Reconstruction of a combined lip-mandible defect by a single fibula flap

Dean D. Ad-El, Eitan Hochvald, Rephael Zeltser, Nardi Casap

Research output: Contribution to journalArticlepeer-review

Abstract

A case of invasive carcinoma to the mandible and adjacent lip was presented. The mutilation of ablative surgery to that region presents a reconstructive therapeutic challenge to maintain aesthetics and function. The reconstruction of a combined lip and mandible defect is usually achieved by using flaps from several locations with few donor sites and less chance of success. The use of a single flap minimizes donor site morbidity as well. The use of a single flap is recommended in those cases in which the skin and the bone defects are close to each other. In the presented case, the fibula was used to reconstruct the mandible and the adjacent lip defect. From our experience, the osteocutaneous septum is usually long enough to enable rotation without jeopardizing its vitality and to cover and reconstruct lip and cheek defects with a satisfactory result. When the skin paddle is folded, the inner skin part can take over and resume the oral mucosa part as seen in any vascularized skin flap to the mouth. As always, the most difficult part to reconstruct is the lip itself, especially if the commissure is involved. When possible, cross lip flaps should be used as primary or secondary reconstructive options. Fixation of the neofold to the adjacent cheek structures must be made to avoid lip incontinence and drooling. Visualization and meticulous handling of the osteocutaneous perforators are essential to maximize skin paddle survival. In cases of a thick flap, a skin graft can be applied to 1 side, thus creating a 2-layer reconstruction. It seems that in the combined lipmandible defect, the fibula may provide a reliable and relatively simple composite reconstruction.

Original languageEnglish
Pages (from-to)1076-1079
Number of pages4
JournalJournal of Oral and Maxillofacial Surgery
Volume60
Issue number9
DOIs
StatePublished - Sep 2002
Externally publishedYes

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