PMC3287129_01
Pre-operative view (frontal view, worm eye view, left and right lateral facial view).
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F1
Four months prior to admission, she had a proliferative mass on the left lower lip that rapidly grew to involve the circumoral region and the left buccal mucosa (Figure 1).
Head and neck computed tomography (CT) examination of patient. This CT scan showed irregular lobulated contour, heterogenous enhancing mass involving upper and lower lip (coronal view, axial view and sagittal view).
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F2
A computed tomography (CT) scan revealed an irregular lobulated contour, heterogeneous enhancing mass involving her upper and lower lips, predominantly on the left side but crossing the midline to the right side of the upper lip (Figure 2).
Intra-operative after en bloc resection (frontal and lateral view).
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F3
Only 0.5 cm of the upper lip and 1 cm of the lower lip could be preserved (Figure 3).
Immediate post-operative view after simultaneous reconstruction of both upper and lower lips and diagram showed local flaps coverage. Illustration shows left nasolabial-cheek cervicofacial rotational-advancement flap (A-A', B-B' and C-C'), right cheek advancement with perialar crescent flap. Reconstruction of the lower lip with bilateral labiomental advancement flap (shaded areas were excised) (Red line shows area en bloc resection).
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F4
Internal lining of the left buccal area was achieved with skin grafts (Figure 4).
Histopathological study of a tissue specimen taken from the lower lip. These slides show a solid nest of polygonal cells with abundant bright-eosinophilic cytoplasm, many keratin pearls, intact intercellular bridges, few mitotic figures, and modest pleomorphic nuclei. (H&E stain, x100 and x400).
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F5
The pathology report showed well differentiated squamous cell carcinoma with lymphovascular invasion (Figure 5).
Two weeks post-operative.
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F6
Only the inferior border of the upper flap became necrotic and it healed with dressings (Figure 6).
Five months post-operative with tumor recurrence on left cheek.
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F7
Five months later, the patient presented with an ulcerative mass at her left cheek, left axillary lymph node and dyspnea (Figure 7).