Lip Cancer
ICD-10 C00 · ICD-11 2B60

Lower Lip Cancer with a Larger Lesion Requiring Reconstruction

This protocol addresses tumours located on the lower lip where the extent of the lesion or the anticipated surgical defect requires a planned reconstructive approach — beyond simple primary closure.

Clinical scenario
The tumour is sited on the lower lip. Lesion size or depth is such that excision alone will produce a defect that needs reconstruction to preserve lip function and avoid microstomia. Larger defects — particularly those involving a substantial portion of the lower lip or its midline — call for a more involved reconstructive strategy than small lesions limited to muscle invasion.
Approach overview
Management centres on surgical excision with reconstruction matched to the size and position of the defect. For larger resections, tissue must be introduced through flap-based techniques; the choice of flap depends on defect extent and whether the midline is involved. Neck dissection is addressed selectively based on cervical node status. The full structured protocol — including the complete surgical algorithm and specific flap selection criteria — is available via the link below.
Instant Access to Structured Evidence-Based Regimens
References

DOI: 10.1017/S0022215116000499

  • Small lesions invading into the adjacent muscle are amenable to a wedge excision.
  • The excision can also be completed using a 'W' plasty or half 'W' plasty to avoid the inferior aspect of the excision encroaching on the crease line of the chin.
  • If the dimensions of the lip resection require the introduction of tissue to minimise functional problems and microstomia, then this may be by means of Abbe, Abbe-Estlander or Karapandzic flaps.
  • The Karapandzic flap is useful for defects involving more than two-thirds of the lower lip, where the defect is in the midline.
  • With larger defects of the lower lip reconstruction requires either large cheek flaps to be advanced to repair the defect or the use of free tissue transfer.
  • The common forms of cheek flap include the bilateral Gillies fan flaps or the Bernard–Webster cheek flap reconstruction.
  • Neck dissection is generally not performed in the absence of clinically suspicious cervical lymph nodes as more than 5 per cent of patients are likely to develop recurrence in the neck following treatment of the primary lesion.
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