Q: Dear Dr. Eppley, I had a revision chin surgery to correct chin ptosis. Ever since, I am unable to protrude my lower lip when speaking. I also noticed that when I smile, the right side of my lower lip remains elevated while the left side goes down into a natural smile position. My ENT stated that the sulcus is unusually high, and the speech pathologist stated that they can not help me improve my speech as it a mechanical issue. My question is…Can the sulcus be lowered to my natural state and can the mentalis or the depressor labi inferior muscle (whichever was suspended..not sure) be released to enable me to speak, smile, etc..normally once again? I greatly appreciate your time.
A:With a high or scar contracted vestibular sulcus of the anterior mandible, the lower lip may well be restricted in movement. The role of the vestibule between the lip and the teeth is a valuable one and allows independent lip movement from that of the jaw. The key to successful vestibular lengthening is to appreciate that this represents a loss of mucosal tissue. Simply releasing scar or moving tissues around in an attempt to deepen or lengthen the vestibule will not work. It will simply be negated by scar contracture. What is needed is a vestibular release combined with a small skin or mucosal graft. Buccal mucosa is my preference for small amounts of vestibular deepening. The graft must be held in place for 7 to 10 days with a specially-designed small intraoral bolster.