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Reconstruction of the Pediatric Oral Commissure After Trauma With Bilateral Ventral Tongue Flaps: A Case Series
Martin Buta
*, Matthew A. DePamphilis, Seamus Caragher, Branko Bojovic, Daniel Driscoll, Matthias Donelan
Surgery, Div. of Plastic & Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
Background: Traumatic injury to the oral commissure presents a significant surgical challenge. Multiple surgical techniques for oral commissure repair after trauma have been published. To date, no paper has described the use of bilateral ventral tongue flaps for this indication.
Methods: A 30-year retrospective review was performed of patients aged 0-21 years admitted for traumatic injury to a pediatric hospital who subsequently underwent reconstruction of the oral commissure using bilateral ventral tongue flaps. Four patients were identified and analyzed using records of clinical examinations, surgical reconstruction, and photographic documentation.
Results: Three of the four patients suffered facial trauma due to electrical burn. The fourth patient suffered severe lower lip and chin mutilation from a wild pig bite. All four patients underwent reconstruction using bilateral ventral tongue flaps in four stages with subsequent minor revisions. Patients ranged in age from 7 to 12 years at the time of their first tongue flap surgery. No dental appliances were required to prevent the teeth from injuring the flaps. No significant complications were noted and all patients were satisfied with the final aesthetic and functional results.
Conclusions: Although uncommon, in cases in which traumatic injury to the oral commissure results in debilitating scarring, immobility, and microstomia, reconstruction using bilateral ventral tongue flaps can restore this critically important landmark and achieve a more normal facial expression and appearance. These results are often superior to those obtained using local tissue rearrangement or splinting in complex cases.
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