A Novel Technique That Protects the Lips during Orthognathic Surgery.

Serious lip injuries can occur during orthognathic surgery. Although an Angle Wider device, which is commonly used during orthognathic surgery, provides some lip protection, it leaves more than half of the lip exposed to surgical instruments. Here, we describe a novel technique to protect the entire upper and lower lips during orthognathic surgery using a minilaparotomy wound edge protector (Lap-Protector). We used this method in 60 patients who have undergone orthognathic surgeries such as sagittal split ramus osteotomy and Le Fort I osteotomy since 2009, and no lip injuries have occurred. Although this technique can be somewhat challenging at first and creates some difficulty in exposing the surgical field on the lateral side, we believe that using a wound edge protector minimizes the risk of lip injury during orthognathic surgery.

Although lip injuries in orthognathic surgery are typically minor, serious complications occur in some cases.[1] The Angle Wider device, which is used to open the mouth wider during orthognathic surgery, offers some protection for the lips. However, this device is not optimal for lip protection because of its shape (Fig. 1A), which leaves more than half of the lip exposed to the risk of injury from surgical instruments (Fig. 1B). In an attempt to solve this problem, we tested a wound edge protector that is commonly used in minilaparotomy procedures.[2-4] Here, we describe a novel technique using this device to protect the upper and lower lips during orthognathic surgery.

Fig. 1.

A, Photograph of an Angle Wider device, which leaves a large part of the upper and lower lips exposed during orthognathic surgery, increasing the risk of lip injury. B, Photograph of an upper lip scar made by an electrosurgical knife during orthognathic surgery. In this case, we had used an Angle Wider device to protect the lips during surgery.

Of the many types of wound edge protectors available, we chose the Lap-Protector (catalog number, 9908T; Hakko Co., Nagano, Japan) because its size and design are ideal for lip protection. The Lap-Protector (Hakko Co.) consists of a large flexible ring (12-cm diameter) and a small flexible ring (10-cm diameter) connected by a thin silicone rubber membrane (Fig. 2A). We inserted the small ring in the patient’s oral cavity, so that the inner small ring and outer large ring of the wound edge protector could be folded around the lips (See video, Supplemental Digital Content 1, which demonstrates how to insert the Lap-Protector into the mouth. The small ring of the Lap-Protector is inserted into patient’s oral cavity, so that the 2 rings enclose the lips, http://links.lww.com/PRSGO/A296). The silicone rubber membrane protects the entire upper and lower lips, and its tension widens the mouth to enlarge the operative field (Fig. 2B; See video, Supplemental Digital Content 2, which shows the silicone rubber membrane that protects the entire upper and lower lips and enlarges the operative field. This video shows the stability of the Lap-Protector during surgery, http://links.lww.com/PRSGO/A297). We used this method in 60 patients who underwent orthognathic surgeries such as sagittal split ramus osteotomy and Le Fort I osteotomy from April 2009 to December 2015, and no lip injuries occurred.

Fig. 2.

A, Illustration of the Lap-Protector device, which consists of 2 flexible rings and a thin silicone rubber membrane. The diameter of the large ring is 12 cm, whereas that of the small ring is 10 cm. B, Photograph of the Lap-Protector after insertion. We insert the small ring into the patient’s oral cavity and fold the flexible rings to enclose the lips. The silicone rubber membrane protects the entire upper and lower lips, and its tension widens the mouth to enlarge the operative field.

See video, Supplemental Digital Content 1, which demonstrates how to insert the Lap-Protector into the mouth. The small ring of the Lap-Protector is inserted into patient’s oral cavity so that the 2 rings enclose the lips, http://links.lww.com/PRSGO/A296.

See video, Supplemental Digital Content 2, which shows the silicone rubber membrane that protects the entire upper and lower lips and enlarges the operative field. This video shows the stability of the Lap-Protector during surgery, http://links.lww.com/PRSGO/A297.

One limitation of this method is the difficulty of exposing the surgical field on the lateral side, especially during plate fixation in the mandible, because the tension of the silicone rubber membrane is relatively strong. We, therefore, remove the wound edge protector when we fix the plate to the lateral side of mandible. In addition, learning this technique can be somewhat challenging. The Lap-Protector (Hakko Co.) works well to protect the lips and exposes the operative field during orthognathic surgery, although it creates a slightly tight window. There may be another type of wound edge protector that is better suited to this purpose. We believe that using a wound edge protector minimizes the risk of lip injury during surgery and makes orthognathic surgery less stressful.