Lip Reconstruction with Motor and Sensory Innervated Composite Flaps

Abstract

Among the most elegant of recent flap refinements are innervated composite skin-muscle-mucosal flaps that restore the oral sphincter and carry both motor and sensory nerves. These flaps are based on the orbicularis oris, depressor anguli oris, and levator anguli oris perioral muscles of facial expression. Each flap can be dissected in a manner that allows transfer of the muscle into the oral sphincteric ring while restoring lip form and preserves the motor and sensory innervation. Each flap can be designed to carry skin and mucosa as needed for cover, lining, and vermilion reconstruction. Choice is determined by the specific anatomic lip defects. The orbicularis oris flap is most useful for large central defects of either the upper or lower lip. The depressor anguli oris flap is most useful for lateral lower lip defects or total lower lip reconstruction with bilateral flaps. The levator anguli oris is most useful for upper lip lateral element defects or for total upper lip restoration with bilateral flaps and an Abbe flap philtral reconstruction. Innervated composite flaps demonstrate substantial advantages when compared with preceding methods because of the superior function conveyed by the sphincter reconstruction and preserved motor and sensory nerve innervation.