PRE-OPERATIVE DIAGNOSIS: Lip Cancer
POST-OPERATIVE DIAGNOSIS: same
PROCEDURE:
1. Resection of a Lip Cancer with Local (40525)
2. Advancement flap for reconstruction of a lip defect (14061)
3. Advancement flap for reconstruction of a cheek defect (14301)
SURGEON: MD
ASSISTANT SURGEON: MD (no qualified resident was available throughout the case)
ANESTHESIA: GETA
KEY FINDINGS:
1. An ulcerated lip lesion was noted at the right oral commissure with extension along the mucosal and cutaneous cheek.
2. A resection was performed of the lip and cheek with a a resultant 5 X 7 cm defect.
3. An Estlander cross lip flap (3 X 4 cm) was used reconstruct the commissure and portion of the lower lip.
4. An lower lip flap (6 X 3 cm) was designed along the mentolabial fold (similar to a Karapanzik flap) to reconstruct the remainder of the lip defect and a portion of the cheek subunit.
5. A cheek flap (9 X 4 cm) was rotated to reconstrct the cheek defect.
INDICATIONS FOR PROCEDURE:
a 64 y.o. male with lip cancer. Risks, benefits, sequelae, alternatives to surgery was discussed with the patient. This includes the risk of bleeding, infection, flap loss, microstomia, Perioperative risks of myocardial infarction, stroke, respiratory failure, DVT and pneumonia, and even death was discussed as well. The patient would like to proceed with surgery.
DESCRIPTION OF PROCEDURE:
After being identified in the holding room, the patient was brought to the operating room and placed under anethesia. During the bed turn, the patient was extubated, but quickly reintubated without desaturation. He was prepped and draped in a sterile fashion, incisions for resection were marked in the skin, and local anesthetic was injected into the skin. The lip lesion was excised with margin, removing the skin, soft tissues and buccal mucosa around the lesion. The lesion was sent for frozen section, all margins were negative. The resultant defect included the lip (Lower upper and commisure; approximately 40% of the lip) and cheek subunits.
Attention was turned to the reconstruction. An Estlander flap was created by incising the nasolabial fold and rotating the upper lip subunit to the lower lip. A lower lip flap was created by making an incision along the mento-labial crease and dissecting along a plane superior to the obicularis oris muscle. This allowed the lip to be rotated to close the remainder of the lip defect and a portion of the cheek subunit. The buccal mucosa was advanced along a plane just deep to the buccinator muscle and approximated. The flaps were inset by approximating the mucosl layer, muscular layer, deep dermal and cutaneous layer. closing the skin meticulously in an interrupted fashion Next, a cheek flap was created along the nasolabial fold and rotated to approximate the resultant cheek defect. The wound was also closed in a similar fashion. A rubber band drain was placed. The patient was then extubated and brought to the PACU in stable condition.
FLUIDS: Crystalloid
EBL: 50 mL
SPECIMENS: Lip
POST-OPERATIVE DIAGNOSIS: same
PROCEDURE:
1. Resection of a Lip Cancer with Local (40525)
2. Advancement flap for reconstruction of a lip defect (14061)
3. Advancement flap for reconstruction of a cheek defect (14301)
SURGEON: MD
ASSISTANT SURGEON: MD (no qualified resident was available throughout the case)
ANESTHESIA: GETA
KEY FINDINGS:
1. An ulcerated lip lesion was noted at the right oral commissure with extension along the mucosal and cutaneous cheek.
2. A resection was performed of the lip and cheek with a a resultant 5 X 7 cm defect.
3. An Estlander cross lip flap (3 X 4 cm) was used reconstruct the commissure and portion of the lower lip.
4. An lower lip flap (6 X 3 cm) was designed along the mentolabial fold (similar to a Karapanzik flap) to reconstruct the remainder of the lip defect and a portion of the cheek subunit.
5. A cheek flap (9 X 4 cm) was rotated to reconstrct the cheek defect.
INDICATIONS FOR PROCEDURE:
a 64 y.o. male with lip cancer. Risks, benefits, sequelae, alternatives to surgery was discussed with the patient. This includes the risk of bleeding, infection, flap loss, microstomia, Perioperative risks of myocardial infarction, stroke, respiratory failure, DVT and pneumonia, and even death was discussed as well. The patient would like to proceed with surgery.
DESCRIPTION OF PROCEDURE:
After being identified in the holding room, the patient was brought to the operating room and placed under anethesia. During the bed turn, the patient was extubated, but quickly reintubated without desaturation. He was prepped and draped in a sterile fashion, incisions for resection were marked in the skin, and local anesthetic was injected into the skin. The lip lesion was excised with margin, removing the skin, soft tissues and buccal mucosa around the lesion. The lesion was sent for frozen section, all margins were negative. The resultant defect included the lip (Lower upper and commisure; approximately 40% of the lip) and cheek subunits.
Attention was turned to the reconstruction. An Estlander flap was created by incising the nasolabial fold and rotating the upper lip subunit to the lower lip. A lower lip flap was created by making an incision along the mento-labial crease and dissecting along a plane superior to the obicularis oris muscle. This allowed the lip to be rotated to close the remainder of the lip defect and a portion of the cheek subunit. The buccal mucosa was advanced along a plane just deep to the buccinator muscle and approximated. The flaps were inset by approximating the mucosl layer, muscular layer, deep dermal and cutaneous layer. closing the skin meticulously in an interrupted fashion Next, a cheek flap was created along the nasolabial fold and rotated to approximate the resultant cheek defect. The wound was also closed in a similar fashion. A rubber band drain was placed. The patient was then extubated and brought to the PACU in stable condition.
FLUIDS: Crystalloid
EBL: 50 mL
SPECIMENS: Lip