Lower Lip Reconstruction after Wide Excision of a Malignancy with Barrel-Shaped Excision or the Webster Modification of the Bernard Operation
A 77-year-old man had a persistent wound that waxed and waned on the lower lip for 7 months. The patient underwent a biopsy at the Department of Dermatology of our hospital, and the lesion was diagnosed as squamous cell carcinoma. The patient was then referred to the authors for treatment. Almost no left vermilion tissue (less than 1/4) was expected to remain after excision, but some of the right vermilion tissue (more than 1/4) was expected to remain. Therefore, the patient underwent the left unilateral Webster modification of the Bernard operation. On the preoperative CT scans of the neck, the patient had neck lymph node involvement in the left submandibular region. The patient additionally underwent neck lymph node dissection at the Department of Otorhinolaryngology of our hospital after reconstruction surgery. The patient had excellent treatment outcomes of the lower lip. After 4 months, however, metastasis of the left neck region was detected. Therefore, the patient had to undergo an additional operation at the Department of Otorhinolaryngology of our institution. Chemotherapy and radiotherapy were also performed ().