Abstract

Squamous cell carcinoma (SCC) of the lower lip is the most common oral cavity malignancy in the world having less than 20% occult metastasis. A 60-year-old male patient presented with a gradually progressive UPG over the lower lip for 3 years with occasional bleeding. On examination, its approximate size was 9.5 x 4 cm with depth of invasion of 12 mm, extending from right angle to left angle of mouth, anteriorly from 2 cm inferior to vermillion border and posteriorly 2cm short of lower gingivo-labial sulcus. The lesion was clinically staged as cT3N0M0 after wedge biopsy report showed early invasive SCC. As per NCCN guidelines, a WLE + bilateral selective neck dissection (I-III) was done with FRAFF reconstruction under general anesthesia. Unfortunately, the FRAFF devitalized even after re-exploration and re-anastomosis. Due to technical difficulties and precision of skill required for local flaps, we have utilized a right lateral forehead flap for the 2nd sitting reconstruction of the lower lip. STSG was used for donor site reconstruction. Post-op cosmesis of both the lower lip and forehead donor site was satisfactory and oral competence was good with a karnofsky score of 100.