Lip Cancer: Treatment and Reconstruction

165 Pages·2014·12.137 MB·English

by  Michael Han DDS, Jasjit Dillon DDS, MD, FDSRCS, BDS (auth.), Antonia Kolokythas (eds.)

Antonia Kolokythas
Editor
Lip Cancer
Treatment and
Reconstruction
123
Lip Cancer

Antonia Kolokythas
Editor
Lip Cancer
Treatment and Reconstruction
Editor
Antonia Kolokythas, DDS, MSc
Department of Oral
and Maxillofacial Surgery
University of Illinois at Chicago
Chicago, IL
USA
ISBN 978-3-642-38179-9 ISBN 978-3-642-38180-5 (eBook)
DOI 10.1007/978-3-642-38180-5
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2013950982
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Pref ace
Lip is a very common site of malignancy in the head and neck region.
Although these cancers if treated early have high cure rates, a signifi cant
percentage demonstrate aggressive behavior. Equally important to treatment
is reconstruction post-surgery that can be challenging as the lip is a prominent
facial esthetic feature and an important functional feature of the face.
Maxillofacial Surgeons are involved in the management of patients with lip
cancer and premalignant lesions on regular basis. Several well written com-
prehensive reference textbooks exist and cover extensively cancers of the
head and neck as well as oral cavity with only little reference specifi cally to
lip cancer treatment and reconstruction. L ip Cancer: Treatment and
Reconstruction is a comprehensive reference textbook to cover the treatment
of lip cancer and premalignant lesions, reconstruction of the lip post ablative
surgery as well as potential complications of treatment and reconstruction.
The clear purpose of this textbook is to provide an easy to follow, comprehen-
sive, well organized approach to management of lip cancer from diagnosis to
treatment as well as management of potential associated complications. L ip
Cancer: Treatment and Reconstruction provides an organized and systemic
approach to lip cancer for residents in training as well as those clinicians practic-
ing full scope oral and maxillofacial surgery. Illustrations, clinical and radio-
graphic material are employed to augment the text contents of the textbook. A
thorough and critical evaluation of the current literature as well as the clinical
expertise of the contributors are the sources for the information in this textbook.
The contributors for each chapter have been chosen based on their unique
training and scope of practice. Their contribution refl ects their extensive
experience and wealth of knowledge of the subject. Each author has done an
outstanding job of proving all information pertinent to the contents of their
chapter and organizing it in an easy to understand and read format. I am truly
appreciative for their contribution to this textbook that could not have been
otherwise possible. I am hopeful that this textbook will provide all necessary
knowledge to the oral and maxillofacial surgeon in training and in practice to
appropriately care for the lip cancer patient.
Surgeons must be very careful. When they take the knife!, underneath their fi ne
incisions, stirs the Culprit—Life!
–Emily Dickinson (1830–1886)
American poet.
Chicago, IL, USA Antonia Kolokythas, DDS, MSc
v

Contents
1 Lip Cancer: General Considerations. . . . . . . . . . . . . . . . . . . . . 1
Michael Han and Jasjit Dillon
2 Anatomic Considerations of the Lips. . . . . . . . . . . . . . . . . . . . . 5
Thomas Schlieve and Antonia Kolokythas
3 Premalignant Conditions of the Lip Actinic Cheilitis . . . . . . . 11
Darren P. Cox
4 Squamous Cell Carcinoma of the Lip . . . . . . . . . . . . . . . . . . . . 17
Andrew Salama
5 Surgical Management of Squamous
Cell Carcinoma of the Lip. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Robert A. Ord
6 Radiotherapy for Cancers of the Lip. . . . . . . . . . . . . . . . . . . . . 37
Michael T. Spiotto
7 Chemotherapy for Squamous Cell Carcinoma of the Lip . . . . 51
Gowri Ramadas and Lucy F. Chen
8 Reconstruction Considerations Based on Size of Defect . . . . . 59
David E. Urbanek and Jonathan S. Bailey
9 Reconstruction of Complex Lip Defects . . . . . . . . . . . . . . . . . . 79
Beomjune Kim and D. David Kim
10 Microvascular Lip Reconstruction. . . . . . . . . . . . . . . . . . . . . . . 115
Carlos A. Ramirez and Rui Fernandes
11 Complications Associated with Treatment of Lip Cancer. . . . 127
Shawn McClure and Jesse Jakubowski
12 Complications Associated with Reconstruction
of Lip Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Mohammed Qaisi and Joshua E. Lubek
13 Complications Associated with Radiotherapy. . . . . . . . . . . . . . 147
Abhishek A. Solanki and Andrew H. Howard
vii
viii Contents
14 Non-epidermoid Malignancies of the Lips. . . . . . . . . . . . . . . . . 153
Antonia Kolokythas
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Lip Cancer: General Considerations 1
Michael Han and Jasjit Dillon
1.1 Introduction of Diseases for Oncology Manual, however,
includes cancers of the mucosal surface in a sub-
The lips play crucial roles in speech, mastication, category of lip cancers, together with cancers of
swallowing, maintenance of dental arch integrity, the oral cavity and pharynx [6 ]. The variation in
and esthetics. Therefore, cancers of the lip can classifi cation is due to the differences in histo-
lead to various functional and esthetic problems. logic characteristics as well as in the environment
Due to their location, lip cancers are easily detected the cutaneous and mucosal portions of the lip are
and diagnosed at relatively early stages. As with exposed to (in general, carcinoma of the vermil-
all pathology of the oral and maxillofacial region, ion is thought be pathophysiologically differ
the role of the dental professional in early detec- from intraoral cancers and be closer to carcinoma
tion of lip cancers cannot be overemphasized. of skin). Unfortunately, confusion exists in the
Cancers of the lip occupy up to 30 % of all data regarding lip cancers due to such variations
malignant tumors of the oral cavity [1 – 3 ]. The and inconsistencies in classifi cation.
vast majority of malignancies of the lips are
squamous cell carcinoma (SCC), followed by
melanoma and minor salivary gland carcinomas 1.2 Epidemiology
[ 4 ]. The American Joint Committee on Cancer
(AJCC) defi nes the boundaries of the lips as “the Cancers of the lip make up to 30 % of all malig-
junction of the vermilion border with the skin and nant tumors of the oral cavity. They also predom-
[including] only the vermilion surface or that inantly occur in the lower lip. The lower lip is
portion of the lip that comes into contact with the affected in 85–95 % of cases, compared to the
opposing lip …joined at the commissures of the much lower incidences found in the upper lip
mouth,” considering only the cutaneous portions (2–7 %) and lip commissure (1–4 %) [ 3 ]. This is
of the lips [5 ]. The Union International Contre le presumed to be due to the higher risk of sun
Cancer (UICC) uses the same defi nition to clas- exposure in the lower lip associated with its ana-
sify lip cancers. The International Classifi cation tomical location and orientation.
The incidence of lip cancer varies considerably
depending on the population. In the USA, the
average incidence is approximately 1.8 per
M. Han, DDS (cid:129) J. Dillon , DDS, MD,
FDSRCS, BDS (*) 100,000; however, signifi cantly higher rates are
Department of Oral and Maxillofacial Surgery, seen in certain parts of the country (12 per 100,000
University of Washington ,
in Utah) [7 , 8 ]. Greater variations in incidence are
B-241 Health Sciences Bldg ,
seen among different regions and countries. For
357134 , Seattle , WA 98195-7134 , USA
e-mail: [email protected] example, the incidence in Southern Australia is
A. Kolokythas (ed.), Lip Cancer, DOI 10.1007/978-3-642-38180-5_1, 1
© Springer-Verlag Berlin Heidelberg 2014