Answer:
Nasotracheal anesthesia is required. The tongue flap is designed on the ventral surface to avoid the conspicous dorsal filiform papillae. An anteriorly based flap is outlined and raised. Enough muscle bulk can be raised with the flap to fill the extent of lip deficiency. The flap is sutured in place. A 2-0 silk suture is used to anchor the tip of the tongue to the lip. Dental appliances are not necessary to prevent teeth from injuring the flap. The exposed tongue mucosa requires constant lubrication with ointment to prevent dessication. The flap is divided at 2 weeks. The advantage is that normal lip and cheek elements are spared by this procedure. Also, enough bulk can be raised to fill full-thickness defects. The disadvantage is the patient’s tongue position for 2 weeks. The color match may not be perfect.