If possible the operation at the oral angles above referred to should be avoided because of a certain amount of scarring of the skin at either side of the mouth and the resultant stiffness of the parts due to the surgical interference; therefore, when practicable, or when the deformity is of moderate extent, the angles of the mouth should be advanced toward the median vertical of the lips. In such case it is best to do such operations before any labial corrections are undertaken.
Author’s Method.—The method advised by the author is the employment of the Dieffenbach procedure as follows:
A V-shaped incision, its apex pointing inward and its distal ends a half inch from the prolabial line, is made quite deep through the mucosa and muscular tissue, as shown in [Fig. 253]. The part included in the V is now drawn toward the median line of the lip, causing the wound to gape. The latter is then sutured with deep and superficial silk sutures in the form of a Y, as shown in [Fig. 254]. The same operation is repeated at the other angle of the mouth.
Fig. 253. Fig. 254.
Author’s Method.
THE CORRECTION OF MICROSTOMA
When the oral orifice has become lessened, as is frequently the result of cicatricial contraction following ulcerations or operative interference, but which may, too, occur congenitally, the condition is termed microstoma.
Dieffenbach Method.—Dieffenbach advocates the following operation for the correction of this abnormality:
Two lateral incisions are made outward from the mouth across the cheeks and through their entire thickness, extending in length a little beyond the intended angle of the mouth (see [Fig. 255]). The mucous membrane from within is brought forward and is sutured superiorly and inferiorly to the skin with fine silk sutures.