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Oral-Lip Mucosa Graft

This page concerns oral-lip mucosa, usually the inner lower lip, as an additional donor for urethral reconstruction. Cheek and lingual mucosa have stronger contemporary comparative support. Lower-lip harvest remains useful in selected patients, with particular attention to mental-nerve symptoms, donor area and lip function.[1][2]

Name the donor explicitly. “Labial” can refer to oral lip or vulvar labia, and some papers call lower-lip grafts “buccal.” Confirm the operative harvest site before applying results. An oral-lip free graft differs from a labia-majora fasciocutaneous flap.

See Grafts in GU Reconstruction, The Oral Cavity, Buccal Mucosa and Lingual Mucosa.

Anatomy and Harvest Planning​

The inner lip has nonkeratinized stratified squamous epithelium, connective tissue and minor salivary glands superficial to orbicularis oris. This resembles other oral lining mucosa, but the tissues are not histologically identical. A buccal-versus-lingual histology study cannot supply lip-specific thickness or vascular-density values.[3][4]

The lower lip and chin receive sensation through the mental nerve, a terminal branch of the inferior alveolar nerve (V3). Upper-lip sensation comes from the infraorbital nerve (V2). The facial artery's labial branches supply the lips. Preserve the supporting muscle and avoid deep dissection around sensory branches.[14][5][6]

Cadaveric studies show variable mental-nerve branching and cross-midline communications. These observations help explain anatomy; they do not guarantee sensory recovery after unilateral injury or define a uniformly safe harvest plane.[5][6]

Practical Sequence​

  1. Examine oral health, baseline sensation, previous graft sites, mouth opening and lip contour. Match the donor plan to the measured recipient defect and discuss alternatives.
  2. Evert the lip and mark a mucosal graft that preserves the vermilion, commissures and adequate surrounding mucosa. Avoid treating published defect lengths as fixed donor-site limits.
  3. Elevate mucosa and supporting connective tissue with controlled superficial dissection; preserve orbicularis oris and protect sensory branches.
  4. Obtain hemostasis and manage the defect without excessive tension or distortion. Closure technique depends on the defect; cheek closure studies do not establish the best method for oral-lip wounds.
  5. Prepare and inset the free graft on a vascular recipient bed. Its blood supply must be re-established; native vascularity does not guarantee take.[3][2][7]

Dessanti's 12-case historical series used upper and/or lower lip alone in seven patients and combined lip/bladder mucosa in five. The 3.5–6 cm and 6–13 cm ranges described urethral gaps, not anatomical harvest maxima. There was one fistula and four early stenoses requiring dilation.[7]

Reconstructive Evidence​

Castagnetti 2009 reviewed 115 children and adults with heterogeneous anterior urethral defects. Reported success was 66% at median 36 months; 39 patients had complications and 18 required additional surgery. Tubular graft configuration was associated with more complications. These historical data favor caution with a one-stage free tube but must not be compared directly with modern cheek-graft success percentages from different populations. Later tubularization of a healed first-stage graft is a different reconstruction.[8]

Caldamone 1998 included 22 complex reconstructions using cheek, lower lip or combinations; 16 were tubular and six onlay. Nine developed urethral complications. It is mixed-donor evidence, not a lower-lip-only outcome series.[9]

The 2025 Jena report describes 204 female “labial mucosal” graft urethroplasties. Its accessible abstract does not specify the anatomical donor sufficiently to establish an oral-lip series. It should not be used to recommend lower-lip harvest or claim a lower-lip-specific 93.5% success rate without confirmation from the full operative report.[10]

Similarly, buccal-graft reports in VVF repair or vaginoplasty do not automatically establish oral-lip effectiveness. Use the specific donor and procedure described by the source; the buccal graft hub covers those applications.

Donor-Site Morbidity​

StudyPopulation and findingLimit
Kamp 200524 patients; 12 lower-lip or combined lip/cheek harvests versus 12 cheek harvests. Longer pain and numbness in the group including lip harvestSmall nonrandomized study; the first group was not exclusively lower lip
Jang 200540 patients: 17 lip, 19 cheek, four combined. More persistent discomfort, sensory deficit and salivary change after lip harvestReported contractures in 1/17 lip and 5/19 cheek patients are descriptive; they do not prove a general protective effect against trismus
Castagnetti 200878 children/adults with mixed oral donors; sensory deficits were found in 28% at long-term assessmentNot a lip-specific incidence; objective findings and perceived bother differed
Tekin 202553 eligible pediatric patients, 21 available for objective testing; tested sensory measures were similar to controlsSelective participation and small sample; reassuring findings do not establish universal mental-nerve safety

Sources:[2][11][12][13]

Counsel about bleeding, pain, numbness, altered oral function, tightness and possible lip contour change. Discuss the patient's need for speech, eating and other oral activities. Avoid promising “scarless” healing, infection immunity or sensory recovery by a fixed date. A healthy, accessible lip donor is useful when its benefits outweigh these trade-offs; it is not established as the preferred graft for female urethral reconstruction.[3][2]

References​

1. Wessells H, Morey A, Souter L, Rahimi L, Vanni A. Urethral stricture disease guideline amendment (2023). J Urol. 2023;210(1):64–71. doi:10.1097/JU.0000000000003482

2. Kamp S, Knoll T, Osman M, et al. Donor-site morbidity in buccal mucosa urethroplasty: lower lip or inner cheek? BJU Int. 2005;96(4):619–23. doi:10.1111/j.1464-410X.2005.05695.x

3. Markiewicz MR, DeSantis JL, Margarone JE, Pogrel MA, Chuang SK. Morbidity associated with oral mucosa harvest for urological reconstruction: an overview. J Oral Maxillofac Surg. 2008;66(4):739–44. doi:10.1016/j.joms.2007.11.023

4. Campos-Juanatey F, Azueta Etxebarria A, Calleja Hermosa P, et al. Histological comparison of buccal and lingual mucosa grafts for urethroplasty: do they share tissue structures and vascular supply? J Clin Med. 2022;11(7):2064. doi:10.3390/jcm11072064

5. Won SY, Yang HM, Woo HS, et al. Neuroanastomosis and the innervation territory of the mental nerve. Clin Anat. 2014;27(4):598–602. doi:10.1002/ca.22310

6. Toure G. Mental nerves in the lower lip: anatomical basis for the recovery of sensation following inferior alveolar nerve damage. Plast Reconstr Surg. 2023;152(2):413–20. doi:10.1097/PRS.0000000000010241

7. Dessanti A, Porcu A, Scanu AM, Dettori G, Caccia G. Labial mucosa and combined labial / bladder mucosa free graft for urethral reconstruction. J Pediatr Surg. 1995;30(11):1554–6. doi:10.1016/0022-3468(95)90155-8

8. Castagnetti M, Rigamonti W. Aptness and complications of labial mucosa grafts for the repair of anterior urethral defects in children and adults: single centre experience with 115 cases. World J Urol. 2009;27(6):799–803. doi:10.1007/s00345-009-0401-5

9. Caldamone AA, Edstrom LE, Koyle MA, Rabinowitz R, Hulbert WC. Buccal mucosal grafts for urethral reconstruction. Urology. 1998;51(5A Suppl):15–9. doi:10.1016/s0090-4295(98)00088-0

10. Jena AK, Jena R, Madhavan M, Madhavan K. Dorsal onlay labial mucosal graft urethroplasty in female urethral stricture: outcomes of over 200 cases from a single surgeon. Urology. 2025;204:216–223. doi:10.1016/j.urology.2025.05.040

11. Jang TL, Erickson B, Medendorp A, Gonzalez CM. Comparison of donor site intraoral morbidity after mucosal graft harvesting for urethral reconstruction. Urology. 2005;66(4):716–20. doi:10.1016/j.urology.2005.04.045

12. Castagnetti M, Ghirardo V, Capizzi A, Andretta M, Rigamonti W. Donor site outcome after oral mucosa harvest for urethroplasty in children and adults. J Urol. 2008;180(6):2624–8. doi:10.1016/j.juro.2008.08.053

13. Tekin A, Tiryaki S, Avcı D, Ulman İ. Lower lip complications: myth or reality? A case-control study on sensory outcomes after buccal mucosa grafting. Urology. 2025;published online. doi:10.1016/j.urology.2025.06.061

14. Baumann D, Robb G. Lip reconstruction. Semin Plast Surg. 2008;22:269–280. doi:10.1055/s-0028-1095886