Reconstruction of large defects of the lower lip occurring after wide excision of Squamous cell carcinoma-Case report

Introduction: Squamous cell carcinoma is the most common cancer that occurs on the lips, and its wide excision is the main cause of large lip defects. Reconstruction of large lower lip defects with good functional and aesthetic results has always been a challenge for maxillofacial surgeons. Materials and methods: This paper is a case study of an 82-year-old patient with a change in the lower lip that appeared about a year ago, when he first came to the Maxillofacial Surgery Department of the Clinical Hospital in Stip, North Macedonia. At the first examination, the change on the lower lip was about 1.5 cm in diameter. The patient was informed in details, but he refused surgical treatment. After one year of the examination, the patient came again, due to the sudden growth of the change in the last months. At the second examination, a large ulcerous-infiltrative formation was found, which completely covers the lower lip, with full width and thickness, with destruction of the corners of the lips and infiltration in the buccal mucosa, on the right. An ultra-echo sonography revealed enlarged lymph nodes on the left side of the neck, stage N2. This is a case of a large full width and depth lower lip defect. A combination of local slices were made for reconstruction. On the right side, a nasolabial incision was made, and on the left, a combination of the Frais and Difenbach methods was made. A supraomohyoid dissection was performed on the left side of the neck. Results: No recurrences were observed during regular check-ups for six months. No enlarged lymph nodes in the neck area were observed on the ultrasound images. During the postoperative period, the patient reported liquid incontinence (14.27%), intermittent salivary incontinence (15.65%), and difficulty fully opening the mouth (21.30%). Conclusion: The combination of two reconstructive slices represents a serious alternative to some other surgical techniques for the reconstruction of the lower lip, which, as independent reconstruction techniques, do not give the desired results, from an aesthetic and functional point of view. Key words: reconstruction; large defects; lower lip; wide excision; squamous cell carcinoma