Cheek Flap Research Articles

Large Basal Cell Carcinoma over Face reconstructed with rotational flap; an experience in a District level hospital

Basal cell carcinoma (BCC) is the most common form of skin cancer. BCC in the head and neck usually presents as a slow growing well defined papule or nodule located above the line connecting the angle of the mouth and ear lobe. It is locally destructive lesion and cause serious disfigurement but metastasizes rarely. Various treatment are available out of which surgical excision is the most standard option. Surgical excision of tumors from the face may create a defect that is difficult to restore. Skin grafts can only cover superficial defects and has a natural tendency to contract and may not take properly. Also, because of the color mismatch, it is not cosmetically identical to the face. The use of regional flaps such as rotational cheek flap can be a very good option for the reconstruction of a moderate to large cheek defect. Herein, we report a case of large BCC over the face for which rotational cheek flap reconstruction was carried out at Modernized Sadar Hospital, Chapainawabganj.Update Dent. Coll. j: 2015; 5 (1): 35-37

Approach to the posterolateral maxilla and retromolar trigone using the lower cheek flap: two cases report and literature review

Approach to the posterolateral maxilla and retromolar trigone using the lower cheek flap: two cases report and literature review

Endotine Midface for Soft Tissue Suspension in Zygoma Fracture

Treatment of zygomatic fractures necessitates dissection beneath the soft tissues of the cheek. Inadequate resuspension may lead to deformities, including cheek ptosis, lower lid ectropion, and lateral canthal dystopia. The authors present their experience using a biodegradable suspension device for cheek flap resuspension. Patients who received open reduction for unilateral zygomatic fracture between January, 2006 and December, 2013 at a single center were included in the study. Patients could choose whether or not to have Endotine midface inserted. Patients rated satisfaction on facial symmetry. Computed tomography (CT) at 15 months was assessed for soft tissue thickness at the level of the midpoint of the nasolabial fold on each side. Photographs at 15 months were viewed by 3 blinded plastic surgeons and rated for cheek drooping. The results for all 3 parameters were compared between the Endotine group and the control group. A total of 83 patients were included (43 in the Endotine group and 39 in the control group). Patient satisfaction scores were statistically higher (P = 0.03) in the Endotine group (3.70 ± 0.76) than the control group (2.85 ± 0.96). Computed tomography soft tissue thickness score ratio between affected and unaffected side was significantly lower (P < 0.001) in the Endotine group than the ratio in the control group. Photography evaluation score difference between affected and unaffected side for the Endotine group (0.70 ± 0.77) was significantly (P = 0.041) smaller than the control group (1.92 ± 1.24). Endotine midface is easy to apply and effective in repositioning the elevated cheek flap in zygomatic fracture patients.

The double opposing myomucosal cheek flap in hard palate reconstruction

Limited defects in the oral cavity can be treated with local and pedicled cheek flaps. It allows to preserve the functions of the resected organ. Large defects in the midline of the hard palate can be reconstructed with double opposing myomucosal cheek flaps. The aim of this study was to discuss the methodology of the flap harvest and to show our experiences of treatment in a group of 15 patients with oral cavity cancer. In 1 patient the double opposing myomucosal cheek flap was harvested due to the wider local defect. The small size of the flap with ability to use the double opposing cheek flap in more extended defects as well as short duration of the surgery procedure can lead to reduced risk of postoperative complications. Finally, cheek flaps form an effective method of treatment of defects in the oral cavity.

Lambeau d’avancement-rotation jugal pour pertes de substance latéronasale et paranasale moyenne

The nasal sidewall and adjacent cheek are frequent sites of cutaneous tumour. The aim of this study is to present an advancement-rotation cheek flap technique for nasal sidewall and paranasal cheek defects. This is a retrospective, non-comparative study of patients undergoing a cheek advancement-rotation flap for nasal sidewall and paranasal cheek defects between September 2008 and October 2012. Sex, age, histological type of the excised lesion, method of anaesthesia, size of the defects, any occurrence of complications and results were compiled from the medical record. Eleven patients with a mean age of 66 years were included. For 10 patients, the tumour was a basal cell carcinoma and in one case was a squamous cell carcinoma. The defects were located in the nasal sidewall and paranasal cheek in four cases, the paranasal cheek/lower eyelid in five cases and in the nasal sidewall, anterior cheek and lower eyelid in two cases. All but one had surgery under a local anaesthetic. No patients presented post-surgical complications. One patient had a subcutaneous granuloma which subsequently subsided completely. The aesthetic result was good: two of the 11 patients had a marked nasolabial fold, one patient had a mild cutaneous deformity due to flap movement under eyelid. No recurrence of carcinoma was observed during follow-up of between 14 and 40 months. This flap should be considered for defects measuring under 3 cm on all or part of the nasal sidewall, paranasal cheek and lower eyelid fold.

Sushruta

Sushruta is considered the "Father of Plastic Surgery." He lived in India sometime between 1000 and 800 BC, and is responsible for the advancement of medicine in ancient India. His teaching of anatomy, pathophysiology, and therapeutic strategies were of unparalleled luminosity, especially considering his time in the historical record. He is notably famous for nasal reconstruction, which can be traced throughout the literature from his depiction within the Vedic period of Hindu medicine to the era of Tagliacozzi during Renaissance Italy to modern-day surgical practices. The primary focus of this historical review is centered on Sushruta's anatomical and surgical knowledge and his creation of the cheek flap for nasal reconstruction and its transition to the "Indian method." The influential nature of the Sushruta Samhita, the compendium documenting Sushruta's theories about medicine, is supported not only by anatomical knowledge and surgical procedural descriptions contained within its pages, but by the creative approaches that still hold true today.

History of reconstructive rhinoplasty.

Amputation of the nose was practiced as a sign of humiliation to adulterers, thieves, and prisoners of war by certain ancient populations. To erase this disfigurement, numerous techniques were invented over the centuries. In India, where this injury was common, advancement cheek flaps were performed (around 600 BC). The forehead flap was introduced much later, probably around the 16th century. The Venetian adventurer Manuzzi, in writing a report about the Mughal Empire in the second half of the 17th century gave the description of the forehead rhinoplasty. Detailed information concerning the Indian forehead flap reached the Western world in 1794, thanks to a letter to the editor that appeared in the Gentleman's Magazine. From this episode, one can date the beginning of a widespread interest in rhinoplasty and in plastic surgery in general. In Europe, nasal reconstruction started in the 15th century in Sicily with the Brancas, initially with cheek flaps and then with arm flaps. At the beginning of the 16th century, rhinoplasty developed in Calabria (Southern Italy) with the Vianeos. In 1597, Gaspare Tagliacozzi, Professor of Surgery at Bologna, improved the arm flap technique and published a book entirely devoted to this art. He is considered the founder of plastic surgery.

Lessons from 28 cases of reconstruction by lenticular island pedicle flap at a single institution.

Lenticular island pedicle flap (LIPF) has been reported to be one of the most useful techniques for reconstructing middle cheek skin defects. LIPF may have been used all over the world on a daily basis; however, no reports have examined a large number of LIPF cases at a single institution. A total of 28 cases of reconstruction by LIPF at the Hokkaido University Hospital from 2005 to 2013 were analysed. We examined the tumour type, location, area of defect and presence/absence of antithrombotic treatment and complications, including transient circulatory impairment, damage to facial nerves and eyelid ectropion. We found that nine patients had transiently impaired circulation. This complication was statistically more frequent in the patients without antithrombotic treatment than in the patients with antithrombotic treatment (0/8 vs. 10/20, P=0.0292; Fisher's exact test). We revelled that LIPF have been safely performed even under antithrombotic treatment, so, when patients are taking antithrombotic agents, we should choose LIPF rather than conventional flap including cheek flap, island pedicle flap and so on.

Aesthetic Refinements of the Island V-Y Advancement Cheek Flap

Aesthetic Refinements of the Island V-Y Advancement Cheek Flap

Neuroendocrine Differentiation of Primary Mucinous Carcinoma of the Cheek Skin

Neuroendocrine Differentiation of Primary Mucinous Carcinoma of the Cheek Skin

Two-stage palatoplasty using a modified Furlow procedure

A two-stage palatal repair using a modification of Furlow palatoplasty is presented. The authors investigate the speech outcome, fistula formation and maxillary growth. In a prospective, successive cohort study, 40 nonsyndromic patients with wide cleft palate were operated on between March 2001 and June 2006 by a single surgeon. 10 patients in the first cohort underwent a Furlow palatoplasty (control group). In 30 patients in the second cohort a unilateral myomucosal cheek flap was used in combination with a modified Furlow palatoplasty (study group). The hard palate was closed in both groups 9–12 months later. The Bzoch speech quality score was superior in the study group, and the hypernasality was significantly reduced in the study group. Overall fistula formation was 0%. At the time of hard palate reconstruction palatal cleft width was significantly reduced. Relative short-term follow up of maxillary growth was excellent. There were no postoperative haematomas, infections, or episodes of airway obstruction. This technique is particularly encouraging, because of better speech outcome, absence of raw surfaces on the soft palate, no fistula formation, and good maxillary growth. Further follow-up is necessary to determine the long-term effects on facial development.

Total reconstruction of lower eyelid in a post-traumatic patient using modified fricke′s cheek flap

Eyelids are very complex structure, reconstruction of which is a challenge to surgeons. Reconstruction of eyelids may be required in a variety of conditions like congenital anomalies, trauma, or postsurgical excision in malignant lesions involving the eyelids. There are numerous ways to reconstruct the eyelids; the best procedure depends on both the skill of the surgeon and the condition of the patient. Fricke’ lateral temporal based flap was first described in 1829 for reconstruction of the eyelids and lateral canthal region. This flap had inherent problems regarding cosmetic appearance of the eyebrows. The modified Fricke's flap based on the cheek has the advantage of avoiding such complications. It is very easy and rapid outpatient department (OPD) based procedure with acceptable cosmetic and functional result. It can be done by all ear, nose, and throat (ENT) and head and neck surgeons without any reconstructive training. In this article we are presenting a case of total reconstruction of lower eyelid using the modified Fricke's cheek flap.

Lower Eyelid and Cheek Reconstruction by a Temporally Extended V-Y Cheek Flap

Reconstruction of medium and large cheek defects involving the whole length of the lower eyelid and suborbital region is a challenging procedure. Several cervicofacial flaps are well described in the literature; most of them require extensive undermining and retroauricular and cervical incisions. A case is presented of an 84-year-old woman, a smoker, with a recurrent squamous cell carcinoma on the left suborbital region. Excision resulted in a 5.5 × 3.5-cm defect of the suborbital region and the whole length of the lower eyelid. Considering that the patient was an elderly smoker, a simple technique was sought. Reconstruction was achieved by a wide temporally extended V-Y cheek flap. The extension was used to reconstruct the eyelid and the main flap to cover the cheek defect. The procedure necessitated minimal undermining and was done under local anesthesia with an excellent functional and cosmetic result.

Advancement Perforator Cheek Flap for Aesthetic One-Stage Reconstruction of Postoncological Extended Split-Thickness Defects of the Nasal Sidewall

Aesthetic reconstruction of soft tissue nasal sidewall loss has an important influence on the appearance of the nose. The unique character of this subunit and the complex relationships with a number of different facial or nasal subunits make the excision of large tumors difficult to manage. Numerous techniques are described in the literature, but a primary reconstruction with a final good result is not often possible. The authors develop an advancement cheek flap for an aesthetic one-stage reconstruction of postoncological extended nasal sidewall defects. Between January 2009 and July 2012, 16 patients (mean age, 63.3 yr) underwent excision of skin tumors of nasal sidewall and immediate reconstruction with an advancement cheek flap nourished by perforators from the transverse facial branch of the superficial temporal artery. The tumors were excised with 0.4–0.6 cm lateral margins and defects size ranged from 2.6 × 2.6 cm to 3.5 × 5 cm. Oncological radicality was obtained in all cases. The aesthetic results were excellent in all patients. No scar revision was needed. The authors' advancement cheek flap can be considered the first choice for reconstruction of split-thickness defect of nasal sidewall larger than 2.5 cm because it reestablishes in one stage the nasal contour detail.

Partial and Total Lower Lid Reconstruction: Our Experience with 41 Cases

Purpose: To report our experience on lid reconstruction in patients with epitheliomas. Methods: A total of 41 consecutive patients affected by basal cell (n = 32) or squamous cell carcinoma (n = 9) underwent partial (n = 35) or total (n = 6) surgical demolition of the lower lid. Surgical defects <25% (n = 10) received direct closure. If the defect involved 30–60% of the eyelid (n = 21), a Tenzel semicircular flap or lateral advancement flap with a free mucosal graft was used. If the entire lid or a major part of the outer lamella had to be reconstructed (n = 10), a cheek advancement flap was used, with a free mucosal graft if the posterior lamella was involved. The success rates and the cosmetic and functional results were evaluated. Results: All 21 flaps used for partial reconstruction remained viable, whereas 1 of the 10 cheek flaps developed partial distal necrosis. Of the 27 mucosal grafts, 2 had to be removed for total necrosis, and 2 developed partial necrosis. In all cases, normal lid function and acceptable cosmetic results were obtained. Complications occurring in 4 cases (1 ectropion and 3 epiphora) were successfully managed with appropriate surgical procedures. Conclusions: Local flaps are the gold standard for lower lid reconstruction as they are highly reliable and guarantee optimal results. The technical details described in this study can help in achieving such results.

Combined Rotation and Advancement Flap Reconstruction for a Defect of the Upper Lip: 2 Cases

Many types of upper lip reconstruction have been introduced to treat defects after a tumor excision or trauma. The authors treated two cases of upper lip defects. A 35-year-old woman presented with a squamous cell carcinoma of the left upper lip that had invaded the corner of the mouth. After resecting the tumor, the defect was 3.7×3.5 cm in size. A 52-year-old woman presented with a dog bite of the right upper lip. The defect measured 4.0×2.2 cm in size. The two cases were reconstructed by combined rotation and advancement of a cheek flap. This technique produced a good functional outcome that allowed for oral competence and created an opening of adequate size. A combination of rotation and an advancement flap can be used to treat upper lip defects in a single-stage procedure. This approach produces a good functional and cosmetic outcome.

Commentary on Inferiorly Based Crescentic Sliding Cheek Flaps for the Reconstruction of Paranasal Surgical Defects

Commentary on Inferiorly Based Crescentic Sliding Cheek Flaps for the Reconstruction of Paranasal Surgical Defects

Transposed Cheek Flap in Lower Lid Reconstruction: A Retrospective Case Note Review

Purpose: To review the results of a cohort of patients that had a transposed cheek flap as part of the lower lid reconstruction.Methods: Patients were identified from a database and a retrospective case note review was conducted. 21 patients were identified but one set of notes was not traceable. 21 lids of 20 patients were included. Data included age, sex, laterality, date and details of surgery and follow up as well as details of any complications and additional surgery where required. Data was collected and analysed using Microsoft Excel.Results: 9 male and 11 female patients were included. Median age was 51. Follow up ranged from 5 to 176 months (median 34). The posterior lamella was reconstructed in 13 patients. Complications included bulky lids and ectropion as well as a few cases of corneal irritation from dermal hairs. 8 cases had no complications. 7 cases required revision—2 for trichiasis, 2 for bulky lids and 3 for ectropion.Conclusion: The transposed cheek flap is a useful technique in the reconstruction of lower lid lesions involving the lateral canthus. The majority of patients had a good cosmetic result and required no further intervention. The most frequent complications were bulky lids and ectropion.

Inferiorly Based Crescentic Sliding Cheek Flaps for the Reconstruction of Paranasal Surgical Defects

Doctors involved in the surgical management of skin cancer frequently encounter the repair of paranasal surgical defects. Similar to other reconstructions, these defects present surgeons with a variety of options, depending on the site, size, depth, and available tissue laxity. In the paranasal region, mobilizing the cheek skin reservoir for flap repairs allows the reconstructive surgeon to optimize tissue match and often to conceal resultant scar lines at the junction of cosmetic units or within naturally occurring rhytides. Another important consideration in this region is to avoid distortion of free margins such as the lower eyelid, ala, and upper lip caused by flap movement.

Myomucosal cheek flaps: applications in intraoral reconstruction using three different techniques

Aim: The use of myomucosal flaps harvested from the cheek area for intraoral reconstruction has been recently popularized in the literature. Several surgical techniques have been reported and each study has described the outcomes and advantages of each method. This work examines the use of the three most important buccinator myomucosal flaps: the buccinator musculomucosal flap (Bozola flap), the facial artery musculomucosal flap (FAMM flap), and the buccinator musculomucosal island flap (Zhao flap).