Abstract / Summary
Well-Differentiated Squamous Cell Carcinoma (WDSCC) of the lower lip is managed by complete oncologic excision with safe margins, appropriate assessment of regional neck, and immediate reconstruction aimed at restoring oral competence, speech, swallowing, and facial symmetry. For extensive lower-lip defects involving the commissure, local flaps may be inadequate because they can cause microstomia or insufficient sphincter support. A 49-year-old male with a 20-year history of kharra/tobacco chewing presented with a painful ulceroproliferative lesion of the lower lip extending to the left oral commissure and gingivobuccal sulcus. Clinical examination showed a 4×3.3×2 cm lesion with restricted mouth opening and no palpable cervical lymphadenopathy. Incisional biopsy confirmed WDSCC. Contrast-enhanced computed tomography was used for locoregional assessment, after which wide local excision with left modified radical neck dissection type I and right supraomohyoid neck dissection levels I-III was performed. The ablative defect was reconstructed using a composite radial forearm free flap incorporating the palmaris longus tendon as a sling to recreate lower-lip support. Histopathology confirmed WDSCC with negative mucosal, skin, and deep margins, Depth Of Invasion (DOI) of 15 mm, positive skin involvement, no lymphovascular or Perineural Invasion (PNI), and 0/15 metastatic lymph nodes, corresponding to pT4aN0Mx. Postoperative recovery was uneventful. At six months of follow-up, the patient had a mouth opening of approximately 40 mm, with satisfactory restoration of oral competence and facial aesthetics. No evidence of recurrence was observed during the follow-up period. The case report provides further evidence in documenting single stage commissure and near total lower lip reconstruction using a tendon incorporated radial forearm flap in a nutritionally vulnerable, medically comorbid patient.