Advances in Oral and Maxillofacial Surgery 8 (2022) 100324

Contents lists available at ScienceDirect

Advances in Oral and Maxillofacial Surgery

journal homepage: www.sciencedirect.com/journal/advances-in-oral-and-maxillofacial-surgery

Case report

Revision of an upper lip scar following a dog bite

Karl Guy Grégoire Kwedi a, b, *, Ababacar Diegane Faye c, Zilefac Brian Ngokwe b
a
Centre Médical du Palais, Douala, Cameroon
b
Department of Oral Surgery, Maxillofacial Surgery and Periodontology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
c
Department of Head and Neck Surgery, Training and Research Unit of Health Sciences, Iba Der THIAM University, Thiès, Senegal

A R T I C L E I N F O A B S T R A C T

Keywords: Animal bites represent a frequent aetiology of loss of labial substance giving unsightly scars. Repair aims to
Animal bite reconstitute the anatomy by meeting several requirements, aesthetic but also functional. Labial reconstructions
Facial trauma can be performed by well-defined surgical techniques which are particularly numerous. In this work, we present
Scar revision
the correction of an upper lip scar in a 15-year-old male patient.
Cameroon

1. Introduction substance resulted in labial incompetence at rest and facial disfigure­

Animal bites represent a frequent aetiology of loss of labial sub­
stance. Three quarters of the cases involve patients under 15 years of
age. In children, 76 to 80% of severe bites involve the face, more pre­
cisely the middle third (nose, cheeks, upper lip, orbit). The actual inci­
dence of Cameroon animal bites is not known, as many are not reported
[1,2].
Animal bites are mainly dog bites. The dog has powerful jaws and
shakes its head once its grip is secured. In the face, the lesions are most
often tangential. In approximately 5% of cases, labial tissue loss requires
reconstruction [2–4].
The reconstruction of lip defects and sequelae involves many
different surgical techniques. This diversity reflects the difficulty of
repairing this organ [5,6]. In this article, we present the results of our
reconstruction.
2. Case presentation
We report a 16-year-old male patient referred to the Centre Médical
du Palais, Douala, Cameroon, for specialized management of an upper
lip scar. The patient had been bitten two years ago on the upper lip while
playing with their guard dog resulting in a labial scar. Despite the loss of
substance, he had been treated by controlled wound healing resulting in
an unsatisfactory aesthetic result.
Clinically, there was a scar associated with a significant loss of
substance of the upper lip. It was about 1.5 cm long and 1 cm high,
involving the mucocutaneous tissue of the philtral region. The loss of
ment (Fig. 1).
After examination, the patient was scheduled and operated on under
general anesthesia. Aesthetic correction of the lip was performed using a
simple triangular suture-excision technique with the base at the level of
the upper vermilion. The incisions respected the natural limits of this
upper labial subunit. The removed part was inferior to 1/3 of the upper
lip (Fig. 2). The postoperative course was uneventful.
3. Discussion
The lips are formed by two distinct zones: the normal skin and the
vermilion separated by a cutaneous-mucosal demarcation line. They are
composed of three planes: cutaneous, muscular and mucosal [5,6].
Three cutaneous subunits of the upper white lip have been described:
two lateral subunits, located under the nostril openings, medial to the
nasolabial folds and extending to the junction with the mucosa. They are
separated from the medial subunit, the philtrum, by a physiological
thickening, the philtral column [5,6].
Loss of substance and sequelae of the upper lip must be analysed
according to their location: normal skin or vermilion. Reconstruction of
the upper lip is very delicate as it must take into account the aesthetic
subunits and the need to maintain symmetry at the Cupid’s bow to avoid
distortion in relation to the base of the nose. In men, pilosity must be
considered [5,6].
When considering scar revisions, several patient characteristics may
influence the choice and timing of treatment such as: age of the scar, age
of the patient, skin pigmentation, number of scars, education.

* Corresponding author. Centre Médical du Palais, Douala, Cameroon.

E-mail addresses: kwedikarlguy@gmail.com (K.G.G. Kwedi), dieganefayemaxillo@gmail.com (A.D. Faye), brianforever25@yahoo.com (Z. Brian Ngokwe).

https://doi.org/10.1016/j.adoms.2022.100324
Received 8 July 2022; Accepted 13 July 2022
Available online 22 July 2022
2667-1476/© 2022 The Authors. Published by Elsevier Ltd on behalf of British Association of Oral and Maxillofacial Surgeons. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
K.G.G. Kwedi et al.
Fig. 1. Image of centred upper lip scar involving the normal skin
and vermilion.
Fig. 2. Postoperative image after correction of the upper lip scar.
Optimization of healing conditions is essential to ensure a satisfactory
clinical outcome in the initial or secondary management of these lesions
[7–9].
A multitude of surgical techniques are available to improve scars.
These include the Z-plasty, W-plasty, geometrical broken line closures or
straight closures. The simplest option for relaxed skin tension lines is
excision followed by careful repair. Up to one-third of the upper lip can
be sacrificed with a primary wound closure. This technique is well suited
Advances in Oral and Maxillofacial Surgery 8 (2022) 100324
to scars with significant surface irregularities or traumatic tattoos and
along relaxed skin retention lines as in this case presented. Scar tissue
should be excised along with mobilization of adjacent tissue and then
meticulously closed layer by layer [8,9].
4. Conclusion
Some mucocutaneous scars of the lips can be improved by simple
incision-sutures. However, it is imperative to ensure that the various
upper lip subunits are respected. Mastery of the subtleties of wound
healing can minimize postoperative complications.
Informed consent
We received approved consent from the patient’s parent.
Author contribution
KWEDI: Conception and design of study/review/case series, Final
approval and guarantor, of manuscript, FAYE: Acquisition of data: lab­
oratory or clinical/literature search, NGOKWE: Analysis and interpre­
tation of data collected, Drafting of article and/or critical revision.
Declaration of competing interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
References
[1] Siberchicot F, Zwetyenga N, Majoufre-Lefebvre C, Ammar-Khodja M. Étiologies des
pertes de substance des lèvres. Annales de Chirurgie Plastique Esthétique 2002;47:
371–9.
[2] Beltramina G, Kadlub N, Cassier S, Constantinescu G, Vazquez MP, Picard A. Greffe
composite cutanéo muqueuse pour la reconstruction labiale des pertes de substances
par morsure. Annales de chirurgie plastique esthétique 2012;57:292–5.
[3] Braun TL, Maricevich RS. Soft tissue management in facial Trauma. Semin Plast Surg
2017;31:73–9.
[4] Cavalcanti Al, Porto E, Ferreira dos SantosB, Cavalcanti CL, Cavalcanti AFC. Facial
dog bite injuries in children: a case report. Int J Surg Case Rep 2017;41:57–60.
[5] Malard O, Corre P, Jégoux F, Durand N, Dréno B, Beauvillain C, Espitalier F. Surgical
repair of labial defect. Eur Annals Otorhinolaryngol Head Neck Dis 2010;127:49–62.
[6] Rousseau P, Arnaud D, Huguier V, Chemli H, Dhouib M, Bali D, Darsonval V.
Chirurgie réparatrice et esthétique labiale. Annales de chirurgie plastique esthétique
2013;58:601–27.
[7] Fattahi T. Reoperative soft tissue Trauma. Oral Maxillofacial Surg Clin N Am 2011;
23:63–71.
[8] Rieck KL, Jonathan Fillmore W, Ettinger KS. Correction of facial Trauma deformity.
Oral Maxillofacial Surg Clin N Am 2013;25:697–713.
[9] Ardeshirpour F, Shaye DA, Hilger PA. Improving posttraumatic facial scars.
Otolaryngol Clin N Am 2013;46:867–81.