Lower Lip Squamous Cell Carcinoma: Surgical Management and Reconstruction Using Bilateral Bernard-Webster Flap

Squamous cell carcinoma (SCC) of the lower lip is a common oral malignancy, strongly linked to environmental and lifestyle factors such as ultraviolet radiation and tobacco use. Early diagnosis and surgical excision remain the cornerstone of management. Reconstruction after wide excision is crucial to restore aesthetics and function. The Bernard- Webster flap provides a reliable single-stage solution for large central lower lip defects. A 61-year-old Nepalese female presented with a painless, progressive ulcer on the lower lip for five months. She had no history of tobacco use or significant sun exposure. Biopsy confirmed squamous cell carcinoma. Contrast-enhanced CT revealed a 2.2 × 1.4 × 1.8 cm lesion without deep invasion or significant nodal involvement, staged as T2N0M0. The patient underwent wide local excision with right modified radical neck dissection (MRND type III). The resulting defect was reconstructed using a bilateral Bernard-Webster flap. Postoperative recovery was uneventful. The patient resumed oral intake on day one, and the surgical site healed without infection, hematoma, or wound dehiscence. She was discharged on postoperative day three. Sutures were removed on day 14, with healthy scar formation and no gaping. At one-month follow-up, the patient demonstrated good lip competence, intact oral continence, and clear speech. By the third postoperative month, scar maturation was satisfactory, cosmetic appearance was acceptable, and functional outcomes including mastication, swallowing, and articulation were preserved. No local recurrence, nodal disease, or distant metastasis were detected during this follow-up period. This case demonstrates that wide excision with MRND and bilateral Bernard-Webster flap reconstruction is an effective approach for lower lip SCC, offering oncological safety, functional restoration, and satisfactory aesthetics. Long-term follow-up remains essential.