Reconstructive Flap Techniques Following Surgery for Advanced Lip Carcinoma: A Retrospective Study of 35 Cases

Abstract

Background: Lip cancers are among the relatively common malignancies encountered in the practice of Otorhinolaryngologists in our country. In their advanced stages, these tumors lead to significant functional and aesthetic sequelae and can be life-threatening, highlighting their severity and the challenges associated with their management, both in terms of oncologic resection and reconstruction.Objectives: To describe the epidemiological, clinical, paraclinical, and therapeutic features of advanced lip carcinomas managed surgically in our department, and to evaluate the reconstructive flap techniques used together with their functional and aesthetic outcomes.Methods: Our study is a retrospective analysis over 11 years, involving 35 cases of advanced lip carcinomas managed in the department of Otorhinolaryngology - Head and Neck Surgery at 20 August 1953 Hospital in Casablanca during the period from January 2012 to November 2024 (2021 and 2022 excluded). Epidemiological, clinical, paraclinical, therapeutic, and evolutionary data were analyzed.Results: The age of our patients ranged from 32 to 90 years, with a mean age of 64.71 years and a clear male predominance (sex ratio = 3.37). The main risk factors identified were chronic smoking, prolonged sun exposure, and poor oral hygiene, no precancerous lesions were detected in our study cohort. The mean interval to consultation was 29.54 months. The predominant tumor location was the lower lip (77.14%), and the macroscopic appearance was predominantly ulcerative-proliferative (65.71%). Histopathological examination confirmed that squamous cell carcinoma was the predominant histological type (97.14%). Tumors were classified as T1-T2 in 65.71% of cases, and lymph node metastases were present in 28.57% of cases. All patients underwent surgical resection, with a safety margin of 10-15 mm. Complete margins were achieved in 34 of 35 patients. Lymph node dissection was performed in 30 patients. Reconstruction was performed with local or regional flaps in 100% of cases, with no requirement for distant flaps; the technique selected depended on the site and extent of the resulting defect. Functional and aesthetic outcomes were satisfactory in most cases. Restricted mouth opening was the most common postoperative complication. From both functional and aesthetic perspectives, the outcomes were deemed satisfactory in most cases. The most common postoperative complication in our study was restricted mouth opening.Conclusion: Local and regional flaps allow satisfactory oncologic, functional, and aesthetic outcomes in the reconstruction of extensive lip defects following resection of advanced lip carcinoma, provided the reconstructive technique is tailored to the site and extent of the defect.