Ann Dermatol.  2017 Apr;29(2):210-214. 10.5021/ad.2017.29.2.210.

Transoral Cross-Lip (Abbé-Estlander) Flap as a Viable and Effective Reconstructive Option in Middle Lower Lip Defect Reconstruction

• Hahn HJ
• Kim HJ
• Choi JY
• Lee SY
• Lee YB
• Kim JW
• Yu DS

• KMID: 2394846
• DOI: http://doi.org/10.5021/ad.2017.29.2.210

Abstract

The Abbé-Estlander flap surgery is a cross-lip procedure that is valuable in repairing a defect on the lower lip using a full-thickness flap, consisting of the skin, muscle and mucosa, from the upper lip. As usefulness and practicality of the flap in reconstruction of lower lip surgical defects in Asian ethnicity have not been documented, the authors present a case of successful lower lip reconstruction with a staged, Abbé-Estlander lip switching flap with commissuroplasty as an illustrative example. A 71-year-old male has presented with an ulcerating lip nodule in the middle one third of the lower lip, measuring about 1.5×2 cm across its long and short axes. Wide excision of the tumor was followed by delineation of the triangular Abbé-Estlander flap from the upper lip, in which the medial hinge point of the base was chosen as the pedicle. Then, the flap elevation was carried out from the lateral commissure and then was transferred into the lower lip defect. Three weeks later, commissuroplasty was performed to correct the rounding at the new commissure. The patient is currently performing his daily activities with no apparent compromise in orbicularis oris strength or oral continence. Given the size of the primary defect and the flap-to-defect ratio of size, the degree of microstomia was acceptable. Even with other myriad of reconstructive options at surgeons' disposal, the Abbé-Estlander lip-switching flap is a reliable, and less morbid method of lower lip reconstruction for Asian surgical candidates. The authors illustrate an exemplary case in which a relatively large lower lip defect was successfully repaired using an upper lip flap of a significantly smaller size in an Asian subject of advanced age, without any remarkable long term sequelae which have traditionally been associated with the trans-oral lip switching flap technique.

Keyword

Abbé flap; Asians; Lip cancer; Microstomia; Transoral lip switching

MeSH Terms

Aged
Asian Continental Ancestry Group
Humans
Lip Neoplasms
Lip*
Male
Methods
Microstomia
Mucous Membrane
Skin
Ulcer

Figure

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  Fig. 1 (A) Clinical photograph of the lesion with extensive involvement of the mid-to-left portion of the lower lip. (B) Wide wedge excision of the primary tumor is followed by design of the flap.

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  Fig. 2 (A) At completion of the first stage operation and (B) 8 weeks postoperative.

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  Fig. 3 Histopathological findings of the excised tumor at (A) low magnification (H&E, ×40) shows poorly-differentiated squamous cell carcinoma showing diffuse invasion. Superficial portion of the underlying skeletal muscle is also involved (inset: ×200). Nuclear pleomorphism and intratumoral nercrosis are evident in (B); H&E, ×200.

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