Correction of senile drooling using the nasolabial sling

Abstract

Facial aging, resulting in lower facial ptosis often leads to downward angulation of the oral commissure, which may lead to troublesome angular chelitis. In this paper we present a treatment pathway for management of such patients. Treatment initially involves a combination of hyaluronic acid injection into the marionette lines and botulinum toxin A to the depressor anguli oris. If this treatment is unsuccessful patients then undergo the creation of a nasolabial sling, using bilateral superiorly-based nasolabial flaps tunnelled through the lower lip with transection of the depressor anguli oris on each side. In addition, two passes of the CO(2) laser are used to resurface the areas of chelitis and to tighten the tissues. Five patients have undergone treatment for their angular chelitis using one or a combination of these methods. All cases were successfully treated and no recurrences occurred. Furthermore, all patients were satisfied with their outcome. Little is available in the literature on the management of this disorder. In this paper we detail our surgical technique, discuss the issues encountered and review the current recommended treatment for this difficult problem.