Our Experience in Oral Commissure Reconstruction After Surgical Excision of Stage 3 and Stage 4 Oral Cavity...

The upper and lower lips represent the most important functional and aesthetic anatomical structures of the lower segment of the face. The reconstructive aims are to restore the oral lining, oral competence and function (i.e. articulation, speech and mastication). Functional and aesthetic restoration of lip and oral commissure defects can be achieved using the composite radial free forearm flap (RFFF) with Palmaris longus tendon.

To present the technique, we have used our experience with this form of reconstruction in 30 consecutive patients with lip and oral commissure defects who were surgically treated between 2012 and 2018. Reconstruction of the lip defect was done with RFFF with Palmaris longus tendon. The ends of the Palmaris longus tendon were passed intraorally and anchored to the remnant orbicularis oris muscle of the upper lip to provide adequate tension so that oral competency could be achieved and sagging of the commissure could be prevented, and in cases, where adequate orbicularis oris was not present, the tendon was sutured to the zygomatic prominence. The patients were followed for 1 year.

In our study of 30 cases of stage 3 and stage 4 oral cavity squamous cell carcinoma, we did RFFF with Palmaris longus and found that the graft uptake was excellent, i.e. 93.33%. Flap failure occurred in only 2 out of the total 30 cases. Re-exploration of the flap was done, and venous congestion was the cause of flap failure. Re-anastomosis of the vessels was done, but still the flap could not be salvaged. Donor site healed satisfactorily without any complications except for scarring. All patients had excellent oral competence during rest, speaking and eating. Good sphincteric function was obtained in early post-operative days. Drooling or air leakage was seen only in 6 out of 30 cases after 1 year of follow-up. The patients' articulation was near-normal. The aesthetic results were accepted by 24 patients. All patients were able to resume regular diet. No complications were observed such as dehiscence, fistula formation or abscess formation. The mouth opening was also adequate (2-3 finger width) in 24 out of 30 patients of oral commissure reconstruction.

The RFFF with Palmaris longus has excellent viability. It is a secure and reliable reconstructive option which produced satisfactory aesthetic and functional results.