Arch Aesthetic Plast Surg.  2018 Jun;24(2):87-90. 10.14730/aaps.2018.24.2.87.

Restoration of an Upper Lip Affected by Necrotizing Ulcerative Stomatitis Using Bilateral Cheek Advancement with a Crescentic Perialar Excision

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Soonchunhyang Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea. peunsoo@schmc.ac.kr

Abstract

Necrotizing ulcerative stomatitis (NUS) refers to ulceration of the oral mucosa that precedes rapid orofacial soft- and hard-tissue destruction. NUS on the upper lip is considered a reconstructive challenge because of the functional importance and complex multidimensional structure of the facial units that are involved, and is most commonly found in developing countries. Therefore, few studies have been conducted on NUS. Moreover, reconstruction options vary from local regional flaps to free-tissue transfers. We report a very interesting case in which we performed regional flap surgery using bilateral cheek advancement in a patient with NUS. A 75-year-old woman with a history of diabetes mellitus and hypertension, but no other immunological diseases, presented with skin necrosis on the upper lip. At presentation, necrotic tissue covered the upper lip and philtrum, but it had not invaded the nose or lower lip. After debridement of the necrotic tissue, approximately 70% of the upper lip was missing. We therefore designed a bilateral cheek advancement and rotation flap, in which the flap was sutured in 3 layers. There was no need to perform additional procedures, as the flap healed well and showed no other complications or recurrence. The patient exhibited good voluntary muscle control and oral competence while eating and drinking, and she was also very satisfied with the cosmetic results. Thus, regional flap surgery using a simple advancement flap may result in good recovery of both functional and aesthetic units in patients with NUS.

Keyword

Gingivitis necrotizing ulcerative; Noma; Reconstructive surgical procedures; Surgical flaps

MeSH Terms

Aged
Cheek*
Debridement
Developing Countries
Diabetes Mellitus
Drinking
Eating
Female
Gingivitis, Necrotizing Ulcerative*
Humans
Hypertension
Immune System Diseases
Lip*
Mental Competency
Mouth Mucosa
Muscle, Skeletal
Necrosis
Noma
Nose
Reconstructive Surgical Procedures
Recurrence
Skin
Surgical Flaps
Ulcer*
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