Rekonstrukcija punog defekta donje usne nakon ablacije tumora

Marijan Kovačić, Ivan Kovačić, Tamara Tačigin, Marija Kera

Pozadina: Postoji velik broj kirurških tehnika rekonstrukcije defekta donje usne. Kontinuirano se usavršavaju stare metode i promoviraju nove. Ova studija imala je za cilj ocijeniti kirurški ishod naše tehnike rekonstrukcije ograničenog defekta donje usne, nastalog nakon resekcije tumorom zahvaćenog segmenta. Osnovu tehnike čini jednostrana ili obostrana preostala muskulatura depresora usnog kuta i donje usne, ovisno o središnjoj ili bočnoj lokalizaciji defekta. Metode: Nakon ablacije tumora, nastali djelomičan pravokutni defekt svih slojeva donje usne rekonstruiran je s predloženom tehnikom u lokalnoj anesteziji. Istezanjem, rotacijom i podizanjem preostalog tkiva donje usne i obraza nadomjestili smo defekt do 75% njezine širine. Ocijenili smo metodu temeljem postignutih funkcionalnih i estetskih rezultata, kao i prisutnosti komplikacija te duljine trajanja bolničkog liječenja. Rezultat: Ukupno 11 bolesnika muškog spola s planocelularnim karcinomom donje usne, srednje životne dobi od 72 godine, uspješno je liječeno predloženom tehnikom. Medijan veličine tumora bio je 3 cm, a boravka u bolnici tri dana, za vrijeme kojega je uspostavljena potpuna oralna kompetencija i omogućen razumljiv govor. Nismo zabilježili prisutnost ranih niti kasnih komplikacija. Postigli smo trajan vrlo dobar funkcionalni i estetski rezultat uz odsutnost bolesti nakon razdoblja praćenja duljeg od 36 mjeseci. Zaključak: Ova predložena tehnika nije kirurški zahtjevna, izvodi se u jednom aktu u lokalnoj anesteziji i kratkom vremenu. Njezinom primjenom rekonstruira se defekt usne s tkivom očuvane motorne i senzibilne inervacije. Oporavak je brz i gotovo potpun, a estetski izgled bolesnika je dojmljiv.

Background: There are a number of surgical techniques for reconstructing the lower lip defect. Old methods are constantly being improved and new ones are being promoted. This study aimed to evaluate the surgical outcome of our technique for the reconstruction of a limited lower lip defect, resulting from the resection of the affected segment. The basis of the technique is unilateral or bilateral residual musculature of the depressors of the corner of the mouth and lower lip, depending on the central or lateral location of the defect. Methods: After tumor ablation, the resulting partial rectangular defect of all layers of the lower lip was reconstructed with the proposed technique under local anesthesia. By stretching, rotating and lifting the remaining tissue of the lower lip and cheek, we compensated for the defect to 75% of its width. We evaluated the method based on the achieved functional and esthetic results, as well as the presence of complications and the length of hospital treatment.
Result: A total of 11 male patients, with a mean age of 72 years, with squamous cell carcinoma of the lower lip were successfully treated with the proposed technique. The median tumor size was 3 cm, and the hospital stay was three days during which full oral competence was established and intelligible speech was enabled. We did not record the presence of early or late complications. We achieved a lasting very good functional and esthetic result with the absence of disease after a follow-up period of more than 36 months. Conclusion: This proposed technique is not surgically demanding, it is performed in one act under local anesthesia and for a short time. Its application reconstructs the defect of the lip with the tissue of preserved motor and sensory innervation. Recovery is quick and almost complete, and the esthetic appearance of the patient is impressive.