In cases where the whole thickness of the cheek is involved the cheek can be incised from the angle of the mouth as far as the border of the masseter muscle down to the adipose layer. A part of the fatty tissue is exsected and pushed aside, the thumb of the operator being introduced into the buccal cavity and pressed outward against the cheek to determine the position and extent of the pathological involvement. The diseased area is cut out with curved scissors, going well into the healthy tissues.
The wound is then brought together by suture while the defect of the mucous membrane is tamponed for four or five days, when it can be covered with Thiersch grafts. The latter in a short time takes on the appearance of mucous membrane and overcomes the contraction of the ordinary sutured wound (Edward-Albert).
Serre Method.—For still larger defects Serre makes the ablation in rectangular form, as shown at A, [Fig. 258], and forms a longer flap of rectangular form from the tissue of the cheek and neck. This flap he dissects off from the margin of the maxillary bone to give it the proper mobility. The flap is drawn upward and sutured, as in [Fig. 259].
There is little retraction experienced in this method, and answers well for defects of medium extent.
Fig. 258. Fig. 259.
Serre Method.
LARGE DEFECTS
In larger defects the flaps to be utilized in overcoming the deformity must be taken from the cheek above as well as the anterior chin, as shown in [Figs. 260 and 261].