OBJECTIVE: This study aims to review our experience in the surgical management of microstomia following facial burns. PATIENTS AND METHODS: For this retrospective study, we searched our burn patients' database for oral commissuroplasties with local mucosal flaps and reviewed the 18 patients suffering from microstomia after facial burns who had been operatively treated between 1995 and March 2007. Fifteen of the patients were primarily treated for severe facial burns in our burns unit, three were referred to our outpatients clinic for secondary reconstruction. Reconstruction of the oral commissures was performed according to one of the following methods: (1) triangular scar excision and mucosal Y-V advancement (n=10), (2) scar excision and wound closure with full-thickness or split-skin graft (n=4) and (3) division of the contracture and closure of the resulting defect with two rhomboid mucosal flaps per side (n=4). RESULTS: All patients showed acceptable aesthetic results and a good functional outcome. Apart from minor wound-healing disturbances, which neither required surgery nor worsened the result, no complications were observed. Patient satisfaction was high. CONCLUSION: Commissuroplasty is an early functional post-burn corrective procedure that often must be performed prior to completion of scar maturation. Mucosal advancement flaps are a viable procedure for the treatment of microstomia after facial burns, resulting in good aesthetic and functional outcome. Direct scar excision and skin grafting, although unavoidable in cases of extensive perioral scarring, frequently produces inferior results.