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

Figure 3: Inset of fascia lata through submucosal lip and subcutaneous cheek tunnels.

Tensioning and inset: The cranial ends of the fascial roll are pulled to set the lip height in a slightly overcorrected position. The fascial grafts are sutured to the deep temporal fascia using “0” polyester sutures.

Results

The above technique was used in two patients who developed lip malposition after oncologic anterior mandibular resection. The patients provided informed consent for surgery and the use of their full-face pictures. Institutional review board permission was obtained.

Clinical Case 1

An 80-year-old female underwent angle-to-angle mandible reconstruction with a fibular osteomyocutaneous free flap. Post-operatively, there was a 25% loss of the skin paddle, which required a radial forearm free flap. She developed lip malposition, which was exacerbated by adjuvant radiotherapy. A fascia lata sling was performed, which corrected lip position and drooling.

Clinical Case 2

A 77-year-old female underwent angle-to-angle mandibular reconstruction using a fibula osteomyocutaneous free flap. Adjuvant radiation resulted in osteoradionecrosis, which required another fibular flap. She developed malunion of the fibula to the radiated mandibular ramus, leading to fibula flap malposition, resulting in an open-mouth deformity and lip ptosis. A fascia lata sling was placed, which resulted in cessation of drooling at rest and during eating.

Conclusions

Resection of the anterior mandible can result in lip malposition due to loss of its soft tissue and muscular attachments. Lip position can be improved by cranial suspension with a fascia lata sling. Restoration of lip competence results in cessation of drooling, improvement in eating, and restoration of facial aesthetics.