Department of Oromaxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, Liaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, Liaoning, 110002, China.
Clin Oral Investig. 2024 Nov 30;28(12):672. doi: 10.1007/s00784-024-06028-z.
Despite the versatility of flap designs for lower lip reconstruction, the notion of orbicularis oris (OO) ring integrity was barely stressed. Traditional flap transfer leads to fibrous orientation inconsistency with the remaining OO. Therefore, the aim of this study is to share the experience of combining local flaps with depressor anguli oris (DAO) transfer for lower lip reconstruction and OO sphincter function restoration.
48 patients were included in this study. Four types of local flaps were transferred for lower lip reconstruction. Each technique was modified by adding an additional DAO transfer for OO reconstruction. Functional outcomes were evaluated by grading scales based on clinical examination and observation. Aesthetic outcomes were evaluated by Patient and Observer Scar Assessment Scale.
The surgical outcomes were favorable in both functional and aesthetic aspects. No statistically significant differences were observed among different types of flaps. Patients at T1 stage showed statistically significant mouth opening compared with patients at T2 stage (P = 0.004). Patients whose commissure was preserved showed statistically significantly better competence compared with patients whose commissure was sacrificed (P = 0.006).
Combining local flap with DAO transfer is a reliable and effective approach for lower lip reconstruction and OO sphincter function restoration. Moreover, the modiolus seems to play a vital role in enhancing competence. Thus, it should be preserved during oncologic ablation if possible.
It is vital to match the orientation of the transferred muscle fiber with the orientation of the remaining OO. Therefore, DAO becomes an excellent candidate.
尽管用于下唇重建的皮瓣设计具有多功能性，但对口轮匝肌（OO）环完整性的概念几乎没有强调。传统的皮瓣转移导致纤维与剩余的 OO 之间的方向不一致。因此，本研究旨在分享结合局部皮瓣与降口角肌（DAO）转移用于下唇重建和 OO 括约肌功能恢复的经验。
本研究纳入了 48 例患者。为下唇重建转移了四种类型的局部皮瓣。每种技术都通过增加额外的 DAO 转移来修复 OO 进行了改进。通过基于临床检查和观察的评分量表评估功能结果。通过患者和观察者瘢痕评估量表评估美学结果。
在功能和美学方面，手术结果均良好。不同类型的皮瓣之间没有观察到统计学上的显著差异。T1 期患者的张口度与 T2 期患者相比具有统计学显著差异（P=0.004）。保留口角的患者与牺牲口角的患者相比，闭唇能力具有统计学显著差异（P=0.006）。
将局部皮瓣与 DAO 转移相结合是下唇重建和 OO 括约肌功能恢复的可靠有效方法。此外，肌索似乎在增强闭唇能力方面起着至关重要的作用。因此，如果可能的话，在肿瘤消融过程中应保留肌索。
将转移的肌肉纤维的方向与剩余的 OO 的方向相匹配至关重要。因此，DAO 成为一个极好的选择。
