The reconstructive process begins with a thorough assessment of the patient and the defect. The etiology of most lip defects is tumor or trauma. Tumors are usually basal cell carcinoma in the upper lip and squamous cell carcinoma in the more sun exposed lower lip. Lesions in the commissures are more aggressive biologically. Congenital causes include, vascular malformations, hemangiomas. And of course cleft lip. Other causes of lip defects such as burns or infections are more rare.
A history of all prior treatments, operations, and radiation therapy is elicited. The pathology of lesion, as well as the status of margins must be known.
The patients overall medical condition and psyche including tolerance for imperfections are assessed.
The defect size, location, depth, and involvement of aesthetic subunits are noted. Photographs are taken. Donor site options are then considered. The adage “replace like with like” is very applicable.
Goals differ based on patient characteristics and etiology.
In general common goals include:
1. Complete skin coverage and oral lininig
2. A semblence of a vermilion
4. Competent oral sphincter
5. And adequate stomal opening