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Defects in the lip and perilabial regions can be caused by lip oncosurgery. Currently, there is a lack of clear classification and principles for repairing and reconstructing the lip and perilabial defects after lip tumor resection surgery. Lip defects are categorized into three types based on their extent by author: partial lip defects, full-thickness lip defects, and full-thickness lip defects with surrounding lip defects. The partial lip defects include four types: labial vermilion defects, labial cutaneous defects, labial mucosal defects, and through-and-through labial defects. There are four types of full-thickness lip defects, including less than half of labial defects, one half of labial defects, subtotal labial defects, and total labial defects. There are three types of full-thickness lip defects with surrounding lip defects, including through-and-through commissure and cheek defects, total labial and nasal defects, and total labial and chin defects. Different types of defects in the lip and perilabial region should be repaired during radical surgery for lip tumors. The methods of repair and reconstruction of lip and perilabial defects include primary closure, skin or mucosal grafting, local flaps, regional flaps, pedicle flaps, free flaps, and allogeneic dermal matrix (ADM). Multiple tissue flaps can also be combined for repair and reconstruction. Among them, the anteriorly based ventral tongue flap is an ideal tissue flap for repairing and reconstructing labial vermilion defects. The Abbe-Estlander flap is a very important technique for repairing and reconstructing lip defects. The combination of bilateral mental neurovascular V-Y island advancement flap and an anteriorly based ventral tongue flap for reconstruction of the total lower lip defect is a reliable and effective method. The Estlander flap, foldable supraclavicular fasciocutaneous island flap, or foldable facial-submental artery island flap can be used to repair the through-and-through labial commissure and cheek defects. Large perilabial defects such as total labial and chin defects or total labial and nasal defects require repair using pectoralis major muscle flaps, trapezius muscle flaps, free tissue flaps, or even a combination of multiple flaps. This article proposes the classification of lip and perilabial defects following oncosurgery and systematically elaborates on the functional repair and reconstruction of the defects, which has certain guiding and promotional application value for clinical practice.

Successfully restoring lateral lip defects, while ensuring proper mouth opening, oral competence, and the creation of an aesthetically pleasing vermilion, has consistently posed a challenging undertaking. In a prospective study conducted from 2006 to 2022, we employed our modified version of the McGregor fan flap technique to reconstruct post-oncosurgical pure lateral lower lip and complete lower lip defects. The study excluded cases involving a central lip defect or accompanying buccal mucosa involvement. A total of 126 flap procedures were performed on 122 patients, encompassing lower lip defects ranging from 30 to 100% in size. Unilateral flaps were performed on 118 patients, while four patients necessitated bilateral flap procedures. The reconstruction of the vermilion was accomplished using our modified flap technique in 114 patients, tongue flaps in two patients, and six patients, the flap's skin was folded to mimic the vermilion. Remarkably, no complications such as hematoma, necrosis, flap loss, infection, microstomia, or dribbling were encountered. The labial sulcus was found to be adequately formed. All patients achieved preoperative mouth opening within 3 months following surgery, with a mean oral sphincteric recovery time of 4.2 months. The color match of the reconstructed vermilion was excellent. Our modified fan flap technique stands as a dependable and robust choice for addressing moderate to large full-thickness lateral defects of the lower lip offering effective vermillion reconstruction in a single surgical procedure. The cases involving associated buccal mucosa or submucous fibrosis may necessitate alternative vermilion reconstruction approaches. [ABSTRACT FROM AUTHOR]

Purpose: Early stage lip squamous cell carcinoma (lip SCC) can be treated with conventional excision, Mohs micrographic surgery (MMS), or brachytherapy. The aim of this retrospective study was to describe the medical outcomes, patient‐reported outcomes, and costs of these treatments. Methods: A retrospective cohort study of T1–T2 lip SSCs treated between 1996 and 2019. Medical outcomes, recurrences, and survival were retrieved from medical records. Facial appearance, facial function, and Quality of Life (QoL) were measured with the Face‐Q H&N and EQ‐5D‐5L questionnaires. Costs were also calculated. Results: Of the 336 lip SCCs, 122 were treated with excision, 139 with MMS, and 75 with brachytherapy. Locally, the recurrence rate was 2.7% and regionally 4.8%. There were 2% disease‐related deaths. T2‐stage and poor tumor differentiation were associated with recurrences. Posttreatment QoL, facial function, and appearance were rated as good. Brachytherapy was the most expensive treatment modality. Conclusion: Early‐stage lip SCC has a good prognosis, with a disease‐specific survival of 98.2% after a median follow‐up of 36 months, there was a high QoL and satisfaction at long‐term follow‐up. Based on the costs and the risk of locoregional recurrences, we believe that, for most noncomplex lip SCCs, MMS would be the most logical treatment option. [ABSTRACT FROM AUTHOR]

Low-dose-rate (LDR) and high-dose-rate (HDR) interstitial brachytherapy are known to be effective in the treatment of lip carcinomas. The aim of this study was to retrospectively compare oncologic and toxicity outcomes between the two techniques. From 2007 to 2018, patients at the Institut de cancérologie de Lorraine (France) who received exclusive or adjuvant interstitial brachytherapy for lip squamous carcinomas were studied. Two groups were defined: the LDR/PDR group, including patients treated with iridium-192 wires, or pulsed-dose rate technique, and the high-dose-rate group, with patients treated by high-dose-rate technique. The dose ranged between 50 Gy and 65 Gy (depending on previous surgery) for low-dose-/pulsed-dose rate treatments, and 39 Gy for high-dose-rate (twice a day). Early, late toxicity events and oncologic control were reported. Among the 61 patients whose data were analyzed retrospectively, 36 received the low-dose-/pulsed-dose rate treatment (59%) and 25 the high-dose-rate brachytherapy (41%). The median follow-up time was 44 months. At 36 months, the local control rates were 96.3% for LDR/PDR group and 100% for HDR (P = 0.180). The regional control rates were 85.9% and 92% without any difference according to the two groups (P = 0.179). The specific overall survival rate was 95.5% with no difference between groups. There were more grade 2 or higher mucositis in the HDR group than in LDR/PDR group (40% versus 16.7%, P = 0.042). One case of grade 3 mucositis was recorded in each group. No grade 3 late complications were recorded. High-dose-rate brachytherapy reduced the length of hospitalization by 2 days (P < 0.001). High-dose- or low-dose-/pulsed-dose rate brachytherapy seemed to be as effective and well tolerated in our experience of 61 patients. [ABSTRACT FROM AUTHOR]

Introduction: Squamous cell carcinoma is the most common malignant tumor of the lips and mainly affects the lower lip. Adequate treatment of this neoplasm must be early and radical, as metastases can occur. Considering that the lips are extremely important in the dynamics and motricity of the face, lip reconstruction after major resections in this region is a challenge for the surgeon in the search for good aesthetic and functional results. This study seeks to present an already established and reliable technique for reconstructing the lower lip after tumor resection, the Karapandizic flap. Method: In this case review, 4 patients with lower lips reconstructed using the Karapandzic technique in 2013-2022 are retrospectively evaluated. Results: The most frequently observed complications were hypertrophic scar, lip vermilion suture dehiscence, and microstomia (reduction of oral opening). The cleft lip (microstomia) reduction was partially corrected through dental orthoses, with no need for commissuroplasty in any of the cases. Another contribution of this work is the use of preoperative color echoDoppler, which allows flap planning by checking the viability of the vascular pedicle and the actual positioning of this pedicle, reducing the chances of inadvertent injury to the vessels during surgery. Conclusion: Even though microstomy is a limitation of this flap, we conclude that this technique meets the need for lower lip reconstruction in large resections, as it can provide satisfactory results in oncological, functional, and aesthetic terms.

The facial submental artery island flap (FSAIF) is a fasciocutaneous flap supplied by the facial submental artery. It is in close proximity with many oral and maxillofacial regions, and its tex ture and color are similar to those of the head and face. The flap has a constant and sufficient blood supply, and it is easy to prepare and has high survival rates and few complications. According to the tissue carried, FSAIF can be divided into fasciocutaneous flaps, myocutaneous flaps and simple flaps. The flap can also be made into an osteofasciocutaneous (myocutaneous) flap with a mandible to repair maxillary defects. Because this flap is a pedicled flap, it can greatly shorten the operation time, bed rest time and hospitalization time and has been widely used in repairing medium-sized defects of the oral and maxillofacial region. The indications for FSAIF in repairing maxillofacial defects should be strictly controlled. It can be safely used for benign or malignant tumors without cervical lymph node metastasis. For malignant tumors with cervical lymph node metastasis but without extranodal extension, the flap can be used on the premise of thorough neck dissection. The contraindication is cervical lymph node metastasis and extranodal extension of malignant tumors; therefore, other flaps should be selected for repair.

Lip cancer at the corner of the mouth (i.e., the oral commissure) is considered difficult to detect as the initial lesion, especially in individuals with Behçet's disease (BD), because aphthous stomatitis frequently occurs at the oral commissure of BD patients, but the incidence of cancer at that site is rather low. We present a rare case of oral commissure carcinoma in a 69-year-old Japanese male with BD. The patient's stomatitis had recurred for 10 years, and symptoms of right angular stomatitis had worsened for 2 months. We observed a 10 mm × 6 mm ulcer with induration at the right oral commissure, surrounded by a 20-mm white lesion. The pathological examination of the biopsy sample revealed squamous cell carcinoma. We resected the tumor with the patient under general anesthesia. Although the incidence of carcinoma of the oral commissure is generally low, it is very important to carefully observe patients with BD so that the risk of overlooking this cancer or misdiagnosing it as a recurrent aphthous ulcer is minimized. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate a novel boosting technique in radiation therapy of lip carcinoma using a suitably designed lip applicator, called (in this study) internal dose enhancer tool. Methods: The internal dose enhancer tool was designed with proper thickness of lead for reducing transmission to tissues located beyond the lips. A 0.5 cm thickness of polystyrene was used to cover the lead and reduce the backscattered electron dose, while an opening in the polystyrene layer allowed electrons to reach the target. Monte-Carlo models of 6 and 8 MeV electron beams were developed using BEAMnrc code and were validated against experimental measurements. Using the developed models, dose distributions in a lip phantom were calculated and the effect of an internal dose enhancer tool on target dose enhancement was evaluated. Findings: Using the internal dose enhancer tool, the maximum dose enhancement as a percentage of dose at dmax of the unshielded field were 57.6% and 36.1% for 6 and 8 MeV beams, respectively. The best outcome was achieved for lip thickness of less than 1.5 cm and target thickness of less than 1 cm. For lateral dose coverage of planning target volume (PTV), the 80% isodose curve at the lip-internal dose enhancer tool interface showed a 12 mm expansion, compared to the unshielded field. Conclusion: This study showed that a conformal external beam radiation therapy (EBRT) of lip is possible by using an internal dose enhancer tool. This boosting method is especially applicable to cases in which other treatment modalities, such as brachytherapy, faces limitations.

INTRODUCTION: Actinic cheilitis (AC) is considered to be a pre-malignant lesion or an incipient and superficial form of lip squamous cell carcinoma. It is commonly found in individuals whose occupational activities are related to chronic sun exposure and the definitive diagnosis is performed with biopsy. Althoug Exfoliative cytology has been used as a screening procedure to evaluate cancer of the oral cavity no studies have proposed the use of exfoliative cytologic analysis to evaluate and diagnose AC. OBJECTIVE: The purpose of this study was to evaluate lower lip lesions on fishermen related to chronic solar exposure using clinical, cytologic and histopathologic analyses. PATIENTS AND METHODS: Smears taken from the vermilion of the lower lips of 125 fishermen and 30 control individuals were subjected to cytologic analysis. RESULTS: The harvested cells were sufficient for cytologic analysis in 83.2% of the samples. Sixteen fishermen exhibited prominent lower lip lesions that justified biopsy and histological studies. In total, 4 specimens were malignant (3.2%), and 12 displayed epithelial dysplasia, demonstrating that the prevalence of epithelial dysplasia and malignant lesions was high among the fishermen population. These conditions were strongly associated with infiltration and blurring of the vermilion margin of the lower lip. CONCLUSION: The cytologic analysis was not useful for detecting epithelial dysplasia or malignant alterations.

a nine-year-old xeroderma pigmentosa (xp) child presented with a non-healing ulcer on the right side of the lower lip. on histological examination the lesion proved to be squamous cell carcinoma. wide excision was done. the excision included lip, buccal mucosa with mucocutaneous junction and only the upper portion of the orbicularis oris muscle. the lip was reconstructed with superiorly based nasolabial flap. recently, his younger brother, who is also suffering from xp developed squamous cell carcinoma of lower lip, and presented to us. wide excision of the lesion was done. the defect was closed primarily. the patient and his brother both have been advised to protect themselves from uv radiation. both are being kept under intense surveillance. ten months of follow-up of the elder brother showed satisfactory, good-looking lip with no sign of recurrence at the local site or at the neck.

A nine-year-old xeroderma pigmentosa (XP) child presented with a non-healing ulcer on the right side of the lower lip. On histological examination the lesion proved to be squamous cell carcinoma. Wide excision was done. The excision included lip, buccal mucosa with mucocutaneous junction and only the upper portion of the orbicularis oris muscle. The lip was reconstructed with superiorly based nasolabial flap. Recently, his younger brother, who is also suffering from XP developed squamous cell carcinoma of lower lip, and presented to us. Wide excision of the lesion was done. The defect was closed primarily. The patient and his brother both have been advised to protect themselves from UV radiation. Both are being kept under intense surveillance. Ten months of follow-up of the elder brother showed satisfactory, good-looking lip with no sign of recurrence at the local site or at the neck.

Purpose: The treatment of lip carcinomas needs tumor surgical resection with safety margins respect. The aim of this study was to report the oncologic and aesthetic/functional outcomes of a retrospective monocentric case series of 39 patients treated for cutaneous lip cancer. Methods: This retrospective study assessed 56 patients who were treated for a lip carcinoma between 2008 and 2012 and included 39 patients with cutaneous lip basal cell carcinoma or squamous cell carcinoma. Clinical, surgical and pathological data were reviewed, and patients were interviewed for follow-up data. A comparison was made between the marked surgical margins and the margins observed under microscopy after histologic process. Results: The most frequent tumor type was basal cell carcinoma in 69.2 %. The measured surgical margins were superior to the histological margins in 24 cases (61.5 %) and were inferior in 13 cases (33.3 %). Overall survival and recurrence-free survival rates at 1 year were 97.5 and 95 % respectively. Conclusion: Differences between the surgical margins and the final histologic margins were the main finding of this retrospective study. These differences were attributed to surgical practices and modification during the histological process. Nevertheless, we did not observe a higher rate of recurrence or death in our study than in literature. [ABSTRACT FROM AUTHOR]

The most frequent tumor related to the lips is the squamous cell carcinoma, with the lower lip more commonly involved than the upper lip. The pivotal risk factors having impact on the prognosis include size of the tumor, histopathological type and grade, perineural invasion, regional lymph node metastasis, and local recurrences. Management of lip cancer and reconstruction is a surgical challenge. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was for us to present our analysis of the results and prognostic factors in squamous lip carcinoma treated with high-dose-rate (HDR) brachytherapy. Methods From 1999 to 2010, 102 patients were treated with HDR-brachytherapy, 54 with T1, 33 with T2, and 15 with T4. Eight cases were N+. Twenty-one patients were treated with surgery plus brachytherapy because of close/positive margins. Nine fractions of 5 Gy were given over 5 days in 67% of the patients. Elective neck treatment was performed in 23 cases. Results The 10-year actuarial local control was 94.6%, nodal regional control was 88.6%, disease-free survival was 84.6%, and cause-specific survival was 93.2%. In the univariate analysis, T4 tumors had higher risk of local failure and T2 of regional relapse. In the multivariate analysis, skin involvement was the only significant factor for tumor progression. Conclusion HDR-brachytherapy yields excellent local control rates. Skin involvement increases the risk of local and cervical recurrence. Elective neck treatment should be done in T2 to T4 tumors or with skin or commissure involvement. © 2014 Wiley Periodicals, Inc. Head Neck 36: 1737-1742, 2014 [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To compare the use of high-dose-rate (HDR) brachytherapy (BT) in patients with lip carcinoma with a former series previously treated with low-dose-rate (LDR) BT. Methods and Materials: Ninety-nine patients treated with LDR-BT were compared with 104 patients treated with HDR-BT. Distribution by stage was 53.5% T1, 15.1% T2, 3.1% T3, and 28.3% T4 for LDR and 52.9% T1, 32.7% T2, 0% T3, and 14.4% T4 for HDR. Some cases with positive or close margins received BT after surgery (34.3% with LDR vs. 16.3% with HDR). Parallel metallic needles were used in 100% of HDR cases and in 76% of LDR cases. Most HDR patients were treated with HDR-BT to a dose of 4.5–5 Gy per fraction prescribed to a 90% isodose, in nine fractions delivered twice daily for 5 days. Results: Median followup was 63 months for LDR-BT and 51 months for HDR-BT. Overall local control for LDR- vs. HDR-BT was 94.9% vs. 95.2%; and 100% vs. 100%, 86.6% vs. 94.1%, and 89.3% vs. 80%, for T1, T2, and T4 stage tumors, respectively. Disease-free survival for LDR vs. HDR was 95.9% vs. 94.2%. Soft tissue necrosis, bone necrosis, and fair-bad cosmesis for LDR vs. HDR was 15.1% vs. 0%, 1% vs. 0%, and 11.1% vs. 0%, respectively. Conclusions: Treatment with HDR-BT using rigid needles is a simple technique that provides good long-term results with minimal complications. LDR- and HDR-BT are regarded as equally effective in local control and disease-free survival, but fewer complications arise when using HDR-BT. [Copyright &y& Elsevier]

Lip cancer is frequently treated with surgery although radiation therapy offers comparable results. The aim of the study was to evaluate the local cure rate in patients with lip carcinoma treated with 192-Ir low dose rate interstitial brachytherapy. Fifty-four patients with a mean age of 70 years (range, 40-90 years) were retrospectively evaluated. The tumour location was the superior lip in 4 (7.4%) and the inferior lip in 50 (92.6%). Tumour stage was T1N0 in 33 patients and T2N0 in 21 patients. The radioactive sources with hypodermic needles in 49 patients (90.7%) and plastic tubes in 5 (9.3%) were placed parallel and equidistant from one another across the tumour volume according to the Paris system rules. The median dose was 61.5 Gy (range, 60-65 Gy). All patients experienced acute brisk skin and mucositis RTOG grade III around the implanted volume, subsiding within 4–6 weeks after the implant. Local control was achieved in 98% of patients. The mean follow-up was 7 years. Low dose rate interstitial brachytherapy with 192-Iridium is a well established and efficacious way to achieve local control of the tumour in lip cancer. It offers the advantage of avoiding surgery in an elderly population. [ABSTRACT FROM AUTHOR]

Background. Lip carcinomas are rare oral tumors, and there have been few reports of lip carcinoma in Japan. Methods. Of 914 patients with oral carcinomas treated between January 1980 and December 1998, 12 (1.3%) had lip carcinoma and 5 (0.5%) had lip mucosal carcinoma. We investigated the clinicopathological features of these 17 patients. Results. Of the 12 patients with carcinoma of the lip, 10 had squamous cell carcinomas (9, external lower lip; 1 commissures) and 2 had mucoepidermoid carcinomas (external upper lip). Of the 5 patients with lip mucosal carcinoma, 3 had squamous cell carcinomas (2, mucosa of the lower lip; 1, mucosa of the upper lip), 1 had mucoepidermoid carcinoma (mucosa of the lower lip), and 1 had acinic cell carcinoma (mucosa of the lower lip). Of the 12 patients with lip carcinoma, 9 were classified as stage I, 2 as stage II, and 1 as stage III; all 5 of the patients with lip mucosal carcinoma were stage I. Five patients with lip carcinoma were treated by resection, 5 by a combination of resection and reconstruction, and 2 by radiotherapy alone. All patients with lip mucosal carcinoma were treated by resection. After the initial therapy, 3 patients without neck dissection had regional recurrences and received delayed neck dissection, and 2 died with neck regional recurrence after dissection. The 5-year cumulative survival rates of the patients with lip carcinoma and those with lip mucosal carcinoma were 82.5% and 80.0%, respectively. Conclusion. We suggest that early-stage carcinomas of the lip and of the mucosa of the upper and lower lips are frequent, and we found that the outcome of these patients was excellent. However, an aggressive therapeutic approach to the lip carcinoma patient with cervical metastasis appears warranted, in an attempt to improve locoregional control and ultimate survival. [ABSTRACT FROM AUTHOR]

In a prospective non-randomized study 21 patients with lower lip squamous cell carcinoma were treated with human natural leukocyte interferon (HNLI). The response rate was measured by a size reduction of more than 25% and was 81%. A complete response rate was considered to be a cure according to histopathological and clinical findings and was 48%. The response rate of six lower lip squamous cell carcinoma cases treated with recombinant interferon alpha 2c was 67% and the complete response rate was 17%. Three patients with basal cell carcinoma of the upper lip were also treated with HNLI. All three patients were cured, as determined by histopathological and clinical findings. These findings indicate that interferon can be a useful alternative therapy for lip carcinoma either with or without surgery. [ABSTRACT FROM AUTHOR]

We present 39 patients with lip carcinoma treated with HDR, (needles) with 5–5.5 Gy per 8–10 fractions b.i.d. (total dose 40.5–45 Gy). Three-year cause-specific survival and local control are 91 and 88% (95% T1–2, 74% T4, p<0.05). Acute and chronic reactions are like LDR cases. We think that HDR results are equivalent to LDR. [Copyright &y& Elsevier]

Purpose: Squamous cell carcinoma (SCC) is commonly treated by electron beam radiotherapy (EBRT) followed by a boost via brachytherapy. Considering the limitations associated with brachytherapy, in this study, a novel boosting technique in EBRT of lip carcinoma using an internal shield as an internal dose enhancer tool (IDET) was evaluated. An IDET is referred to a partially covered internal shield located behind the lip. It was intended to show that while the backscattered electrons are absorbed in the portion covered with a low atomic number material, they will enhance the target dose in the uncovered area. Methods: Monte-Carlo models of 6 and 8 MeV electron beams were developed using BEAMnrc code and were validated against experimental measurements. Using the developed models, dose distributions in a lip phantom were calculated and the effect of an IDET on target dose enhancement was evaluated. Typical lip thicknesses of 1.5 and 2.0 cm were considered. A 5 × 5 cm2 of lead covered by 0.5 cm of polystyrene was used as an internal shield, while a 4 × 4 cm2 uncovered area of the shield was used as the dose enhancer. Results: Using the IDET, the maximum dose enhancement as a percentage of dose at dmax of the unshielded field was 157.6% and 136.1% for 6 and 8 MeV beams, respectively. The best outcome was achieved for lip thickness of 1.5 cm and target thickness of less than 0.8 cm. For lateral dose coverage of planning target volume, the 80% isodose curve at the lip-IDET interface showed a 1.2 cm expansion, compared to the unshielded field. Conclusions: This study showed that a boost concomitant EBRT of lip is possible by modifying an internal shield into an IDET. This boosting method is especially applicable to cases in which brachytherapy faces limitations, such as small thicknesses of lips and targets located at the buccal surface of the lip. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the effectiveness of low-dose-rate brachytherapy for local control and relapse-free survival in squamous cell and basal cell carcinomas of the lips. We compared two groups: one with tumors on the skin and the other with tumors on the lip. Patients and methods: All patients had been treated at Claudius Regaud Cancer Centre from 1990 to 2008 for squamous cell or basal cell carcinoma. Low-dose-rate brachytherapy was performed with iridium 192 wires according to the Paris system rules. On average, the dose delivered was 65 Gy. Results: 172 consecutive patients were included in our study; 69 had skin carcinoma (squamous cell or basal cell), and 92 had squamous cell mucosal carcinoma. The average follow-up time was 5.4 years. In the skin cancer group, there were five local recurrences and one lymph node recurrence. In the mucosal cancer group, there were ten local recurrences and five lymph node recurrences. The 8-year relapse-free survival for the entire population was 80%. The 8-year relapse-free survival was 85% for skin carcinoma 75% for mucosal carcinoma, with no significant difference between groups. The functional results were satisfactory for 99% of patients, and the cosmetic results were satisfactory for 92%. Maximal toxicity observed was Grade 2. Conclusions: Low-dose-rate brachytherapy can be used to treat lip carcinomas at Stages T1 and T2 as the only treatment with excellent results for local control and relapse-free survival. The benefits of brachytherapy are also cosmetic and functional, with 91% of patients having no side effects. [Copyright &y& Elsevier]