Preserving the Modiolus: Enhanced Functional and Aesthetic Restoration with the Modified Bernard-Webster Technique in Lip Reconstruction.

Abstract

Optimal functional and aesthetic reconstruction of the lip remains a surgical challenge. Traditional Bernard-Webster procedures effectively reconstruct moderate-to-large defects but often disrupt the modiolus and orbicularis oris muscle, increasing the risk of oral incompetence and long-term functional impairment. This study presents a modiolus-preserving modification of the Bernard-Webster technique designed to maintain perioral neuromuscular integrity and optimize functional recovery. Between 2023 and 2025, 16 patients successfully underwent lower lip reconstruction using this modified technique. Defects ranged from 33.3% to 80% of the lower lip length. All reconstructions were successful, with primary healing and no major complications or tumor recurrence. Transient early functional impairment and neurosensory deficits were observed in 56.25% and 37.5% of patients, respectively, with complete resolution by 12 months. Oral competence and speech intelligibility were preserved in all patients. Patient and Observer Scar Assessment Scale (POSAS) scores confirmed favorable aesthetic outcomes. This modified technique offers a reliable reconstructive option characterized by modiolus preservation, stable blood supply, and favorable functional recovery. We recommend it for full-thickness lower lip defects involving more than 33.3% of lip length, particularly in elderly patients with sufficient cheek laxity.