Modified Marionette lip-split incision for bucco-gingival cancer

Selection of incision in anterior bucco-gingival cancer is challenging. Midline vertical incision could lead to lower lip necrosis in cancer surgery due to vascular compromise of labial artery in lesion side. Marionette line incision decreases the risks of lower lip necrosis. However, it leads to oral commissure sagging and subsequent saliva drooling after wide excision and reconstruction. We modified the Marionette line with an upward and oblique manner in the beginning of incision (modified Marionette line incision, MMLI). The results were retrospectively analyzed in this study. A retrospective case series was conducted at Linkou Chang Gung Memorial Hospital (Taiwan), between 2019 and 2022. It comprised individuals diagnosed with oral squamous cell carcinoma (OSCC) at the bucco-gingival complex, and whose tumor was approached by the application of MMLI. Thirteen participants (92.31% male) with bucco-gingival OSCC and verrucous tumor, resected through the application of a MMLI, were included in this study. All the patients did not develop lower lip necrosis after radical surgery and reconstruction. The oral commissure sagging was successfully avoid after adopting MMLI. Lip insufficiency was presented in 2 patients, 1 patient presented drooling as a result of suboptimal defect reconstruction. Lip vermillion notching was observed in 1 case. No major postoperative complications developed after surgeries in all the patients. MMLI represents an effective approach for treatment of extensive buccal/anterior gingival OSCC, since it preserves lower lip vasculature and improves postoperative cosmesis. The commissure sagging and asymmetry were overcome by the modification of Marionette incision line.