Modified Bilateral Neurovascular Cheek Flap: Functional Reconstruction of Extensive Lower Lip Defects

Prevention and treatment of microstomia

The mouth, located in the lower third of the face, is a uniquely visible structure. It serves as a vital organ both aesthetically and functionally, playing a key role in speech, expression, and fundamental oral functions. Consequently, any alterations or defects in its shape, due to various causes, can lead to aesthetic and functional deficiencies. These issues may also result in challenges with social interactions and a decrease in confidence. In cases of microstomia, various surgical approaches are proposed based on the location, extent, shape, and cause of the defect, leading to numerous case reports. Plastic surgeons are proficient in oral reconstruction; however, cases of microstomia are relatively rare, which reduces their familiarity and interest in these cases. Additionally, preferences for oral size and shape vary according to factors such as geographical region and ethnicity, further complicating the functional definition of microstomia. Therefore, both subjective patient and physician judgments play crucial roles in the diagnosis and treatment of microstomia, as these may vary depending on individual and societal aspects. This review aims to classify the various causes and definitions of microstomia, as well as its non-surgical and surgical treatment options, with the goal of the treatment of this condition.

Single-stage reconstruction of traumatic lower lip defects with chin island myocutaneous and labial mucosal flap

In the present study of eight cases of traumatic lower lip defects, the reconstruction was achieved in a single stage by V-Y advancement island chin myocutaneous flap and labial mucosal advancement flap. There are many methods described for the reconstruction of small-to-large size of lower lip defects from straight-line closure of small defects to local flaps and free flaps for large defects. V-Y advanced chin flap has been reported previously also for the repair of lower lip defect with varying results. The vermilion reconstruction in others reported cases was done with the free mucosal grafts, V-Y labial mucosa advancement, or pedicled tongue flaps. Tongue flap is a two-stage procedure with esthetically unnatural look and an irregular surface of the vermilion. The free mucosa graft showed necrosis partial or complete resulting in irregular surface of vermilion and notching in the lip. V-Y labial mucosa advancement was done more for a small defect of the lip only. In the present series, we have repaired the vermilion of the lip by labial mucosal advancement flap, muscle by advancement of orbicularis oris from chin flap, and skin by V-Y advancement of island myocutaneous chin flap. Our results showed normal oral size with no evidence of microstoma or commissural distortion; oral competence was good with normal sphincteric function. The vermilion reconstructed had normal color and sensation. Lip seal was very good without notching defect in the vermilion. Drooling of saliva or speech defect was not noticed. The facial expressions and the look of the face were near normal. Hence, esthetically and functionally, the results were good without any irregularity or notching of the lip along with no incidence of drooling of saliva. We think that this technique may be considered as a procedure of choice for managing the moderate-to-large post traumatic defects of the lower lip. It is good esthetically and functionally besides being single stage for reconstructing moderate-to-large defects of the lower lip and is satisfying to the patient.