Surgical Management of Microstomia: A Comprehensive Review of Treatment Options

Background: Microstomia is characterized by a reduced oral aperture, leading to impairments in speech, feeding, dental hygiene, and facial expressions. Nonsurgical treatments offer limited benefits for mild cases although surgical interventions have been shown to yield better outcomes. However, the unique anatomical challenges and limited availability of adjacent tissue present obstacles in surgical management of this condition. This review aims to provide a comprehensive summary of the reported surgical techniques for microstomia management and discuss their specific indications, advantages, and potential limitations. Methods: A comprehensive review was conducted in June 2024 to identify studies that have reported on the surgical techniques for microstomia management. A database search was performed on Medline, Embase, Scopus, and Web of Science. The study findings have been reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Quality assessment was conducted using the Case Report (CARE) guidelines and Methodological Index for Non-randomized Studies (MINORS) assessment. Results: The search yielded a total of 1315 studies; of these, 28 met the inclusion criteria following a full-text screening. Ten surgical techniques for microstomia management were identified and cate gorized into the following three reconstructive modalities: grafts, local tissue transfer, and autologous free tissue transfer. The average scores of the CARE and MINORS assessments were 27.20/30 and 11.33/14 respectively. Conclusion: Selection of the appropriate surgical technique is critical for achieving successful results in microstomia reconstruction. The primary objective is to enlarge the oral opening while preserving oral function and achieving satisfactory cosmetic outcomes. The key considerations for choosing a surgical technique include contracture severity, perioral tissue availability, and the surgeon's familiarity with different surgical options. (c) 2025 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)