This branch of surgery has to do with the plastic restoration of the oral orifice. Operations of this kind are required to enlarge a contracted mouth, termed microstoma, whether the same be due to congenital origin or to cicatricial contraction after operative interference about this origin.
Stomatoplasty may also be needed to rebuild an abnormally enlarged mouth, termed macrostoma, which has already been described on page 149.
THE CORRECTION OF MACROSTOMA
The operative methods to correct the latter need little mention, since there is usually sufficient tissue present from which the orifice can be properly formed.
The simplest method is to excise the borders of the enlarged mouth or buccal clefts, whether unilateral or bilateral, and to bring the raw edges together by suture. These sutures should be made nearly through the muscular walls of the cheek and at sufficient distance from the edges of the wounds to avoid tearing through.
When the cleft is of sufficient length to warrant tension sutures, they may be employed, alternating with superficial sutures to neatly coapt the skin surfaces.
The mucous membrane should also be sutured with fine silk to insure a perfect closure of the parts, and to avoid, as far as possible, intra-oral infection.
When possible the vermilion borders of the lips should be neatly brought out to the angles of the mouth, where they should be sutured one to the other somewhat diagonally. This will tend to give the angles a normal appearance and shape.
Dieffenbach-Von Langenbeck Method.—It is not unusual after the extirpation of a malignant growth that a greater part of the prolabium has been sacrificed in either of the lips. In this event the vermilion border must be carefully and neatly trimmed away from the healthy lip, leaving a median attachment (see [Fig. 251]).