The Esser cheek rotation can be used to reconstruct portions of the nose as well as the medial cheek (see also Fig. 5.50a). From the defect, the incision extends along the lower eyelid and up into the temporal area, then curves down in front of the ear, where it may run a short distance back below the earlobe if necessary. It then proceeds downward and forward behind the mandibular angle (Fig. 8.1). The circumscribed flap is mobilized in the fat plane and rotated forward. Ectropion is prevented by fixing the flap to the periosteum of the infraorbital region. Burow's triangles are excised to close the secondary defect. If greater rotation is needed, the submandibular limb of the incision can be extended. The surgeon should not dissect too deeply in the fat, especially in the temporal area, as this could damage intact facial nerve branches.
Fig. 8.1 Esser cheek rotation (1918). The flap is cut somewhat higher in the temporal area to provide excess tissue at the lower lid (to prevent ectropion). It is fixed to the periosteum of the orbital rim, and the cheek skin is mobilized (sparing the branches of the facial nerve).
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