Correction of Lower Lip Malposition with Fascia Lata Slings Following Anterior Mandibular Resection

INTRODUCTION

Lip incompetence can result from the resection of the anterior mandible due to loss of soft tissue and muscular attachments of the lower lip to the mandible and obliteration of the anterior gingivobuccal sulcus. The resulting lip ptosis and malposition lead to an inability to create an oral seal despite an intact orbicularis oris. This results in constant drooling at rest and food leakage while eating. Patients start avoiding normal social activities, such as eating at restaurants and going out in public, resulting in social isolation.

We have used fascia lata slings to correct lip ptosis after free-flap mandible reconstruction. Suspension of the lower lip with tendon or fascial slings is an established technique for total lip reconstruction and facial paralysis; however, the use of fascial slings has not been previously reported for the correction of lip incompetence after anterior mandibular resection and reconstruction with a bony free flap. In this article, we describe our surgical technique.

Methods/Surgical Technique

The following is a brief overview of the steps of the operation.

Markings: Surgery is performed under general nasotracheal anesthesia. Two-centimeter incisions are marked immediately behind the temporal hairline. A straight line is drawn from the temporal marks to the oral commissure. The red line (junction of wet and dry vermilion) of the lower lip is marked (Figure 1).

Fascia lata harvest: The length of the fascia needed is determined by adding the length of the cheek and lip markings, plus a few centimeters. Step incisions are made for harvesting a 1.5-cm-wide strip of fascia lata from the lateral thigh. This strip is turned into a roll by rolling it longitudinally and suturing it to itself with a 4-O polypropylene suture (Figure 2).

Deep temporal fascia exposure: The deep temporal fascia is exposed on both sides by making a 2-cm incision in the temporal scalp at the previous markings.

Creation of tunnels: A 1-cm transverse incision is made just lateral to the oral commissure. A subcutaneous tunnel is created between the oral commissure incision and the temporal scalp incision at the previously marked line. A submucosal tunnel is created in the lower lip along the previously marked red line.

Passage of fascial graft through tunnels: The fascia lata roll is passed through the lower lip submucosal tunnel via the previously made bilateral oral commissure incisions (Figure 3). Each end of the fascial roll is then passed through the cheek subcutaneous tunnels and into the temporal opening.