Release of mandibular ankylosis due to gross tissue loss in the cheek

Abstract

Experience with mandibular ankylosis due to the loss of variable amounts of cheek tissue as a result of cancrum oris is reviewed. Where enough cheek has been lost to cause an ankylosis, replacement tissue in the form of a graft is necessary to prevent recurrence and to reconstruct the cheek. A number of methods are reviewed, including free grafts, local flaps and pedicled skin from the neck and abdomen. The best functional and cosmetic result was obtained by using a tubed pedicle of abdominal skin based on the superior epigastric artery and attached to the wrist as a carrier. This can be raised under local anaesthesia prior to the release of the ankylosis so it is available to cover the raw surfaces and to reform the cheek at the time of operation. Blind intubation was found to be feasible and desirable when compared with administering the anaesthetic through a tracheostomy. The importance of close supervision of post-operative exercises is emphasized, but was not able to be carried out under the conditions of treatment.