We performed a single-stage operation to reconstruct a large defect of the lips and commissure using a composite radial forearm-palmaris longus free flap. To obtain cranial traction and a voluntary smile, independently from any jaw movement, traction was achieved by using a lengthening temporalis myoplasty. The tendon attached to the coronoid process was fixed to the palmaris longus tendon, recreating a new commissure and a “neo-modiolus.” Physical therapy was started on the 21st postoperative day to facilitate progress from a “mandibular smile,” to ideally a spontaneous and symmetric smile after 3 months of therapy. This procedure was able to obtain good oral continence and a good commissural movement during smile which has not previously been mentioned in the published literature.
From the *Department of Maxillo-Facial and Facial Plastic Surgery, University Hospital Center of Tours, Tours, France; and †Department of Dermatology, University Hospital Center of Tours, Tours, France.
Received March 3, 2011, and accepted for publication, after revision, May 2, 2011.
Conflict of interest and sources of funding: none declared.
Reprints: Thomas Martin, MD, Department of Maxillo-Facial and Facial Plastic Surgery, University Hospital Center of Tours, Trousseau’s Hospital, 37044 chambray les Tours, Tours, France. E-mail: email@example.com.