الفهرس 
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Abstract
Functional and cosmetic restoration of lip defects can present a considerable challenge to the reconstructive surgeon. Although the lip seems to be a relatively simple structure, it has a role in many complex functions. It is a prominent esthetic component of the central face, with elegant lines and structures that are difficult to reconstruct.
Cancer lesions, trauma, or burns cause most common defects of the lips. Small defects of the lip are straightforward to repair. Adhering to some basic principles and practices will ensure an optimal cosmetic and functional result. Larger defects of the lower lip and defects involving the upper lip and commissure present a challenge to the reconstructive surgeon because of the important functional and aesthetic concerns that interplay. Maintaining oral continence, preventing microstomia, and achieving an aesthetically acceptable result are the primary goals of reconstruction.
A thorough knowledge of the lip anatomy, function, and different techniques available is useful in planning a complex repair. The creative demands in this area make lip reconstruction a rewarding and artistic pursuit for the facial plastic surgeon.
This study aimed to evaluate the different modalities for lip reconstruction after excision of mucocutaneous neoplasms regarding their advantages and disadvantages.
This study was carried out on 23 patients diagnosed to have lip neoplasms, all patients were managed by surgical tumor excision and reconstruction by different reconstructive modalities.
Patients were divided into four unequal groups, according to the site, size, and depth of the lip defect after tumor excision:
The first group (G I): included four patients with partial-thickness lip defects (i.e. the orbicularis oris muscle is intact).
The second group (G IIa): included five patients with full-thickness defects less than one-third of total lip length.
The third group (G IIb): included twelve patients with full-thickness defects between one-third and two-thirds of lip length.
The fourth group (G IIc): This group included two patients with total or subtotal lip loss.
The ages of the studied group varied from 4 to 90 years (mean: 57 years). There were 17 males (73.9%) and 6 females (26.1%). Tobacco smoking was identified in 12 cases (52.2%). In 14 cases (60.9%) an association was found between the disease and chronic sun exposure. The period of time between the appearance of the first symptom to the first visit of the plastic outpatient clinic varied from 1 month to 2 years. The presenting symptom was the presence of lip ulcer or nodule.
Neoplastic disorders were the main lip pathology encountered in this study. Malignant neoplasms in the form of SCC were the most common malignancy that occurred in 14 cases (60.9%) followed by BCC in 7 cases (30.4%). Benign neoplasms were also encountered in only 2 cases (8.7%) in the form of intradermal nevus and infantile hemangioma. The tumor location was in the lower lip in 18 patients (78.3%) and in the upper lip in 5 cases (21.7%). There was no cervical lymph node metastasis or distant metastasis in any case at the time of the first presentation.
The method of reconstruction was chosen according to the site and size of the lip defect after tumor ablation.
G I: included 4 patients with partial thickness lip defects; 2 cases with cutaneous only defect managed by A to T flap and V-Y advancement flap & 1 case by primary repair (V excision) and 1 case by a unilateral inferiorly based nasolabial flap.
G IIa: included 5 patients with full-thickness defects less than one-third of total lip length; primary repair (V or W excision) was chosen for reconstruction.
G IIb: included 12 patients with full-thickness defects between one-third and two-thirds of total lip length; 1 case managed by W-plasty, 2 cases by Gillies fan flap, 3 cases by a unilateral Nasolabial flap, 3 cases by Abbe flap, 2 cases by Estlander flap and 1 case by Karapandzic flaps.
G IIc: included 2 patients with subtotal lip defects which were managed by bilateral Karapandzic flaps.
Post-operative evaluation of cases was done; all cases in this study were followed up for a period of three months. They were assessed for detection and management of early and late postoperative complications if present. Each method of reconstruction was evaluated from the functional and aesthetic point of view at the end of the follow-up period by means of subjective evaluation by the patient and the doctor.