Reconstruction of Large Commissural Defects

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As in the previous reconstruction, a two-layer trapezoidal flap is cut above and below the defect, and the

Reconstruction Oral CommisureWeerda Cheek Reconstruction

Fig. 6.51 a, b Reconstruction of the commissure by dual V-Y advancement. (Vermilion reconstruction see Figs. 6.48-6.50.)

Fig. 6.52 Large full-thickness reconstruction of the cheek and commissure by Esser's cheek rotation combined with a tongue flap (Lexer 1909; Weerda 1985). a The defect is excised and the epithelium turned inward. An Esser cheek rotation flap is outlined. An incision is made below the lower lip, and the skin is mobilized. b All defects are closed, and the scars are dispersed with Z-plasties in the RSTLs. The Burow's triangles are closed. Residual defects in the oral portion of the cheek can be covered with a superiorly or posteriorly based flap of tongue mucosa. The pedicle is divided about 3 weeks later (see Fig. 6.43).

Fig. 6.51 a, b Reconstruction of the commissure by dual V-Y advancement. (Vermilion reconstruction see Figs. 6.48-6.50.)

a b vermilion is restored by turning a mucosal flap (S) over a corresponding deepithelialized area (D) (Fig. 6.51b). If mucosa is not available on the cheek flap, a mucosal flap can be taken from the side of the tongue or the remaining vermilion can be advanced to cover the defect (see Fig. 6.55).

Fig. 6.52 Large full-thickness reconstruction of the cheek and commissure by Esser's cheek rotation combined with a tongue flap (Lexer 1909; Weerda 1985). a The defect is excised and the epithelium turned inward. An Esser cheek rotation flap is outlined. An incision is made below the lower lip, and the skin is mobilized. b All defects are closed, and the scars are dispersed with Z-plasties in the RSTLs. The Burow's triangles are closed. Residual defects in the oral portion of the cheek can be covered with a superiorly or posteriorly based flap of tongue mucosa. The pedicle is divided about 3 weeks later (see Fig. 6.43).

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