40527 Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander)

Name of the Procedure:

Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander)

Summary

The Abbe-Estlander procedure involves surgically removing a portion of the lip (full thickness) and reconstructing it using tissue from the opposite lip. This method helps to ensure the lips function correctly and look natural after the excision.

Purpose

This procedure is primarily used to address conditions like tumors, trauma, or congenital abnormalities affecting the lip. The goal is to restore normal appearance and function, allowing for proper speech and eating.

Indications

• Presence of malignant or benign tumors on the lip
• Severe trauma resulting in significant tissue loss
• Congenital deformities affecting lip function and appearance
• Persistent lip lesions that do not respond to other treatments

Preparation

• Patients might need to fast for a few hours before the procedure.
• Any medications that increase bleeding risk should be adjusted as per the doctor's advice.
• Preoperative assessments may include blood tests and imaging studies (e.g., MRI or CT scan) to plan the surgery.

Procedure Description

1. The patient is placed under general anesthesia or local anesthesia with sedation.
2. The surgeon carefully marks the area for both the excision and the donor site on the opposite lip.
3. An incision is made to remove the diseased or damaged tissue from the lip.
4. A corresponding flap of tissue is taken from the opposite lip and rotated or transferred to cover the excised area.
5. The flap is carefully sutured into place to ensure proper alignment and function.
6. The donor site is also sutured, ensuring cosmetic and functional effectiveness.
7. The surgical site is monitored for proper blood flow and healing.

Duration

The procedure typically takes about 1 to 3 hours, depending on the complexity of the case.

Setting

This surgery is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Plastic or Oral and Maxillofacial Surgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Scarring and cosmetic dissatisfaction
• Nerve damage resulting in temporary or permanent numbness
• Flap failure due to poor blood supply

Benefits

• Restoration of normal lip appearance and function
• Improved ability to speak, eat, and form facial expressions
• Enhanced self-esteem and quality of life Expected benefits can usually be noticed within a few weeks as healing progresses.

Recovery

• Patients will need to follow a soft or liquid diet initially.
• Pain management with prescribed medications.
• Keeping the surgical site clean and following dressing change protocols.
• Avoid strenuous activities for a few weeks.
• A follow-up appointment will be scheduled to monitor healing.

Alternatives

• Radiation or chemotherapy for malignant lip lesions.
• Less extensive surgical procedures if the condition is less severe.
• Non-surgical management for minor deformities or lesions. Each alternative has its pros and cons, including varying degrees of effectiveness and recovery times.

Patient Experience

During the procedure, the patient will be under anesthesia and not experience pain. Postoperatively, there may be swelling, bruising, and discomfort, which can be managed with medication. Full recovery and return to normal activities typically occur within several weeks, though this can vary based on individual cases.