- 期刊
- OpenAccess
Reconstruction for Mouth Angle Defect-Tips for Avoiding Pitfalls
摘要
Background: Oral cancer is frequently involved with defects of lip and commissure. How to maintain the continuity of orbicularis oris musculature that is anchored to the modiolus is the key to maintaining oral competency. There are many techniques to reconstruct the defects; however, there are often conflicts between oral competence and microstomia, as well as the issue of cosmetic results after repair. Methods: A literature review and clinical review. Results: Since commissure defects are always accompanied with variable amounts of lip defect, our approach to commissure reconstruction is built upon existing algorithms for lip reconstruction and is categorized in terms of the percentage of lip loss. Oral sphincter was defined as a complete circumference (200%) formed by the upper lip (100%) and the lower lip (100%), as previously reported. Orocutaneous defects with commissure defect are classified as follows: those with the lip defect size less than 30/200% are defined as small defects, those with the lip defect size from 30/200% to 60/200% are defined as moderate defects, those with the lip defect size larger than 60/200 to 100/200% are defined as large defects, and those with the lip defect size involving two commissures over 100/200% are defined as huge defects. Conclusions: We have summarized and presented our approach to maximize cosmetic and functional results for patients with varying degrees of lip defect. Functionally, the continuity of orbicularis oris musculature that is anchored to the modiolus is the key to maintaining oral competency. In the case of a free flap reconstruction, serial excision of mismatched flap and the creation of a new commissure can be done in secondary procedures to achieve better functional and aesthetic results.