Cheek reconstruction

Cheek Reconstruction

Cheek reconstruction is a complex surgical procedure aimed at restoring the form and function of the cheek after trauma, surgical resection due to cancer, congenital defects, or other causes. The cheek, being a prominent feature of the face, plays a crucial role in facial aesthetics, expression, and functions such as chewing and speaking. This article provides an overview of the techniques, considerations, and outcomes associated with cheek reconstruction.

Indications

Cheek reconstruction may be indicated in cases of:

• Significant soft tissue loss or deformity due to trauma, including burns, lacerations, or blunt force injuries.
• Surgical resection of tumors, such as squamous cell carcinoma, basal cell carcinoma, or melanoma, which may result in substantial defects.
• Congenital anomalies like hemifacial microsomia or cleft lip and palate-associated defects.
• Infections or inflammatory conditions leading to tissue loss.

Preoperative Assessment

A thorough preoperative assessment is crucial for successful cheek reconstruction. This includes:

• Detailed medical and surgical history.
• Physical examination focusing on the extent of the defect, skin quality, and available local tissue for reconstruction.
• Imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI), to assess the underlying bone structure and any involvement of adjacent structures.
• Discussion of patient expectations and potential outcomes.

Reconstruction Techniques

Cheek reconstruction employs various techniques, often in combination, to achieve the best aesthetic and functional outcomes. These include:

• Primary Closure: Suitable for small defects, where the edges of the wound can be brought together directly.
• Skin Grafts: Involves the transplantation of skin from another part of the body to cover the defect. Options include split-thickness and full-thickness skin grafts.
• Local Flaps: Utilizes adjacent tissue to cover the defect. Examples include the rotation flap, advancement flap, and transposition flap.
• Regional Flaps: Tissue is transferred from a nearby region while maintaining its blood supply. The pectoralis major flap is a common choice.
• Free Flaps: Involves the transfer of tissue from a distant site, along with its blood supply, which is then reconnected using microvascular techniques. Commonly used free flaps include the radial forearm flap and anterolateral thigh flap.
• Tissue Expansion: Involves the gradual expansion of surrounding tissue using an inflatable balloon, creating excess skin that can be used for reconstruction.

Postoperative Care

Postoperative care is essential for the success of cheek reconstruction and may include:

• Pain management.
• Antibiotic therapy to prevent infection.
• Wound care and monitoring for signs of flap failure or complications.
• Physical therapy to maintain facial function and reduce scarring.

Complications

Complications of cheek reconstruction can include infection, hematoma, flap failure, scarring, and dissatisfaction with aesthetic outcomes. Early detection and management of complications are critical.

Outcomes

The outcomes of cheek reconstruction vary depending on the extent of the defect, the chosen reconstruction technique, and the patient's overall health. While the primary goal is to restore function, significant emphasis is also placed on achieving the best possible cosmetic result.