The Depressor Anguli Oris Flaps Neither with The Mental Nerve Nor The Marginal Mandibular Nerve

A series of 25 cases of lower lip reconstruction with flaps including depressor anguli oris
muscle were presented. Depending on the general conditions of each patient, operations were performed under local or general anesthesia. In 4 of the patients, by elevating the flap bilaterally a complete lower lip reconstructions were performed. In three cases, since the defects existed without mucosal involvement, the flaps were elevated only as musculocutaneous flaps. The other cases were repaired by a flap including three layers of
skin-muscle and mucosa. In some cases, full thickness skin grafting were necessary, as the mucosa with the flap was not enough for lining. Although not seen in all cases, some fatty appearance on the flap peninsula was observed following the reconstruction. No attempts were made to preserve the so-called flap and mental nerve relationships, except for the first three cases among this series. No patient suffered from any sensorial loss on
the newly reconstructed lower lips. Taking into consideration the oral sphincteric functions, although the new oral sphincter was not competent as much as a healthy one, no patient showed incompetence. On the last 5 patients, the flap peninsula was elevated by direct cutting without caring the so-called motor nerve of the flap, too. In an earlier short article of us, it was argued that the depressor anguli oris flap’s sensorial innervation did not come from mental nerve but buccal nerve. Now, I would like to add one more discussion about the flap anatomy and this is to say that the flap can be elevated without any attempts to protect neither mental nor marginal mandibular nerve since it may have some cross innervations. This conclusion may make us think that the depressor anguli oris flap is an easy flap to elevate with very little morbidity and can be useful to reconstruct the lower lip defects, except those that are located centrally.