The Establishment Of A New Surgical Approach For Functional Lower Lip-splitting Incision

[Research Objective] A clinical retrospective study was conducted to evaluate the effect of functional lower Lip-splitting incision approach on postoperative facial appearance and neurological function.By evaluating the clinical results and efficacy of this incision,a new surgical approach for functional lower lip-splitting incision was finally established.[Research materials and methods] A retrospective analysis was performed on clinical data of 20 patients who underwent functional lower lip-splitting incision during the period of oral and maxillofacial surgery at the First Affiliated Hospital of Fujian Medical University Hospital from September 2017 to September 2019.Postoperatively,House-Brackmann facial nerve function rating scale and facial dynamic and static fixed-point measurement were used to evaluate facial nerve function,a simple sensory test was used to evaluate the sensory function,and a Patient and Observer Scar Assessment Scale(POSAS)and a Visual Analogue Scale(VAS)were used to evaluate the postoperative facial appearance.Using SPSS 22.0 software to perform Fisher’s exact probability analysis on H-B classification results of patients with different tumor sites.Repeated measurement analysis of variance was used to evaluate the dynamic and static facial measurement data of the face before and after the operation to evaluate the degree of deviation of the lower lip and the corner of the affected mouth.Median descriptive statistics and rank correlation analysis were performed on the results of scar score and appearance satisfaction scores between physicians and patients in the POSAS scar assessment data and VAS scale.P<0.05 was considered to be significant.[Results] Good blood flows in the flap area after the operation in 20 patients.Within 2months after surgery,65% of patients with grade I facial nerve function and 35% of patients with grade II facial nerve function.Fisher exact probability analysis showed no significant difference in facial nerve function in patients with type 4 oral cancer within 2months after surgery(P = 0.659).Within two months to six months postoperatively and after six months postoperatively,the level of neurological function in patients with grade Ⅰ has increased to 80% and 85%,respectively,and no grade III-V patients with severe facial nerve injury were found.Facial dynamic and static fixed-point measurements using single-factor repeated measurement analysis of variance showed that the degree of midline skewness was only significant when the lower lip opened mouth movements before and after surgery(P = 0.008),and there was no obvious abnormality in the corner of mouth movement and the lower lip movement under other conditions.No patients presented complete sensory disturbance after the operation.The sensation of pain,temperature,touch,and pressure in the 6 months after the operation was significantly improved compared with that in the 3 months after the operation,only10% of the patients with negative direction discrimination test were diagnosed,and 25%of the patients showed normal facial sensation in the lower lip about 8 months after the operation.The patient’s scar score(M = 7.5),satisfaction score(M = 8.5),physician scar score(M = 7),and satisfaction score(M = 9)in POSAS scar assessment all showed that facial scars and appearance were good after surgery.Rank correlation analysis showed that patients had a good correlation with the physician’s score(P<0.001),and the evaluation results were relatively objective and reliable.[Conclusion] The functional lower lip-splitting incision approach can effectively protect the blood vessels in the corner of the mouth and the mandibular limbs of the facial nerve.The good oral function can be obtained after surgery,which can prevent the mouth corners from drooling and improve the quality of life of tumor patients.The hidden scars after making an incision along with the "puppet pattern" may be more beneficial to elderly patients with loose skin.