Cheek and Gums

Abstract

This chapter explains at length, the detailed layered anatomy of the cheeks and their functional and aesthetic significance. All degrees of asymmetry of cheek substance and facial expression are highly conspicuous and this must be borne in mind while planning reconstructions.

The importance of sub-mucous fibrosis and trismus are stressed and are highly relevant in populations where chewing habits are rife. Surgical anatomy and patterns of spread have been discussed, to provide guidance for the design of excision.

A simple classification of cheek defects is presented, based on size, depth and complexity.

For the many types of consequent defects, reconstructive alternatives are presented through detailed intra and post-operative photographs.

For “pure” mucosal defects sparing the buccinator muscle completely, the options include split skin grafts and biological dressings such as Kollagen, and their respective indications and roles are illustrated.

With thicker lining defects that include the buccinator muscle and often encroach upon the sub-cutaneous fat, it becomes necessary to interpose tissue, and the many alternatives are illustrated, and their choice depends largely upon the dimensions and complexity of the defect. If the stensen’s duct is in the base of resection and alternative salivary drainage is possible and practicable, it is provided.

For full-thickness defects that include the overlying skin, some sort of tissue transfer is essential, and the several alternatives and strategies are illustrated.

Being among the commonest Head and Neck cancers in south-east Asia, this chapter should be of assistance to many engaged in the treatment of buccal cancers.