Outcomes of the modified neurovascular cheek flap compared with nasolabial flap in lower lip reconstruction: a retrospective cohort analysis

Background: Lower lip reconstruction following cancer resection commonly employs the nasolabial flap (NLF) or modified neurovascular cheek flap (MNCF). Both techniques inadequately restore the orbicularis oris sphincter, theoretically predisposing patients to oral incompetence and drooling. However, direct comparative data on functional outcomes remain limited. To compare the incidence of postoperative drooling and wound complications between NLF and MNCF reconstruction for lower lip defects. Methods: : This retrospective cohort study included 125 patients with lower lip squamous cell carcinoma who underwent reconstruction with either NLF (n= 47) or MNCF (n= 78) between August 2012 and August 2025 at a single tertiary center. The primary outcome was drooling at the 3-month follow-up. Secondary outcomes included overall wound complications within 30 days. Multivariate logistic regression was performed to adjust for confounders. Results: Baseline characteristics were comparable except for defect size, which was significantly larger in the MNCF group (75.0% vs. 60.0%; p= 0.007), and flap laterality, with bilateral procedures more common in the MNCF group (56.4% vs. 12.8%; p< 0.001). The overall drooling rate was 14.4%, with no significant difference between groups in univariate analysis (MNCF 11.5% vs. NLF 19.1%; p= 0.240). However, after adjusting for confounders, including flap laterality, the MNCF demonstrated a significantly lower risk of drooling (adjusted odds ratio [OR], 0.18; 95% confidence interval [CI], 0.04-0.82; p= 0.026). The MNCF group also showed significantly lower complication rates (1.3% vs. 14.9%, p= 0.003; adjusted OR, 0.06; 95% CI, 0.01-0.76; p= 0.030). Conclusion: : The MNCF is associated with significantly lower rates of drooling and wound complications than the NLF, despite reconstructing larger defects. After controlling for flap laterality, the MNCF demonstrates superior functional outcomes, establishing it as the preferred technique for extensive lower lip reconstruction when surgical expertise is available.