Restoring Lower Lip Competence After Fibula Free Flap Mandibular Reconstruction: A Stage 2 Salvage Procedure

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic and Reconstructive Surgery

Background:

• Composite mandibulo-labial defects necessitate reconstruction for both mandibular continuity and oral competence.
• While initial fibula free flap reconstruction addresses bony and soft tissue deficits, restoring orbicularis oris continuity is crucial for oral function.
• Persistent issues like drooling, poor lip seal, and obliterated gingivolabial sulcus often occur post-stage 1 surgery.

Purpose of the Study:

• To describe a stage 2 salvage procedure for improving oral competence in patients with residual defects after initial mandibulo-labial reconstruction.
• To evaluate the efficacy of this salvage procedure in restoring lip seal and reducing drooling.

Main Methods:

• The described stage 2 procedure involves releasing vestibular scar bands.
• It includes mobilization of the fibula free flap skin paddle to recreate the gingivolabial sulcus.
• Direct reapproximation of orbicularis oris muscle stumps using a figure-of-eight suture technique is performed.

Main Results:

• In a pediatric case of ballistic injury, the salvage procedure led to improved lip seal.
• Post-rehabilitation, visible drooling during conversation was eliminated.
• However, active lip excursion remained limited.

Conclusions:

• A secondary salvage procedure can effectively improve oral competence after initial fibula free flap reconstruction for composite mandibulo-labial defects.
• Direct orbicularis oris reapproximation is a viable technique for addressing muscle discontinuity and improving lip function.
• Further rehabilitation may be necessary to optimize active lip movement.