Reconstruction of the oral commissure with the use of a new technique: the asterisk design.

ABSTRACT

Microstomia reconstruction due to the presence a blunted oral commissure is a challenging task because it requires the restoration of intricately balanced distinct layers of tissues the oral mucosa, the orbicular muscle, the vermilion border, and the perioral skin. The reliability of commissural reconstruction depends on 2 factors the first one is breaking the contraction vectors causing blunting of the commissure and the second one is restoring the integrity of the oral sphincter. We have used local skin, vermilion border-muscle, and mucosa flaps designed in an asterisk pattern to break the contraction vectors and have paid certain attention to the restoration of the sphincter function of the circular muscle fibers. Our results have shown that, with the use of our asterisk design, a new commissure aesthetically comparable to the natural one can be created with the reestablishment of reliable oral competence.