Patient-Reported Aesthetic and Functional Outcomes Following Reconstruction of Mohs Defects of the Lip
J. Reed McGraw*1, Annika Deitermann2, Stephanie Lin2, Carolyn Stull2, Daniel Mazzaferro1, Charles Messa1, Corey M. Bascone1, Robyn B. Broach1, H William Higgins2, Christopher Miller2, Stephen J. Kovach1
1Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; 2Department of Dermatology, University of Pennsylvania, Philadelphia, PA
Vermilion lip defects secondary to Mohs micrographic surgery (MMS) present significant challenges to the reconstructive surgeon as the lip is a crucial aesthetic and functional subunit of the face. Patient-reported outcomes of MMS defects of the lip have not been previously evaluated.
A retrospective review of patients who underwent MMS and reconstruction of defects involving the vermilion lip between 2017-2021 was performed. Instruments from the FACE-Q Head and Neck Cancer module were prospectively administered to patients via email. Patients were stratified by the MMS defect size. The impact of defect size on FACE-Q scores was modeled with multivariable linear regressions adjusting for patient demographics and reconstructive technique.
A total of 119 patients met inclusion criteria, and 72 patients completed the FACE-Q survey (response rate: 60.5%). Thirty-one patients (43.0%) had MMS defects smaller than 1.5 cm2, 23 (31.9%) had defects between 1.5 and 3.0 cm2, and 18 (25.0%) had defects larger than 3.0 cm2. Functionally, patients reported the most positive outcomes in speech (98.4 ± 6.0) and eating (97.3 ± 7.9). Patients were most impacted functionally in smiling (88.6 ± 17.2). Patients reported the lowest domain score in appearance distress (74.7 ± 33.6). Increased MMS defect area was predictive of reduced facial appearance (b = -1.7, p = 0.03), eating and drinking (b = -0.8, p = 0.02), and smiling (b = -2.0, p = 0.005) scores. Defect area did not predict reductions in oral competence, speaking, appearance distress, drooling distress, or smiling distress scores. Reconstructive technique did not predict differences in FACE-Q scores.
Patients reported generally positive outcomes following reconstruction of MMS defects of the lip, with many patients experiencing few difficulties with eating, oral competence, and speech. Patients were most negatively impacted by facial appearance distress, likely related to impact on their smiles following reconstruction. Larger defects were predictive of worsened patient-reported outcomes in multiple domains.
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