Chapter 13: Lateral Lower Lip

INTRODUCTION

The type of repair used on the lateral lower lip depends on the size of the defect.¹ Defects that involve less than 50% of the lip may be repaired by a wedge excision. Defects larger than 50% of the lip are usually repaired using a combination of a wedge and flap repair. The mental crease should be preserved where possible by using a W-plasty or advancement flap along the crease.

SIDE-TO-SIDE CLOSURE

Advantages

• Minimal extra incisions

• Scars hide in relaxed skin tension lines

Disadvantages

• Defect must be small

• Best for vertically or obliquely oriented defects

Technique

1. Prior to anaesthesia, identify the vermilion border and mark each side with a marker pen. Also identify the surrounding rhytides to determine the orientation of the ellipse (vertical or oblique).

2. Once anaesthetised, the vermilion can be scored with a scalpel blade or marked with sutures (since the marking pen can rub off with surgery).

3. Mark the ellipse of skin to be excised.

   • If possible, avoid crossing over the vermilion border to keep the ellipse within the cutaneous lower lip.

   • If the defect size is slightly larger, the ellipse can continue across the vermilion and onto the mucosa on the inside of the lip. This should be considered an extension of the ellipse and does not involve cutting the orbicularis oris.

   • An alternative to extending the ellipse onto the inside of the lip is to stop at the vermilion border and perform a T-plasty advancement by incising along the vermilion border to make a bilateral advancement flap (see Fig. 13.5). An M-plasty performed at the vermilion border can also shorten the ellipse.

4. Excise the elliptical skin and place absorbable sutures deep in the wound, followed by superficial non-absorbable sutures.

WEDGE REPAIR

See Video 1 Wedge Excision and Video 2 Wedge Excision with Cutaneous Bilateral Advancement Flaps (In Mental Crease)