this method for lip reconstruction in a 94-year-old Japanese female after the removal of a cancerous mass.

Data sources Data was from The Health Improvement Network (THIN) database from January 1999 to May 2016.Study selection This was a series of population-based, case-control studies looking to evaluate the association between hydrochlorothiazide (HCTZ) exposure and skin, lip and oral cancer in the UK population.Case/control selection Using the THIN database, patients with the following outcomes were grouped: squamous cell carcinoma (SCC) skin cancer; basal cell carcinoma (BCC) skin cancer; melanoma; lip cancer and oral cancer. Patients within the lip cancer and oral cancer groups were accepted with a history of non-melanoma skin cancer (NMSC). Patients in the SCC and BCC groups were not accepted with a history of cancer. Patients with a history of organ transplantation, human immunodeficiency virus (HIV) or immunosuppressant drug use before the index date were not accepted, due to the risk of predisposition to cancer. Controls were randomly selected using incidence density sampling. Up to 100 controls were randomly selected, matched on sex, exact year of birth and calendar year of cohort entry for lip cancer. However, for the remaining outcomes, only 20 controls were matched as above. Adults with incident NMSC, melanoma, lip cancer and oral cancer were matched to controls. Incidence rate ratios (IRRs) for the aforementioned outcomes were calculated for every cumulative HCTZ exposure.Data analysis Odds ratios were calculated using conditional logistic regression. Associations were presented using a two-year HCTZ exposure lag-time and a five-year HCTZ exposure lag-time. Associations were evaluated using sensitivity analysis, restricted to patients with at least ten years' follow-up. There was adjustment for smoking status and BMI. Published incidence rates were used to calculate the absolute risk estimate for SCC as the incidence of SCC in the cohort was less than expected. For high-dose cumulative HCTZ exposure, the number of patients needed to treat to cause one additional cancer (number needed to harm) per year overall was estimated using rate differences. Analysis was carried out using SAS Enterprise Guidev7.1 and STATAv15.Results Relative incidence of SCC, BCC and lip cancer was significantly elevated with every use of HCTZ. Relative incidence of melanoma and oral cancer was not significantly elevated with HCTZ exposure. Smoking was inversely associated with BCC and melanoma risk, but significantly increased the risk of lip and oral cavity cancers. SCC risk was not strongly associated with smoking. Significantly reduced risk of SCC, BCC melanoma and oral cavity cancer was associated with a BMI ≥30 kg/m2.Conclusions The risk of NMSC and lip cancer in a UK population is increased with cumulative high-dose HCTZ exposure. It is therefore important for dentists to note as it may increase suspicion of lesions in patients taking these medications.

Actinic cheilitis (AC) is a chronic condition that affects mainly the lower lip. To investigate the use of lip photopro-tection in patients with AC. A cross-sectional multicentre study of patients, =45 years of age, was performed in eight dermatology departments in the Galicia region over a period of one year. From 1,239 patients included in the study, 410 were diagnosed with AC and complete data were available for 408. An analysis of lip photopro-tection habits and possible associations in patients with AC is reported. Mean age of patients with AC was 71.9 years and 53.8% were women. More than 90% of AC patients (370/408) had never used lip photoprotection. In the group of patients who used it, 62.16% of them had only used a single stick within the previous year. The only variable significantly associated with the use of lip sun protection was low Fitzpatrick’s skin types I and II (p=0.039). Study limitations include the inclusion of patients 45 years or older and the use of a semiquantitative scale for measuring the frequency of application of lip photoprotection. To our knowledge, this is the first European study focused on lip photoprotection in patients suffering from AC. Only a minority of AC patients protect their lips from UV radiation. Specific lip sun protection recommendations should be promoted, especially in high-risk populations.

Background The goal of this study was to establish and validate two nomograms for predicting the long‐term overall survival (OS) and cancer‐specific survival (CSS) in lip squamous cell carcinoma (LSCC). Methods This study selected 4175 patients who were diagnosed with LSCC between 2004 and 2015 in the SEER (Surveillance, Epidemiology, and End Results) database. The patients were allocated randomly to a training cohort and validation cohort. Variables were selected using a backward stepwise method in a Cox regression model. Based on the predictive model with the identified prognostic factors, nomograms were established to predict the 3‐, 5‐, and 8‐year survival OS and CSS rates of LSCC patients. The accuracy of the nomograms was evaluated based on the consistency index (C‐index), while their prediction accuracy was evaluated using calibration plots. Decision curve analyses (DCAs) were used to evaluate the performance of our survival model. Results The multivariate analyses demonstrated that age at diagnosis, marital status, sex, race, American Joint Committee on Cancer stage, surgery status, and radiotherapy status were risk factors for both OS and CSS. The C‐index, area under the time‐dependent receiver operating characteristic curve, and calibration plots demonstrated the good performance of the nomograms. DCAs of both nomograms further showed that they exhibited good 3‐, 5‐, and 8‐year net benefits. Conclusions We have developed and validated LSCC prognosis nomograms for OS and CSS for the first time. These nomograms can be valuable tools for clinical practice when clinicians are helping patients to understand their survival risk for the next 3, 5, and 8 years.

Background: Radiotherapy is a valuable therapeutic option for the treatment of non-melanoma skin cancer (NMSC) in the ageing population, in non-surgical candidates, or when the tumor is extensive o...

Objectives Programmed death ligand-1 (PD-L1) and human leukocyte antigen-G (HLA-G) are considered immune checkpoint molecules that inhibit T-cell effectiveness, contributing to tumor immune escape. This study investigated PD-L1, HLA-G, CD8, and granzyme B (GrB) expression at different stages of lip carcinogenesis. Design and results Forty cases of lip squamous cell carcinoma (LSCC), 55 actinic cheilitis (AC), and 10 healthy lip mucosa (HLM) were submitted to immunohistochemistry. Semiquantitative (PD-L1, HLA-G), and quantitative (CD8, GrB) analysis were performed. PD-L1 and HLA-G expression in neoplastic cells/keratinocytes and stroma/connective tissue was significantly higher in LSCC and AC, compared to HLM (p 0.05). PD-L1 was not associated with clinicopathological features of the lesions. HLA-G expression by malignant cells was significantly higher in LSCCs with distant metastasis (p = 0.041).CD8+ and GrB+ cell numbers progressively increased from HLMs to LSCC, with AC exhibiting intermediate numbers (p 0.01). Most LSCCs showed coexistence of PD-L1+ and CD8+ cells (72.5%). PD-L1 was directly correlated to CD8+ and GrB+ lymphocytic infiltration in LSCCs (p 0.05). Low cytotoxic immune response was associated with lymph node metastasis in LSCC (p 0.05). Conclusions PD-L1 and HLA-G-mediated immune evasion mechanisms are likely to occur from early pre-malignant to advanced malignant stages of lip carcinogenesis, which might provide a rationale for therapeutic blockade of these pathways. PD-L1 expression in LSCCs was correlated with the cytotoxic markers, suggesting that PD-L1 may appear as an escape mechanism in response to an active antitumor response.

Cancers of the lips and oral cavity are a leading cause of death worldwide. Although they account for only 2% of the global cancer burden, they significantly affect the comfort of patients and eventually lead to a person's death. Also, defects in the cellular stress response and apoptosis mechanisms regulated by p53 activity is an important hallmark of cancer cells. Here, we aimed to decipher miRNAs associated with cellular stress response and apoptosis mechanisms regulated by p53 activity in patient with lower lip cancer and reveal the association of these miRNAs with the clinical course of the disease. The present research included a total of 40 eligible individuals with pathologically confirmed lower lip cancer diagnosis. Formalin-fixed, paraffin-embedded (FFPE) tissue samples of patients were obtained, and miRNAs expressions were analyzed by qPCR. Immunohistochemistry was used to determine p53 and Ki67 expression status. While three of these miRNAs (miR-130a, -375, and -128a) were found to be elevated in tumor cells compared to normal tissues of lower lip cancer patients, five were downregulated (let-7a, -7b, -7c, and miR-138, -23a), but only three were significantly altered. Particularly, we identified three miRNA signatures in which miR-128a was significantly upregulated and miR-23a and let-7c were significantly downregulated in patients with lower lip cancer. Remarkably, let-7c identified to be a promising prognostic factor for lip cancer. Our findings demonstrate that these miRNAs play important regulatory roles in lower lip cancer pathobiology, highlighting their potential relevance in diagnosis and prognosis of these patients. Moreover, these miRNAs can be targeted in future therapeutic interventions against lower lip cancer.

The incidence of oral cavity squamous cell carcinoma (OSCC) is particularly high in South Asia. According to the National Comprehensive Cancer Network, OSCC can arise in several subsites. We investigated survival rates and the clinical and pathological characteristics of OSCC in different anatomical subsites in the Taiwanese population. We retrospectively analyzed data for 3010 patients with OSCC treated at the Changhua Christian Hospital. Subsequently, we compared clinical and pathological features of OSCC in different subsites. Pathological T4 stage OSCCs occurred in the alveolar ridge and retromolar trigone in 56.4% and 43.7% of cases, respectively. More than 25% of patients with tongue OSCC and 23.4% of those with retromolar OSCC had lymph node metastasis. The prognosis was worst for hard palate OSCC (hazard ratio 1.848; p p = 0.017). Retromolar OSCC recurred most often and tongue OSCC second most often. The risk for cancer-related mortality was highest for hard palate OSCC, followed by alveolar ridge and retromolar OSCC. We found distinct differences in survival among the different subsites of OSCC. Our findings may also help prompt future investigations of OSCC in different subsites in Taiwanese patients.

Resumen El leiomioma vascular (LV) es un tumor benigno de tejido blando que rara vez se observa en los tejidos orales. El objetivo de este trabajo es presentar un nuevo caso de leiomioma vascular del labio (VLL), describiendo sus características clínicas, microscópicas e inmunohistoquímicas, y revisar la literatura sobre el tumor. Una mujer de 27 años presentó una pequeña lesión dolorosa en la mucosa del labio inferior. La biopsia escisional reveló una masa encapsulada bien circunscrita formada por células pequeñas y fusiformes. El análisis de inmunohistoquímica reveló una expresión intensa y difusa de actina del músculo liso (AME) dentro de las células tumorales y la inmunorreactividad CD34 de las células endoteliales que recubren los espacios vasculares, lo que indica la presencia de vasos sanguíneos. Se estableció un diagnóstico final de VLL. No se observaron signos de recurrencia después de cinco años de seguimiento. Aunque VLL es una lesión rara, debe considerarse en el diagnóstico diferencial de las lesiones nodulares en los labios inferior y superior. Abstract Vascular Leiomyoma (VL) is a benign soft tissue tumor rarely observed in oral tissues. The aim of this paper is to present a new case of vascular leiomyoma of the lip (VLL), describing its clinical, microscopical, and immunohistochemical features, and review the literature on the tumor. A 27-year-old woman presented with a small painful lesion on lower lip mucosa. Excisional biopsy revealed a well-circumscribed, encapsulated mass formed by small and fusiform cells. Immunohistochemistry analysis revealed intense and diffuse expression of smooth muscle actin (SMA) within the tumor cells and CD34 immunoreactivity of the endothelial cells lining the vascular spaces, indicating the presence of blood vessels. A final diagnosis of VLL was established. No signs of recurrence were observed after five years of follow-up. Although VLL is a rare lesion, it must be considered in the differential diagnosis of nodular lesions on lower and upper lips. Resumo O Leiomioma Vascular é um tumor benigno de tecidos moles raramente observado nos tecidos da cavidade bucal. O objetivo desse artigo é apresentar um novo caso de um leiomioma vascular no lábio (LVL), descrevendo seus achados clínicos, microscópicos e imunoistoquímicos, e revisar a literatura sobre o tumor. Uma mulher de 27 anos de idade se apresentou com uma pequena lesão dolorosa na mucosa do lábio inferior. A biópsia excisional revelou um massa encapsulada e bem circunscrita, formada por células pequenas e fusiformes. A análise imunoistoquímica revelou expressão intensa e difusa de actina musculo liso (AML) nas células tumorais e imunorreatividade para CD34 em células endoteliais que revestem espaços vasculares, indicando a presença de vasos sanguíneos. O diagnóstico final de LVL foi estabelecido. Não foram observados sinais de recorrência após cinco anos de acompanhamento. Embora o LVL seja uma lesão rara, deve ser considerada no diagnóstico diferencial de lesões nodulares nos lábios inferior e superior.

Repair of a surgical defect following Mohs micrographic surgery can be particularly challenging when it involves free margins of the face. Lip reconstruction falls under this category, requiring careful planning of the repair to avoid not only aesthetic but also functional complications of the oral aperture. Our technique, termed V-to-flying-Y closure, allows for an aesthetically pleasing and functional outcome for repairs of surgical defects that involve both the cutaneous and mucosal lip.

To describe a new technique of surgical treatment of the lip commissure or buccal mucosa carcinomas, where we use local flaps (skin, buccal mucosa) of the sliding type.According to the current technique, the ectomy ranges horizontally and in a cuneiform shape towards the side of the buccal cavity, and in the whole thickness of the layer (skin - mucosa), where the neoplastic focus is enclosed.The difference in our technique consists of the following: To the vertical bi-cuneiform part of the wound a horizontal cuneiform part (with the top showing upwards) is added, with extent and width analogous to those of the cancerous injury (tri-cuneiform ectomy). The width of the gap across its horizontal part is larger on the side of the mucosa (continuous line), compared to the one along the side of the skin (punctuated line), since the mucosa, as a more versatile tissue, can be sutured easily, in contrast to the buccal skin, which is of greater thickness and shows lack of versatility, so that it can be pulled on with difficulty in order to be sutured. The planning of the injury, according to our described technique, facilitates the broad ectomy of the intraoral injuries in the area of the lip commissure and the buccal mucosa, with immediate suture of the flaps (buccal and skin gap), and the occlusion of the wound by primary intention.Using this specific technique, in the cases of extended injuries infiltrating the skin or the subcutaneous tissue, the harming use of transposition (sliding or free) flaps is avoided.

A 33-year-old female visited the outpatient department of Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi with chief complains of painful ulcer over lower lip. On taking proper history the patient said she was apparently alright 4 months back when she noticed a painful non healing ulcer over lower the front region of jaw which was initially small in size and gradually increased to the present size of 5.3 x 2.3cm approximately. Patient had history of pain which was gradual in onset, dull aching, intermittent and localized in nature. Pain aggravated on mastication and relieved after taking medications. Patient also had history of change in quantity and consistency of saliva from normal to thick and ropy with intermittent bleed and pus discharge since 3months. On clinical examination face was asymmetrical due to soft tissue defect present over lower lip with irregular everted margins. On incisional biopsy of lesion done under local anaesthesia on 15/09/20 revealed squamous cell carcinoma of lower lip.

Chondroid syringoma is a benign, rare, asymptomatic, slow-growing mixed tumor. Tumors larger than 3cm are considered giant and may be malignant. We present a 65-year-old man with a chronic, indolent, subcutaneous tumor with upper lip deformity. An excisional biopsy was performed under local anesthesia. Based on histopathological analysis, the resected lesion was identified as a chondroid syringoma of the apocrine type. There was no recurrence during the one-year follow-up after surgery. The occurrence of a large chondroid syringoma in the upper lip is rare.

The mucocutaneous line and the lip vermilion are important structures from an esthetic standpoint but also in relation to the functionality of the mouth. In the literature, several types of flaps have been described for reparation of labial defects in adults. In this study, the authors analyze results of surgical reconstruction of the lower lip in the pediatric population using unilateral or bilateral mucomuscular elastic flaps for labial reconstruction. A retrospective analysis of 10 patients operated between 2003 and 2018 at our institution was made. The following demographic and clinical data were collected: age, sex, diagnosis, type of flap, follow-up, results, and complications. The Strasser scale was chosen for assessment of postoperative photographic results. Average age was 8.1 years (range 3-18). The most frequent etiology was arteriovenous malformation seen in 60% of cases. All cases corresponded to a defect of the lower lip. The average percentage of lip compromised was 44% and the largest length of compromise observed was 60% of the lip. Follow-up was on average 2.4 years. Esthetic results according to the Strasser method were as follows: 1 patient presented an excellent esthetic result, 5 good, 4 regular, and 0 poor.Considering the esthetic outcomes and low incidence of complications of the mucomuscular elastic flap, it is an acceptable and recommended technique of choice for lip vermilion reconstruction.

OBJECTIVE To determine the implication of the new AJCC staging system for pT classification in a cohort of patients with SCC of the lip mucosa and compare it to other oral cavity sites. METHODS Retrospective cohort of 744 patients treated between 2002 and 2017, by the Head and Neck Surgery Department of the University of Sao Paulo. RESULTS Of 95 lip patients, 42 had pT upstage (58.1% of pT1 to pT2-3 and 50% of pT2 to pT3). Similar DFS/OS observed for those pT1 maintained or upstaged to pT2-3, pT2 patients upstaged to pT3 presented worse OS (49.4% versus 92.3%, P = .032). The comparison between lip and other mouth topographies, denoted better prognosis for pT1-2, but not for pT3-4a. Lip tumors had lower DOI, rates of perineural/angiolymphatic invasion, nodal metastasis, recurrence, and death. CONCLUSION The inclusion of DOI to the new pT classification better stratifies patients with SCC of the lip mucosa upstaged to pT3 by assessing inferior OS. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2770-E2776, 2021.

Actinic cheilitis (AC) presents as a diffuse clinical-histopathological alteration throughout the lower lip.To analyze AC lesions using reflectance confocal microscopy (RCM) and evaluate criteria for the early diagnosis of incipient squamous cell carcinoma (SCC).This prospective study comprised cases of clinically diagnosed AC. RCM was performed over the entire extension of the lower lip. The sites that showed the highest degree of morphological alteration by RCM, according to established criteria for AC and SCC, were biopsied. The RCM findings and histopathology were correlated to establish the precise and early diagnosis of SCC.A total of 61 cases that had been clinically diagnosed with AC were included. The RCM findings that correlated independently with SCC were: nonedged papillae (sensitivity 84% and specificity 88%, p 0.0001, and OR 42), cell-filled papillae (sensitivity 82% and specificity 93%, p 0.0001, and OR 71.3), inflammation (sensitivity 68% and specificity 68%, p = 0.0163, and OR 4.8), large and roundish cells in the lamina propria (sensitivity 65% and specificity 100%, p 0.0001, and OR infinity), and nests in the lamina propria (sensitivity 54% and specificity 100%, p 0.0001, and OR infinity). An independent histopathological analysis classified the cases as partial epithelial dysplasia (25 cases, 41%) and SCC (36, 59%), and in 57 cases (94%), the results agreed with the categorization that was rendered by the RCM exam.RCM can be used to monitor AC cases, guide the biopsy site, and identify the early progression of AC to SCC with good sensitivity and specificity.

Resumen El carcinoma de labio es uno de los más comunes de la cabeza y el cuello. El tipo histológico más frecuente es el carcinoma escamocelular y afecta predominantemente al labio inferior. Existen distintas técnicas para la reconstrucción de los defectos del labio inferior posterior a la resección oncológica, sin embargo, preservar la funcionalidad y la estética de esta zona es un desafío debido a la alta incidencia de xialorrea, microstomia, alteraciones de la continencia y el habla posterior a la reconstrucción. Se presenta un caso de reconstrucción total de labio inferior ampliada hacia el mentón utilizando el triángulo de Burow y que obtuvo buenos resultados funcionales y estéticos. Abstract Lip carcinoma is one of the most common malignancies in the head and neck region. Squamous-cell carcinoma is the most frequent type of histological cell carcinoma, chiefly affecting the lower lip. Different techniques for reconstructing defects of the lower lip after neoplasia resection are used; however, preserving the functionality and aesthetics of this area poses a challenge due to the anatomical position that causes accumulation of saliva, thus delaying the healing process. We present a total lower lip reconstruction extended towards the chin by using the Burow's triangle, significantly improving functional and aesthetic results.

Increasing clinical evidence indicates that Th17 cells may promote or inhibit tumor progression, however the exact role of these cells in Oral Squamous Cell Carcinoma (OSCCs) pathogenesis and progression remains unclear. Tumor associated macrophages are highly plastic phenotype cells which can differentiate as M1 or M2. The mechanism and cellular phenotype of IL-17 expressing macrophages are unknown. 40 cases of lip and 28 of tongue SCCs were submitted to immunohistochemical analysis, and histologically graded. In tongue cases TNM was analyzed. The number of IL-17

Reconstruction of defects involving the upper lip can be challenging. The purpose of this review was to analyze the anatomy and function of the upper lip and provide an approach for reconstruction of upper lip defects. The primary role of the upper lip is coverage of dentition and animation, whereas the lower lip is critical for oral competence, speech, and eating. The orbicularis oris (OO) and several other muscles contribute to upper lip function. There are various insertion points for animation muscles, including the upper lip dermis, OO, and modiolus. Special attention should be paid to the philtrum, Cupid's bow, and vermilion border during reconstruction. Advantages and disadvantages of the Abbe, Estlander, and Karapandzic flaps are presented. Knowledge of mechanics, indications, and properties of local flaps while considering unique characteristics of upper lip anatomy and function are crucial for optimal aesthetic and functional outcomes.

Background It has always been a great challenge for clinical doctors to reconstruct total and near-total lower lip defects. Compared with elderly patients, the repair operation in young patients is more difficult where free flaps are usually used for transfer. In order to obtain better postoperative results, the authors combined two kinds of local skin flaps for operation purpose, and evaluated their postoperative clinical effects. Methods From April 2011 to May 2019, a total of 5 young patients with lower lip tumor or trauma were included in this study, with an average age of 30.4 years old. The lesion was all resected and resulted in a defect of 87% to total area of the lower lip, accompanied by a partial defect of the chin each. To repair the defect of the lower lip, the authors firstly used the modified Bernard flap. Then the authors designed the double Abbe flap to perform the operation according to the recovery of the patient 3 months later than the first operation. Finally, the outcomes of either operation were compared upon slit width, mouth opening height, aesthetics, and function of the patients, and statistically analyzed the results. Results All patients underwent the repair of modified Bernard flaps and double Abbe flaps of with no hemodynamic disorder of the flaps and well-recovery. At 3 months after the operation, the average gap width of lip was 4.34 ± 0.24 cm, the average opening height was 3.18 ± 0.28 cm, the average aesthetic score was 7.98 ± 0.51 (full score of 10), and the average functional score was 11.4 ± 0.55 (full score of 12). The 5 patients showed no obvious scar but a good shape on the lower lip. The function of eating, pronunciation, expression of feelings and smiling change were close to normal. Three patients had mild numbness in the lower lip, while the other two had normal sensory function. Conclusion Combined modified Bernard flap and double Abbe flaps can bring out promising reparative outcomes of near-total or total lower lip defects in lower lip in young patients with good aesthetic and functional recovery, which is recommended while considering surgical alternatives.

Successful management of lip and perioral trauma requires a nuanced understanding of anatomy and surgical techniques. Surgical correction is particularly challenging in instances of tissue loss, due to a narrow tolerance for aesthetic deformity and highly specialized functions of the perioral region, including facial expression, communication, and oral competence. Restoring continuity of the orbicularis oris musculature is critical for dynamic sphincter function of the upper and lower lips. Lip and perioral tissue symmetry are also critical for aesthetic balance, and failure to restore a natural appearance can adversely affect personal identity, with attendant psychological trauma. This discussion of lip and perioral trauma management encompasses lip and perioral anatomy, evaluation of injuries, reconstructive techniques, and prevention and management of complications. Perioral injuries are classified by size, depth, and extent of injury, and the corresponding reconstructive approaches are a function of complexity. These approaches proceed sequentially up rungs of the reconstructive ladder including primary repair, local flaps, grafting, regional flaps, as well as microvascular free tissue transfers. Procedures may be single stage or require multiple stages or subsequent refinement. Regardless of the defect size or location, the guiding principle of repair in the perioral region is restoring natural function and aesthetic appearance. This still-evolving area of facial plastic and reconstructive surgery lends itself to artistry and technical precision, offering opportunities for further innovation to improve the outcomes of patients with lip and perioral trauma.

Epidermal barrier disruption caused by atypical squamous proliferations of the lip (SOL) creates an ideal environment for fungal growth. Histologic features of SOL include parakeratosis overlying partial- or full-thickness keratinocyte atypia with or without invasion of the dermis, dermal solar elastosis, and scattered inflammatory cells which are predominantly lymphocytes. Histologic features of SOL with fungal superinfections overlap those seen in primary fungal cheilitis with reactive atypia, creating a diagnostic challenge. One-hundred seventy SOL cases were examined for the presence of fungal elements, and the histological features associated with superinfection were identified. Cases diagnosed as actinic cheilitis with fungal superinfection were carefully examined to rule out the possibility of misdiagnosed primary fungal cheilitis with reactive atypia. Histopathological characteristics commonly present with fungal hyphae included intraepidermal or intradermal neutrophils, bacterial colonies, and erosion or ulceration. Medical record review of those patients treated conservatively with topical antifungals revealed persistent clinical neoplasm and histological evidence of residual SOL on repeat biopsy. Thus, when biopsies exhibit histological overlap between these 2 entities, clinicians should keep a high index of suspicion for underlying SOL and carefully follow these patients if conservative antifungal therapy is initially trialed.

By virtue of their multiple functions, lips are essential organs. Thus, lip cancers represent a distinct entity in head and neck surgery. Their treatment is fundamentally surgical. We aimed, in this study, to define modalities of repairing techniques of lip defects after surgical resection and post-operative complications.We conducted a 4 years retrospective descriptive study including 70 adult patients admitted with lip cancers.Suture, local and regional flaps were the performed techniques for repairing defects (respectively n=28, 35 and 7). The most common postoperative complications were wound dehiscence (n=4), and surgical site necrosis (n=2) and infection (9 patients). Functional sequelae were dominated by microstomia (n=26), (food leakage) (n=9) and gingival exposure (n=11). Aesthetic results were good, fair or poor respectively in 54.3%; 32.9% and 12.8% of patients.Lip cancers surgery is relatively well-codified. However, it may be difficult to choose the best repairing technique, especially in case of large lip defect considering functional and aesthetic prejudices.