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Page 2 of 6 Al Shetawi et al. Plast Aesthet Res 2018;5:1 I http://dx.doi.org/10.20517/2347-9264.2017.61

A B

Figure 1. (A) The classic appearance of the recalcitrant upper lip; (B) inset of the radial forearm free flap at the base of the nose and the
depth of the oral vestibule improves the lip, vermilion and vestibule

Table 1. Summary of patients

Patient Age Gender Diagnosis Ablative Adjuvant Primary reconstruction Secondary Follow Dental
treatment treatment reconstruction up rehabilitation
1 68 years Female Intermediate Left total Yes Scapulaosteocutaneous Trismus release 7 years Yes
grade MEC maxillectomy free flap Fat grafting
Orbital floor Canthopexy and
reconstruction tarsorrhaphy
RFFF
Flap debulking
2 60 years Female Verrucous Bilateral No Iliac crest bone graft RFFF 3 years Yes
carcinoma subtotal Flap debulking
maxillectomy
Bilateral neck
dissection
3 57 years Female Stage 4 SCC Right total Yes Fibular free flap Zygomatic 6 years Yes
maxillectomy Orbital floor implants
Right neck reconstruction Fat grafting
dissection Vestibuloplasty
RFFF
Flap debulking
MEC: mucoepidermoid carcinoma; SCC: squamous cell carcinoma; RFFF: radial forearm free flap

incompetency, difficulty in controlling the food bolus, speech intelligibility and difficulty in prosthetic
rehabilitation.

There is paucity of reports in the surgical literature on the management of the recalcitrant upper lip. In this
report, we present our experience with three patients [Table 1] using the radial forearm free flap (RFFF)
and describe the surgical technique in details.

CASE REPORT
Case 1
This is a 68-year-old female with a history of mucoepidermoid carcinoma of the left maxillary sinus.
She underwent left total maxillectomy and adjuvant radiotherapy. She subsequently underwent scapula
osteocutaneous free flap reconstruction. Multiple secondary procedures were performed to improve her
facial symmetry and function including trismus release, fat grafting, canthopexy and tarsorrhaphy. She
continued to have the classic appearance of the retracted and shortened upper lip on the affected side
with intractable maxillary vestibule [Figure 2A]. RFFF reconstruction was performed to reconstruct
the recalcitrant upper lip and oral vestibule [Figure 2B]. The postoperative course was unremarkable.
Flap debulking was done to achieve improved symmetry. She was able to wear dental prosthesis and had
improved speech and mastication [Figure 2C]. She was followed up for 7 years.