抄録
A 89-year-old man presented to us with a squamous cell carcinoma of the lower lip. The tumor was 3 7 mm i n diameter, and no lymph nodes could be palpated in the neck (T2N0M0). A radica l fullthickness rectangular shaped excision, including a 10 mm safety margin around the tumor, was performed under general anesthesia. Bilateral oral commissures were preserved at a distance of 7 mm (distance from the angle) from the right side and 3 mm from the left. The excisional defect (85.5%)was immediately reconstructed basically by way of the Webster modification of Bernard cheiloplasty. Since reconstructed commissures tend to form cicatricial contractures and secondary cornmissuroplasty may sometimes be required with this modification, we altered the procedure. (1)Each side of the preserved vermilion with the labial angle was raised as a vermilion flap from the advancement buccal flap, and (2) to decrease the downward tension and to raise the central portion of the advancement buccal flaps we a dded a h orizontal sawed-off t he mental protuberance of t he mand ible. (3) After making the frontal wall of the lower lip using advancement buccal flaps, the raised vermilion flaps were replaced to form a new oral commissure on each side. (4) Stripped mucosal flaps, which are usually used for formation of t he oral c ommissures and the vermilion of the lower lipi n t he Webster modification, were placed between the new oral commissures. No contracture was observed in the new commissure six months postoperatively. The results of this technique were excellent both cosmetically and functionally.
