One-stage reconstruction of a large defect of the lower lip and oral commissure.

Large lower lip defects including the oral commissure are very difficult to reconstruct and obtain an aesthetic appearance and an acceptable function. We report two patients who had a large defect in the lower lip including oral commissure and were treated using free radial forearm flap and temporal muscle transfer in one-stage. For the cutaneous defects, in one a local flap was elevated from the adjacent cheek and in the other a turned over area of the forearm flap was used. In each case, the reconstructed lower lip could maintain adequate elevation of oral the commissure using the temporal muscle was worked. The first case which used a local flap externally could avoid sialorrhea and had good sensation, and could close the mouth firmly soon after surgery. The appearance was acceptable. In the other case, leakage of oral contact and air occurred at the oral commissure because of the thickness of the forearm flap but improved after minor correction some 8 months after the surgery.