A New Technique of Drooling Management after a Through-and-Through Cheek Defect Reconstruction

Drooling is a common problem after microsurgical free flap reconstruction for through-and-through cheek defects involving the oral commissure. Among causes which lead to drooling, lack of an adequate sulcus is a major one. The authors presented a sulcus-deepening technique, long cheek triangular (LCT) flap transposition to circumvent this problem.

A long triangular flap was designed and elevated from the previously transferred skin flap in the cheek with its base located at the oral commissure. This triangular flap can be 7.5 × 1.5 cm in size depending on the dimension of the sulcus. The flap was inverted into the oral lining to create a deep sulcus. Advancement of the upper and lower lips and revision of the residual flap together completed oral commissure reconstruction.

From July 2003 to December 2004, a total of 20 patients received secondary oral commissure revision and sulcus deepening with this technique. All were male patients. The flaps for initial soft tissue defect reconstruction were 19 anterolateral thigh flaps and 1 pectoralis major flap. The lower lip defect averaged 2.7 cm (range: 0.7 to 5.2 cm). There was no loss or partial necrosis of the elevated triangular flaps. One patient developed wound dehiscence at the oral commissure which healed spontaneously. Follow-up at an average of 10 months (4 to 18 months) revealed good drooling control, and cosmetic improvement was reported by 18 patients (90%).

Drooling due to lack of adequate sulcus and oral commissure can be corrected with proper use of a transferred flap to the cheek and angle of the mouth combined with a lip advancement procedure.