Surgical management of lip cancer

Abstract

Lip cancer is the most frequent malignant neoplasm of the oral cavity. The study reported herewith refers to the clinico-pathological features and surgical treatment of lip cancer. The most frequent tumour related to the lips is squamous cell carcinoma, with the lower lip more commonly involved than the upper lip. Typically, squamous cell carcinoma originates in the red lip, whereas basal cell carcinoma involves the white lip. The management of lip cancer involves the control not only of the primary tumours with oncologically appropriate margins and subsequent reconstruction to allow oral competence during the oral phase of swallowing, but also the possible metastatic spread to the neck. Reconstruction is a surgical challenge especially for advanced and extended lesions. A successful reconstruction depends on careful pre-operative planning, knowledge of the anatomy and use of the various surgical techniques. Lymph node neck metastases significantly reduce long-term survival. Although the management of the neck is controversial in lip cancer, particularly with respect to the neck, elective or curative supra-omohyoid neck dissection is the best choice for occult or evident loco-regional metastases. Early stage tumours have good prognostic, aesthetic and functional results after surgery compared to the treatment of advanced lesions, which alter the appearance and functionality of the lip. The Authors report their experience in the treatment of lip tumours at the primary site, considering reconstructive problems, together with management of neck metastases.

Keywords: Lip; Malignant tumours; Neck dissection; Reconstruction; Surgical treatment.

Fig. 1.

Male patient (57 years old) with squamous cell carcinoma of the lower lip. Surgical defect was repaired with Sabattini-Abbé flap: a) pre-operative view; b-d) intra-operative view; e) post-operative view after 3 weeks, before the resection of the vermillion bridge; f-g) post-operative view after 4 months.

Fig. 2.

The oldest patient (84 years old) with an advanced carcinoma of the lower lip spreading to the soft tissues of the chin with lymph node metastases at first levels: a-b) pre-operative view; c) CT scan; d) surgical specimen; e) reconstruction of the defect with double modified "fan-flap"; f) post-operative view after 3 months.

Fig. 3.

Patient with relapsing carcinoma treated repeatedly with surgery and radiotherapy. The tumour occupied the entire lower lip, extending to the vestibular and alveolar surface and spreading to the mandibular symphisis: a) pre-operative view; b) CT scan; c) intra-operative view after the tumour resection; d) modelling of the fibula free flap to restore the continuity of the jaw; e) patient at the end of the operation with myocutaneous pedicled latissimus dorsi flap to cover the fibula bone and reshape soft tissues; f) post-operative view after a series of reconstructive and re-shaping plastic surgery interventions.