The modified vermilion border-marionette line approach: A management for buccal cancer with wider indications and higher satisfaction

The Labiomandibular Fold Anatomy for Comprehensive Lower Facial Rejuvenation: A Micro-Computed Tomography Investigation

BACKGROUND

Perioral rejuvenation is challenging due to the lack of spatial anatomical understanding of the labiomandibular fold (LMF). The LMF's formation mechanism remains underexplored due to intricate relationships between musculature and subcutaneous structures. This study aimed to clarify the three-dimensional structures of the LMF using micro-computed tomography and histology.

METHODS

Twenty-two rectangular specimens, following the LMF as the diagonal line, were retrieved bilaterally from eleven fresh frozen cadavers (mean age, 69.3 years). Eleven specimens were imaged with phosphotungstic acid contrast staining for micro-computed tomography, and the rest were histologically examined using Masson and Verhoeff-van Gieson staining. The LMF was divided into three equal-width regions for analysis.

RESULTS

The LMF serves as a border between the lateral fat-abundant zone and the medial fat-scant zone statically. Dynamically, the LMF is accentuated with age by the downward pull of depressor muscles via a compact slanted collagen-elastin-muscle (CEM) network composed of the depressor anguli oris, platysma, and buccinator muscle fibers.

CONCLUSIONS

The LMF formation is governed by subcutaneous composition differences between the lower lip and cheek region and vertical dermal insertions of mimetic muscles. Perioral muscle contractions transmit directly at the skin via the CEM network, governing regional wrinkle severity and appearance. The micro-CT findings provide crucial three-dimensional insights into the layered architecture and intricate musculature correlation of the LMF region, providing regional-specific evidence for holistic rejuvenation practices.

LEVEL OF EVIDENCE III

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Full-thickness nasolabial facial artery flap: A modified surgical approach for reconstruction of lower lip defects

OBJECTIVES

Reconstruction of large lower lip defects remains challenging in terms of aesthetics, function and safety. The aim of this study is to explore a modified nasolabial flap to repair large lower lip defects.

METHODS

The full-thickness nasolabial facial artery flap was used for reconstruction of defects in lip squamous cell carcinoma (LSCC) patients after tumor ablation. The postoperative recovery of patients was obtained through clinical review and follow-up in the first and sixth month.

RESULTS

There were four LSCC patients who received tumor ablation at the Beijing Stomatological Hospital of Capital Medical University from November 2022 to March 2023, were included in our study. All patients did not suffer from postoperative infection, orocutaneous fistula, flap necrosis, and flap loss. One patient had the trapdoor deformity. These patients achieved better lip closure function. One patient developed cervical lymph node metastasis 2 months after surgery.

CONCLUSIONS

The modified nasolabial flap could achieve good outcomes in terms of aesthetics, function, and safety. It provided a supplementary strategy for the using of nasolabial flap in larger defects of lower lip.

Reverse submandibular gland flap: An alternative for reconstruction of medium-sized oral defects

Despite the development of microsurgery, local flaps still play an essential role in the reconstruction of head and neck defects. The submandibular gland flap (SMGF) has proven to be a reliable method for repairing medium-sized defects. It requires a shorter duration of general anesthesia and has fewer donor site complications compared to the free flap. However, the restricted vascular pedicle length limits its application. Retrograde flow is one solution. The authors describe a novel technique of using reverse submandibular gland flap (RSMGF) for the reconstruction of oral cavity defects. Additional vascular pedicle length was obtained by ligating the proximal end and dissecting the distal end of the facial vessels, thus extending its application range. The RSMGF is technically feasible and suitable for repairing medium-sized defects of the oral cavity (cT2 stage tumor) like buccal mucosa, especially for the elderly in poor general condition, for whom free flaps are not applicable.