Functional Outcomes of Various Flap Techniques for the Reconstruction of Oncologic Lower Lip Defects

Various local and free flap techniques have been developed for lower lip reconstruction, aiming to preserve oral competence, maintain adequate mouth opening, and ensure anatomical integrity for proper speech. This study compared the dynamic functional outcomes of selected local and free flaps in post-oncological lower lip reconstruction. Forty-four patients were categorized into 3 groups based on reconstruction techniques: Group 1: local flaps with or without dynamic properties that reduce oral aperture. Group 2: local flaps that preserve the oral aperture. Group 3: free flaps. Functional outcomes were assessed through interalveolar distances (IAD), intercommissural distances (ICD), oral aperture areas (AA), sphincter strength, and water retention capacity. Groups 1 and 2 showed significantly higher IAD, ICD, and AA values compared with group 3 (P<0.001), with group 2 outperforming the others (P<0.01 and P<0.001). Group 1 demonstrated superior sphincter strength and water retention. Overall, oral function scores in groups 1 and 2 exceeded those of group 3 across all categories. Dynamic local flaps from perioral donor sites yielded the best functional outcomes for subtotal lower lip defects. In subtotal and total lower lip defects, local flaps from extraoral donor areas are preferable due to improved mouth opening and competence. Free flaps should be reserved for cases where local flaps are not viable in total reconstructions.