Surgical Technique
September 2005

The Split Orbicularis Myomucosal Flap for Lower Lip Reconstruction

Author Affiliations

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas; and Division of Otolaryngology and Facial Plastic Surgery, John Peter Smith Hospital, Fort Worth, Tex.

Correspondence: Yadranko Ducic, MD, FRCSC, Division of Otolaryngology and Facial Plastic Surgery, John Peter Smith Hospital, 1500 S Main St, Fort Worth, TX 76104 (


Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Facial Plast Surg. 2005;7(5):347-352. doi:10.1001/archfaci.7.5.347

Objectives  To describe the split orbicularis myomucosal flap and to review our center’s experience with this technique for large defects of the lower lip.

Methods  All patients presenting to the senior author (Y.D.) for lower lip reconstruction using this flap were reviewed in a retrospective fashion.

Results  A total of 14 patients with a minimum follow-up of 6 months (mean, 3.4 years; range, 6 months to 5 years) underwent lower lip reconstruction using the split orbicularis myomucosal flap from May 1999 to May 2004. Twelve of the defects arose as a result of cancer resection (squamous cell carcinoma [n = 8], basal cell carcinoma [n = 3], and melanoma [n = 1]), and 2 arose secondary to trauma. The defect crossed the vermilion in two thirds of the cases, extending for a variable distance onto the cutaneous portion of the lower lip. The defect size varied from 50% to 80% of the transverse dimension of the lower lip (mean, 68%) and involved the commissure in 4 patients. There were no flap failures, facial nerve palsies or paralyses, oral incompetence, or need for scar revision in any of our study population.

Conclusion  The split orbicularis myomucosal flap is a reliable method of reconstructing significant defects of up to 80% of the lower lip with minimal risks of microstomia or functional impairment.