Advancement cheiloplasty for reconstruction of floor of mouth defects.

In many cases of carcinoma of the floor of mouth, oncologic resection includes marginal mandibulectomy. Reconstruction poses a significant challenge. Requirements include coverage with thin but supple tissue to allow for dental implant or denture, and recreation of a mobile tongue and sensate floor of mouth gutter. Reconstructive efforts have ranged from skin grafts to free flaps, with variable success in fulfilling the above-mentioned requirements. This paper describes the preferred technique of the author, in which external mandibular periosteum is saved and elevated with a submucosal flap of lower lip, raised to the level of the vermilion border. This flap is then advanced to ventral tongue. In this manner the entire anterior floor of mouth can be reconstructed. Cases are presented demonstrating different aspects to the technique.