Ventral tongue myomucosal flap: a suitable choice for shaved lower vermilion border reconstruction

Squamous cell carcinoma (SCC) or verrocous carcinoma (VC) occurs frequently on the border of the lower lip and surgical excision is the mainstay of treatment. The vermilion border area is difficult to reconstruct and is very complex both morphologically and anatomically. Various reconstructive approaches for defects of the vermilion border have been described. However, for esthetics, reconstruction of the vermilion border defect by tissue of normal texture and color is paramount.We used a ventral myomucosal tongue flap for reconstruction of the vermilion border after radical excision of squamous cell carcinomas of the lip in 15 patients with labial carcinoma. The tumor was resected with a safe margin (1 cm in SCC and 0.5 cm in VC) in an approximately rectangular shape. Free-border confirmation was done using frozen section. A longitudinal strip of the free border of the tongue nonkeratinized mucosal layer with submucosal muscular layers of the tongue including the terminal branch of the lingual artery was raised. This strip extended to the angles of the mouth to cover the defect. The mucosal or myomucosal flap of the ventral tongue is designed according to the shape and size of a vermilion defect. The vermilion and subcutaneous tissue are incised, and the specimen is sent for histopathological free-border confirmation by frozen section. The flap is sutured in 2 layers, joining the mucosal border of the tongue and the upper border of the skin. The tongue flap pedicle was cut off after 3 weeks, and the oral side of the vermilion was sutured. The donor site of the tongue was closed primarily. Application of moisturizing cream for at least 2 months after surgery would be continued. In all 15 cases, the reconstructed vermilion with a tongue flap was ideal and with almost no disturbance in the patients' speaking, swallowing or taste with satisfactory cosmetic results. The ventral tongue flap is a suitable choice for vermilion border reconstruction. This flap is useful because the procedure does not require complicated surgery, and preservation of the orbicularis oris muscle and mental artery and nerve is possible.