Page 9 - Read Online

Al Shetawi et al. Plast Aesthet Res 2018;5:1 Plastic and
DOI: 10.20517/2347-9264.2017.61 Aesthetic Research

Case Report Open Access

Management of the recalcitrant upper lip

Al Haitham Al Shetawi , Rui Fernandes 1
1,2
1 Division of Head & Neck Surgery, Department of Oral & Maxillofacial Surgery, University of Florida Health, Jacksonville, FL 32209, USA.
2 Maxillofacial, Head & Neck Surgery, Division of Surgical Oncology, Vassar Brothers Medical Center, Dyson Center for Cancer Care,
Poughkeepsie, NY 12601, USA.

Correspondence to: Dr. Rui Fernandes, Division of Head & Neck Surgery, Department of Oral & Maxillofacial Surgery, University of
Florida Health, Jacksonville, FL 32209, USA. E-mail: Rui.fernandes@jax.ufl.edu
How to cite this article: Al Shetawi AH, Fernandes R. Management of the recalcitrant upper lip. Plast Aesthet Res 2018;5:1.
http://dx.doi.org/10.20517/2347-9264.2017.61
Received: 4 Sep 2017 First Decision: 18 Jan 2018 Revised: 24 Jan 2018 Accepted: 24 Jan 2018 Published: 29 Jan 2018

Science Editor: You-Bin Wang Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract

The aim of this study was to present our experience in the management of the recalcitrant upper lip and describe the
surgical technique. We took a retrospective chart review of all patients who underwent reconstruction of the recalcitrant
upper lip after maxillectomy and radiation therapy. Three female patients were identified. All patients had a history of
malignant maxillary tumors, mucoepidermoid carcinoma (n = 1), verrucous carcinoma (n = 1), squamous cell carcinoma
(n = 1). Tumor extirpation was carried out through total maxillectomy (n = 2), and bilateral subtotal maxillectomy
(n = 1). Primary reconstruction was accomplished with scapula free flap (n = 1), fibula free flap (n = 1), and nonvascularized
iliac crest bone graft (n = 1). Two patients underwent adjuvant radiotherapy. All patients developed recalcitrant upper
lip. All patients had secondary reconstruction to correct of the recalcitrant upper lip using radial forearm free flap. All
patients had successful dental rehabilitation. The mean follow-up was 5 years (range 3-7 years). Subjective functional and
aesthetic outcome was assessed in all patients at the last follow up visit. All patients reported subjective improvement in
speech, mastication and aesthetics. Free tissue transfer provides an ideal method to reconstruct the recalcitrant upper
lip. Favorable functional and aesthetic outcomes can be successfully achieved using the technique described in this series.

Keywords: Recalcitrant upper lip, upper lip reconstruction, maxillectomy, radiation therapy

INTRODUCTION
Complex post-ablative reconstruction often requires secondary refinements to improve the aesthetic and
functional outcome. A challenging problem encountered after post-ablative maxillary reconstruction
and adjuvant radiotherapy is the recalcitrant upper lip. Patients with recalcitrant upper lip present with
retracted and shortened upper lip, thin vermilion and intractable vestibule [Figure 1]. This results in lip

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.parjournal.net