(78) Reconstruction of Large Lower Lip Avulsion Defect Using the Modified Stairstep Technique

Abstract: Defects of the lip, whether resulting from trauma, congenital anomaly, or malignancies, pose significant challenges in reconstruction. Considering aesthetic and functional outcomes carefully is crucial, especially in cases involving subtotal and total lower lip defects. Speech and articulation are important outcome measures of success. Defect analysis, a crucial step in the choice of repair for reconstruction, informs the decision-making process. Regional transpositional and rotational flaps can be employed for reconstruction, but each has challenges.

We present a case of a 32-year-old female who presented to the Emergency Department status post dog bite by Cane Corso to the lower lip, sustaining complete avulsion of approximately 4x2 cm central lip segment. Patient also sustained significant intraoral laceration of anterior mandibular vestibule. Considering the facial esthetic units and long-term cosmesis goals in a young adult, we utilized a modified stairstep technique to reconstruct the lower lip. The modified stairstep technique with lateral tissue advancement flaps is an excellent option for reconstructing significant central lower lip defects that cannot be closed primarily. This modified technique, which involves making the stairstep incisions in the plane superficial to the orbicularis oris muscle, ensures the preservation of continuity of the orbicularis oris and depressor anguli oris, thereby significantly improving functional outcomes and preserving both motor and sensory nerve supply while also maintaining the aesthetics of the lip.

This case report serves as evidence of the unique application of the modified stairstep technique, a novel approach that guided the reconstruction of a subtotal lower lip defect with exceptional mouth opening, cosmesis, and lip function. The innovative use of the modified stairstep technique has led to exceptional outcomes, instilling optimism about its potential in lower lip trauma reconstruction cases and encouraging further exploration and adoption of this technique.

References
Kuttenberger, J.J., and N. Hardt. “Results of a modified staircase technique for reconstruction of the lower lip.” Journal of Cranio-Maxillofacial Surgery, vol. 25, no. 5, Oct. 1997, pp. 239–244, https://doi.org/10.1016/s1010-5182(97)80059-5.

Malard, O., et al. “Surgical repair of labial defect.” European Annals of Otorhinolaryngology, Head and Neck Diseases, vol. 127, no. 2, May 2010, pp. 49–62, https://doi.org/10.1016/j.anorl.2010.04.001.
Subtotal Lower Lip Defect With Modified Stairstep Incision Design Modified Stairstep Incision Design With Measurements Six Week Post-operative Follow-up