Managing lip large papilloma extirpation defect by arterialized advancement vermilion flap

Abstract

The close resemblance of squamous papilloma with verrucous carcinoma and the chief etiological factor associated with its development, the human papillomavirus (HPV) raises a doubt about its close association with malignancy. The best way to treat HPV growths is surgical removal and assessment of lesion by histopathology. The defect needs reconstruction with full function and aesthetic outlook. Thirty-seven years old young man with history of tobacco chewing developed slow growing papilloma in upper lip in one year. It was excised fully and the defect was repaired by arterialized lip vermilion mucosal flap based on slightly tortuous labial vessel and so the flap could be elastically stretched even up to fifty percent of lip length and applied successfully. Same patient developed papilloma in lower lip as a separate primary after two years of nonrecurrence of previous operated upper lip papilloma. Lower lip lesion was excised similarly and repaired with same type of vermilion mucosal advancement flap from adjacent part of lower lip defect created. The post-operative period was uneventful and after three years of last operation there is no recurrence in either lip. Vermilion flap which is based on labial artery containing composite tissue comprising of mucosa and portion of orbicularis muscle mainly has been utilized to reconstruct the post excision papilloma lip defect with excellent functional and aesthetic results. There was no microstomia. It is single stage not involving donor site like tongue or cheek mucosa and is good upto half of lower lip defects.