Its outline follows the pre-auricular contours of the tragus and helix; goes around the sideburn, across the zygomatic arch, and into the lower eyelid-cheek junction; and then passes inferiorly along the nasal sidewall into the nasolabial fold and marionette line, around the chin and toward the submental crease.
[2] The primary goals of cheek reconstruction include the restoration of native function, maximization of aesthetic outcome, and limitation of repair related morbidity.
Implicit in this statement is the intent to re-established both internal and external coverage, expressivity, masticatory function and aesthetic contour and quality.
Lower eyelid ectropion should be prevented, by minimizing tension and by overcorrection and suspension of the cheek flap to the lateral orbital rim.
This anterior-based flap is supplied by the facial and submental arteries and advances upward from the cervical area and rotates forward.
For larger anterior cheek defects, the posterior-based cervicofacial flap is continued inferiorly along the sternum, then laterally down across the chest, above the nipple and toward the axilla.
The arc of rotation is suitable for reconstruction of the anterior and lateral floor of mouth, buccal mucosa, retromolar trigone, and skin of the lower cheek and parotid region.
Advantages of the PMF is that the platysma flap has an appropriate thickness, minimal donor- site morbidity, acceptable scar and colour match and it is easy and faster to harvest.
The vessels can be found using a hand held doppler in the triangle between the dorsal edge of the sternocleidomastoid muscle, the external jugular vein, and the medial part of the clavicle.
Free flaps are the first choice in case of complex, composite, and through-through cheek defects with exposed bone, sinuses, orbit or dura.
It is primarily used for reconstruction of complex defects where conventional techniques are not available (in burn patients where common donor sites may have been damaged or destroyed).
Flap prefabrication starts with introduction of a vascular pedicle to a desired donor tissue that on its own does not possess an axial blood supply.
After a period of neovascularization of at least 8 weeks, this donor tissue can then be transferred to the recipient defect based on the newly acquired axial vasculature.
Donor site morbidity, patient characteristics such as skin laxity, age, tobacco use and sun exposure, potential radiotherapy, planned lymph node dissection, the size of the defect, structural involvement (skin, muscle, nerves, bone), functional concerns like maintaining oral hygiene, swallowing, mouth opening, aesthetic concerns, experience of the surgeon are all factors that influence the kind of reconstructive technique that should be chosen.