Lower Lip Suspension With Gore-Tex Suture: Technique and Literature Review

Objective: Oral incompetence is a problem frequently experienced after free-flap reconstruction of the oral cavity for patients with oral carcinoma. We describe an interesting treatment modality to deal with this pathology. Methods: A 60-year-old woman diagnosed with squamous cell carcinoma of her oral floor was treated with chemoradiation with complete response, and after suffering recurrence underwent composite mandibulectomy via visor flap and immediate fibular free flap reconstruction. Postoperatively, she was treated with adjuvant chemoradiation and developed oral incompetence months afterward. We performed lower lip suspension with Gore-Tex (Gore – Flagstaff, Arizona) suture with good functional and aesthetic outcome. Results: As of 9 months postoperatively, oral competence was achieved with good functional and aesthetic outcome. Conclusions: This approach is a viable, simple means of restoring oral competence secondary to loss of static control of the lower lip.

[1]  L. Yoleri,et al.  Tension Adjusted Multivectorial Static Suspension With Plantaris Tendon in Facial Paralysis , 2013, The Journal of craniofacial surgery.

[2]  K. Broadley,et al.  Floor of mouth carcinoma: Surgery still the dominant mode of treatment , 2012, Journal of medical imaging and radiation oncology.

[3]  Rodney K. Chan,et al.  Lower Lip Suspension Using Bilateral Temporalis Muscle Flaps and Fascia Lata Grafts , 2012, Plastic and reconstructive surgery.

[4]  R. Fernandes,et al.  Outcomes of total or near-total lip reconstruction with microvascular tissue transfer. , 2011, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[5]  M. Jakubietz,et al.  Adequacy of palmaris longus and plantaris tendons for tendon grafting. , 2011, The Journal of hand surgery.

[6]  Adriaan O Grobbelaar,et al.  Reanimation of the middle and lower face in facial paralysis: review of the literature and personal approach. , 2011, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[7]  L. Ishii,et al.  Minimally invasive temporalis tendon transposition. , 2011, Archives of facial plastic surgery.

[8]  R. Bains,et al.  Achilles tendon graft for static facial sling. , 2010, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[9]  E. Rosenthal,et al.  Outcomes of static and dynamic facial nerve repair in head and neck cancer , 2010, The Laryngoscope.

[10]  A. Orlando,et al.  Bilateral facial palsy and oral incompetence due to muscular dystrophy treated with a palmaris longus tendon graft. , 2009, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[11]  A. Gabriel,et al.  An objective comparison of holding, slippage, and pull-out tensions for eight suspension sutures in the malar fat pads of fresh-frozen human cadavers. , 2008, Aesthetic surgery journal.

[12]  Yohei Tanaka,et al.  Facial reanimation by transposition of the masseter muscle combined with tensor fascia lata, using the zygomatic arch as a pulley , 2008, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[13]  M. Wax,et al.  Immediate Gore-Tex Sling Suspension for Management of Facial Paralysis in Head and Neck Extirpative Surgery , 2007, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[14]  K. Moe,et al.  Temporalis tendon transfer as part of a comprehensive approach to facial reanimation. , 2007, Archives of facial plastic surgery.

[15]  A. Aslan,et al.  A total lower lip reconstruction with a composite radial forearm-palmaris longus tendon flap: a clinical series. , 2005, Plastic and reconstructive surgery.

[16]  A. Moss.  Is there an association between an absence of palmaris longus tendon and an absence of plantaris tendon? , 1988, European Journal of Plastic Surgery.

[17]  D. Sherris.  Refinement in reanimation of the lower face. , 2004, Archives of facial plastic surgery.

[18]  K. Oberg,et al.  Bidirectional lift of the anterior midcheek with Gore-Tex cable sutures. , 2003, Aesthetic surgery journal.

[19]  D. Hidalgo,et al.  Free‐Flap Mandibular Reconstruction: A 10‐Year Follow‐Up Study , 2002, Plastic and reconstructive surgery.

[20]  E. Williams,et al.  Tissue response to expanded polytetrafluoroethylene and silicone implants in a rabbit model. , 2002, Archives of facial plastic surgery.

[21]  P. Miller,et al.  Complications of Static Facial Suspensions With Expanded Polytetrafluoroethylene (ePTFE) , 2001, The Laryngoscope.

[22]  M. Pensak,et al.  Early perioperative use of polytef suspension for the management of facial paralysis after extirpative skull base surgery. , 2000, Archives of facial plastic surgery.

[23]  P. Gullane,et al.  Reconstruction of total lower lip and chin defects using the composite radial forearm--palmaris longus tendon free flap. , 2000, Archives of facial plastic surgery.

[24]  J. Maegawa,et al.  Muscle bow traction method for dynamic facial reanimation. , 1999, Annals of plastic surgery.

[25]  P. K. Sinha,et al.  Vertical suture plication of the orbicularis oris muscle: a simple procedure for the correction of unilateral marginal mandibular nerve paralysis. , 1998, Facial plastic surgery : FPS.

[26]  E. Williams,et al.  Tissue Response to Suture Materials Implanted Subcutaneously in a Rabbit Model , 1997, Plastic and reconstructive surgery.

[27]  D. Hidalgo.  Fibula free flap: a new method of mandible reconstruction. , 1989, Plastic and reconstructive surgery.

[28]  S. Soeda,et al.  A compound radial artery forearm flap for the reconstruction of lip and chin defect. , 1989, British journal of plastic surgery.

[29]  G. I. Taylor,et al.  THE FREE VASCULARIZED BONE GRAFT: A Clinical Extension of Microvascular Techniques , 1975, Plastic and reconstructive surgery.