Tratamento do Carcinoma Espinocelular do Lábio Inferior Quando o Defeito Envolve Mais de Dois Terços do Comprimento Labial
Cenário Clínico
Este protocolo aborda o carcinoma espinocelular do lábio inferior em pacientes nos quais o tumor ou sua excisão resulta em um defeito que abrange mais de 2/3 (60–100%) do comprimento total do lábio T3 · ≥4 cm. Essas lesões extensas requerem excisão oncológica coordenada e uma abordagem reconstrutiva planejada.
Abordagem Terapêutica (Visão Geral Parcial)
O manejo consiste na excisão radical de espessura total do tumor do lábio inferior sob anestesia geral, seguida de reconstrução labial com técnicas de retalho regional — a estratégia específica de retalho é selecionada de acordo com a extensão da perda tecidual e está detalhada no protocolo completo.
Objetivos do Tratamento
Obter margens cirúrgicas de ressecção saudáveis (livres de tumor) e ausência de recorrência tumoral local.
References
DOI: 10.1016/j.maxilo.2015.03.006
- The remaining patients had T2 lesions ≥2 cm, up to 2/3 of lip involvement (50 patients), T3 lesions ≥ 4 cm, more than 2/3 of lip involvement (18), and a T4 lesion ≥5.5 cm with commissure involvement (1).
- The Bernard–Freeman–Fries technique is performed under general anesthesia with nasotracheal intubation.
- It was imperative that each lesion be radically excised, leaving an adequate safety margin on all sides (always 6–10 mm if margins were not examined by a pathologist working in the operating theater, and 3 mm otherwise).
- When a defect involved 60–100% of the lower lip, a Bernard–Freeman–Fries flap was the favored solution and was constructed for 5.7% of patients.
- If over 2/3 of the lower lip is lost (over 60%), a combination of a Sabattini–Abbé flap and a bilateral staircase flap should be considered.
- The prognosis improves if the margins are healthy and the resection radical.
- In our present study, we report no disease recurrences.
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