Reconstruction of the Oral Commissure With the Zisser Flap

The aim of this study was to investigate the role of the Zisser flap in the reconstruction of defects of the oral commissure. We describe our personal experience with this method and present some interesting aspects from the relevant literature. We retrospectively evaluated the records, from the period between 2003 and 2017, of all patients with defects of the oral commissure after resection of malignant tumors, traumas, or burns and reconstruction by means of the Zisser flap. We looked for information on the origin of the commissural defect, method of vermillion reconstruction using the lingual or buccal mucosa, functional result, esthetic outcome, and postoperative complications. The functional result of the reconstruction of the oral commissure was assessed regarding postoperative subjective speech integrity, preservation of competence of the oral sphincter, and lip sensation. The esthetic outcome was evaluated regarding limitations in facial expression and scar formation. The study included 13 patients. The follow-up period in the oncologic cases was 63.2 months (range, 10 to 140 months). No tumor recurrences were detected. Vermillion reconstruction was achieved by means of a buccal mucosal flap in 11 cases and a lingual mucosal flap in 2. All patients achieved normal oral competence and mouth opening except for 1 case, in which secondary commissuroplasty with restoration of sphincter function was needed. No cases of blunting or microstomia were detected. Reconstruction of the oral commissure with the Zisser flap is associated with an outstanding functional outcome that is cosmetically very acceptable.