Intraoral Extraction of Cheek Skin Cyst

BACKGROUND: When a physician encounters a benign subcutaneous cyst in the cheek, his or her decision whether to excise and how to excise the cyst takes into account the potential risk of postsurgical scarring. OBJECTIVE: To describe and show an intraoral buccal mucosal approach to excising a cyst in the inferior-anterior cheek so that skin scarring is avoided. METHOD: An incision was made intraorally in the buccal mucosa, and dissection was carried through the buccinator muscle until the cyst wall was seen. Careful separation of tissue around the cyst was done by blunt dissection, and the unruptured cyst was removed through the buccal mucosal incision. RESULT: The entire intact cyst was removed without creating any excision marks in the cheek skin. No complications were encountered, and buccal mucosal healing was excellent. CONCLUSION: A buccal mucosal intraoral approach is an alternative to a percutaneous excision to remove a cyst in the lower cheek region. The intraoral approach avoids a visible scar on the cheek skin.     

Buccal fat pad excision: aesthetic improvement of the midface

Visual criteria for a harmonious midface depends on (1) a distinction between the anterior border of the parotid gland and cheek hollow, (2) a visible posterior border of the nasolabial fold (this signifying the most variable criterion), (3) an intervening cheek soft-tissue convexity that does not exceed the plane of a perpendicular from the midzygoma to the mandible (subtle submalar depression), (4) prominent zygomatic eminences, and (5) a well-defined mandible, particularly the angle. The space within the zygomatic arch and the mandible that defines the ideal midfacial "cheek hollow" has been established. This can be achieved through a combination of: aesthetic contouring of the facial skeleton, facial liposculpture, and cervicofacialplasty. A series of 25 consecutive patients undergoing submuscular fat removal by buccal fat pad excision to improve aesthetic midface were treated and are presented. To preserve the subcutaneous fat commonly lost with aging and to avoid late secondary deformities, only submuscular buccal fat excision is recommended in a carefully selected group of patients. The anatomy, indications, and technique for buccal lipectomy in midface contouring are discussed.     

Adenomatoid hyperplasia of the minor salivary glands on the buccal mucosa: A rare case report

INTRODUCTIONAdenomatoid hyperplasia of the minor salivary glands is a hyperplastic oral lesion which may be seen on minor salivary gland bearing areas on all oral mucosa, especially on soft and hard palate. This study reports a rare case of buccal adenomatoid hyperplasia of the minor salivary glands and discusses the clinical significance.PRESENTATION OF CASE48 year old male patient presented with a complaint of a swelling on his left cheek. Clinical examination revealed a bluish mass on the buccal mucosa. A provisional diagnosis of salivary gland neoplasm was made and the lesion was excised under local anesthesia. The histological diagnosis was adenomatoid hyperplasia of the minor salivary glands.DISCUSSIONBuccal localization of the adenomatoid hyperplasia of the minor salivary glands is quite uncommon in the literature. There are two cases in the English literature for our knowledge. In the clinical examination, the nodular and protuberated appearance of the lesion resembles buccal minor salivary gland tumors and vascular lesions. Histological analysis is fundamental to achieve correct diagnosis.CONCLUSIONThe differential diagnosis of buccal nodular, exophytic and colored mucosal lesions should include adenomatoid hyperplasia of the minor salivary glands.     

Reconstructive Management with Buccal Urethroplasty

We present the historical evolution of the use of buccal mucosa in reconstructive surgery, from the first application in ophthalmology to paediatric surgery and, finally, urethral surgery. This process spanned 99 yr, from 1894 to 1993. The harvesting of buccal mucosa from the cheek requires careful preoperative patient evaluation and selection. To avoid postoperative complications related to the harvesting site, we provide some suggestions based on a large series of patients. The use of a one- or two-stage repair procedure in penile urethroplasty is discussed, and some step-by-step surgical techniques are suggested. The reconstruction of the bulbar urethra using buccal mucosa in traumatic and nontraumatic strictures is also discussed, and different techniques are presented. Finally, appraisal and discussion of some challenging topics (eg, evidence for efficacy, complications, implications, worldwide use) concerning the use of buccal mucosa for urethral stricture reconstruction are presented based on the current literature.Patient summaryWe looked at the history and evolution of the use of buccal mucosa for reconstructive urethral surgery and found that harvesting the buccal mucosa from the cheek is a safe procedure. The use of buccal urethroplasty represents the gold standard in the management of patients with anterior urethral strictures.     

Inflammatory Variant of Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma of the Buccal Mucosa: An Overview and Case Report with a 10-Year Follow-Up

Liposarcomas of the oral cavity are rare. Those originating in the buccal mucosa cause challenging diagnostic and therapeutic issues since less than 40 cases of liposarcomas of the buccal mucosa and cheek have been reported in the worldwide literature. Herein, we present a case of atypical lipomatous tumor/well-differentiated liposarcoma affecting a 45-year-old female patient. Ultrasonography and magnetic resonance imaging confirmed a well-defined mass located in the right buccal mucosa, extending to the submucosal layers of the cheek. Histopathologically, a well-differentiated fatty neoplasm with presence of prominent stromal inflammatory cells was observed. Multifocally scattered bizarre hyperchromatic stromal cells, some of which multinucleated, were also observed. An immunohistochemical panel comprising vimentin, S-100, CD10, CD34, CD20, CD3, CD68, CD138, MDM2, Ki-67, and P53 was employed to better characterize the lesion. A local recurrence event occurred during a 10-year follow-up period. Surgical resection was performed during both episodes. We also provided an overview of demographic and clinicopathological characteristics, immunohistochemical features, imaging findings, and the differential diagnosis of liposarcoma of the oral cavity. Knowledge of the etiopathological and clinical aspects of this rare neoplasm is fundamental in order to rule out other conditions, including lipomatous lesions that affect the buccal mucosa.     

ANATOMICAL REASONS FOR PROBLEMS AFTER NEURECTOMY FOR BLEPHAROSPASM: A STUDY IN CADAVERS

The purpose of this study is to clarify the mechanisms of the problems that develop after neurectomy for blepharospasm. The left facial nerves in 10 Japanese cadavers were dissected under a surgical microscope. The temporal, zygomatic, and buccal branches innervated to the orbicularis oculi muscle. These three groups formed a well-communicating plexus posterior to the orbicularis. The most inferior buccal branch curved in the deep layer in the lower part of the cheek. In the cheek, both the buccal and the temporal branches had ramifications of other facial muscles. The information given in previous anatomical textbooks did not specifically define the denervation of the orbicularis. When neurectomy was done in the past, the inferior buccal branch may have been kept intact, or other facial muscles as well as the orbicularis may have been denervated which caused the blepharospasm to recur and complications to develop after neurectomy.     

Anatomical reasons for problems after neurectomy for blepharospasm: a study in cadavers.

The purpose of this study is to clarify the mechanisms of the problems that develop after neurectomy for blepharospasm. The left facial nerves in 10 Japanese cadavers were dissected under a surgical microscope. The temporal, zygomatic, and buccal branches innervated to the orbicularis oculi muscle. These three groups formed a well-communicating plexus posterior to the orbicularis. The most inferior buccal branch curved in the deep layer in the lower part of the cheek. In the cheek, both the buccal and the temporal branches had ramifications of other facial muscles. The information given in previous anatomical textbooks did not specifically define the denervation of the orbicularis. When neurectomy was done in the past, the inferior buccal branch may have been kept intact, or other facial muscles as well as the orbicularis may have been denervated which caused the blepharospasm to recur and complications to develop after neurectomy.     

Use of the cheek blade of the Dingman mouth gag to aid elevation of the buccal cheek flap in cleft palate surgery

The use of additional mucosal bolstering of the nasal layer in cleft palate repairs is a commonly used technique. The buccal cheek mucosal flap is a common donor site. This flap is normally elevated using the surgeon's finger for counterpressure from the skin side of the cheek. A simple idea, using the cheek blade of the Dingman mouth gag externally, to serve as a stable platform to aid the elevation of this flap is presented.     

Clinical, radiological and histological correlation in the diagnostic work-up of cemento-ossifying fibroma of the maxilla: case report

Cemento-ossifying fibroma is a relatively rare tumor classified between fibro-osseous lesions. This lesion appears within the bone although in some occasions it involves the gingivae soft tissues. It is a slow growing and well-defined tumorous lesion, because of this, it is considered as a benign lesion. We report a case of a young female presenting a mass in the right cheek. The evolution of the process was 4 years. She was treated with surgical resection via a Weber-Fergusson approach. The histology was that of a benign fibro-osseous proliferation composed of bony spicules and spherules admixed with a fibrous stroma. Clinical and radiological information was essential for the final diagnosis. The histologic findings alone may be similar to other pathologies such as osteoblastoma, low-grade osteosarcoma and particularly to fibrous dysplasia. An accurate diagnosis requires careful clinical, radiological and histological correlation in order to make an optimal treatment and an excellent outcome.     

Reconstruction of full-thickness cheek defects with combined temporalis myofacial and facial-cervico-pectoral flaps.

OBJECTIVE: The objective of this study was to assess using the temporal myofacial flaps (TMFF) and the facial-cervico-pectoral flap (FCPF) to provide both inner and outer linings for large full-thickness cheek defects following ablative oral cancer surgery. STUDY DESIGN: Twelve patients with malignant tumors in the buccal region were treated by extensive surgical dissection, and the cheek mucosa defects were repaired with the TMFF and the cheek skin defects were reconstructed with the FCPF. There were 9 male and 3 female patients, age range from 18 to 70 years (mean 52.8). The full-thickness cheek defects ranged from 7 x 6 cm to 10 x 8 cm in size. RESULTS: No patient had complete loss of flap; 3 patients had minor complications (TMFF and FCPF partial necrosis and FCPF distal dehiscence) all of which settled with conservative management. Mouth opening was normal in 10 patients, and facial contour was satisfactory in 8 patients. The follow-up period varied from 6 to 26 months (mean 15.2); 3 tumors had local recurrences and 2 patients died from tumor metastasis. CONCLUSION: We found the technique to be anatomically sound, technically easy and reliable, and believe it is a useful method for the reconstruction of large full-thickness cheek defects.     

Buccal fat pad pedicle flap for midface augmentation.

Midface aging is characterized by soft-tissue ptosis with loss of cheek projection. Subperiosteal midface lifts may reposition the soft-tissue mounds and improve the tear trough, but may not fill the lateral cheeks in patients with significant jowls or poor bony support. Correction with alloplastic implants is helpful, but may not be accepted by many patients. During subperiosteal midface lifts, the author often excises Bichat's fat pad to decrease the jowl and to diminish face fullness. He has modified this approach and used a vascularized Bichat's fat flap to aid lateral cheek projection while still improving lower face fullness and the jowl. For the last 4 years, close to 150 patients undergoing subperiosteal midface lifts have had vascularized Bichat's fat pad flaps. The jowls were marked preoperatively. All patients had complete cheek undermining either through a buccal sulcus incision or through a crow's-foot incision, or through a muscle-sparing limited lower blepharoplasty incision. Bichat's fat pad is identified in its pocket medial to the masseter tendon. Mobilization of Bichat's fat pad is done by blunt dissection, preserving its thin fascial envelope. The "hernial saclike" pocket, excluding Stensen's duct and the buccal branches of the facial nerve, is identified and protected. Suspension is accomplished by fixation with 3-0 polydioxanone sutures either to the temporalis fascia (via the temporal incisions), to the arcus marginalis, or to the suborbicularis oculi fat pad. Fixation technique is dependent on where the fat pad is needed and the surgeon's preference. Fat pad repositioning is accomplished with a minor learning curve. The most common problems are tearing of the fat pad during fixation and temporary numbness of the long buccal nerve. Attention to leaving the capsule intact and gentle handling is essential to fixation. Nevertheless, in some patients with poor-quality fat pads, fixation is extremely difficult. Four-year results have been excellent. Further studies with magnetic resonance imaging of postoperative patients are necessary to assess longevity. Bichat's fat pad provides autologous vascularized tissue for midface fill. Placement may be lateral for cheek augmentation or medial for deep nasolabial folds. Jowl improvement also occurs with the removal of Bichat's fat pad from its pocket.     

应用带腹壁下动静脉的腹膜皮瓣修复面颊洞穿性缺损

目的应用带腹壁下动静脉的腹膜皮瓣修复面颊洞穿性缺损。方法先对口颊部鳞癌和面颊部恶性黑色素瘤行联合根治术，再应用腹膜皮瓣修复创面。该皮瓣包括脐旁皮瓣、腹直肌后鞘、腹膜及腹壁下动静脉，皮瓣大小为8cm×5cm～9cm×6cm。结果临床应用3例，术后皮瓣成活，有一例腹膜远端约2cm×1cm大小坏死，经换药后愈合。结论腹膜皮瓣是一种新的修复面颊部洞穿缺损的手术方法。     

无覆盖带蒂颊脂垫瓣在修复口腔缺损中的应用

目的：介绍无覆盖带蒂颊脂垫瓣用于口腔缺损修复的实践。方法：将颊脂垫瓣转移到相应的口腔缺损区,暴露的颊脂垫瓣表面无需植皮,可以自行上皮化。结果：共治疗口腔缺损病例13例,均获成功,颊脂垫瓣封闭效果好。结论：无覆盖带蒂颊脂垫瓣作为局部区域性组织转移瓣,对口腔内颊部、软腭和牙槽等部位软组织缺损的修复尤为适宜,是一种口腔内软组织缺损理想的充填材料。     

Neurovascular musculocutaneous latissimus dorsi free-flap transfer for reconstruction of a major cheek defect with facial palsy in a 14-month-old child

This report deals with a female infant 14 months old at time of surgery. Three weeks before admission, she suffered a direct blow to the left cheek by hitting a table. Within 24 h, she developed a hematoma involving the whole cheek. Ten days later, she developed an eschar on the cheek and was referred to us. Three weeks after the initial trauma, the damaged tissues were debrided, including the skin, subcutaneous tissue, and muscle. The buccal mucosa remained intact. Facial palsy involving the territory of the buccal and mandibular branches was already evident at 3 weeks, as well as facial asymmetry. Consequently, a free musculocutaneous neurovascular latissimus dorsi free flap was proposed to restore the volume, shape, and function of the left half of the face. We present the surgical technique and the results 3.5 years later.     

Cheek and neck sculpturing: simultaneous buccal fat pad removal and subcutaneous cheek and neck lipoplasty

A combined procedure removing the buccal fat pad by excision and the subcutaneous fat of the cheek and neck by lipoplasty is described; this results in an improved contour in both the cheeks and neck. The technique has been applied in 28 patients of various ages without complications and with satisfactory results. Both the immediate results of the operation and the results noted 1 year or more after the operation are very satisfactory. Excellent results have been noted for nine young patients, and good results were obtained in 19 older patients. A review is given of the findings previously reported in the literature. At present, we are inclined to believe that removal of the buccal fat pad and lipoplasty of the subcutaneous fat of the cheeks and neck offers more improvement than either procedure alone. It is hoped that this combined procedure will give a solution to the troublesome problem of chubby cheeks and lead to a method of safely recontouring the cheek to a more youthful and beautiful appearance.     

Radiation-induced carcinoma in a hemangioma

A case of squamous cell carcinoma arising in repeatedly irradiated buccal hemangioma is reported, and the surgical techniques used in reconstructing the cheek and lips are described.     

Solitary neurofibroma arising from the infratemporal fossa in a child

Neurofibromas are derived from the nerve sheath and are commonly located in the head and neck region. They usually occur between the ages of 30 and 50 years. Neurofibromas arising from the infratemporal fossa are quite rare, especially in children. We describe a solitary neurofibroma arising from the infratemporal fossa in an 8-year-old boy who presented with a painless mass in his right cheek. Computed tomographic scan showed a soft-density, not well-circumscribed mass located in the right infratemporal fossa. The tumor was resected via the transmandibular approach with an excellent outcome. The histologic examination with immunohistochemical staining yielded the diagnosis of neurofibroma.     

Functional lower lip reconstruction with a forearm flap combined with a free gracilis muscle transfer.

We applied a forearm flap combined with a gracilis muscle flap for total reconstruction of the lower lip. The motor nerve of the gracilis muscle was repaired to the buccal branch in the cheek. The patient obtained good sphincter function for eating and speaking, and he could inflate a balloon without air leakage.     

Oral frictional hyperkeratosis (morsicatio buccarum): an entity to be considered in the differential diagnosis of white oral mucosal lesions

A 55-year-old man presented with desquamating lesions on his bilateral buccal mucosa intermittently for approximately 3 years. The alteration in texture within his mouth created an uncomfortable sensation and, at times, the lesions spontaneously peeled away requiring him to spit repeatedly. The patient denied any history of trauma, cheek biting, or use of tobacco products. On initial examination, the patient was asymptomatic and the oral mucosa had no abnormal findings, but on repeat examination when symptoms were present, the patient had shaggy white plaques on the bilateral buccal mucosa limited to the line of dental occlusion (Figure 1). The plaques could be easily peeled away from the underlying skin with a cotton swab without any pain, leaving behind normal underlying mucosa. A review of the prior biopsy of the affected mucosa revealed an irregularly hyperplastic epithelium with foci of ballooned epithelial cells within the upper layer, parakeratosis, and bacterial overgrowth (Figure 2). Microscopic examination of fragments of mucosa peeled away from the affected area revealed fragments ofparakeratotic cornified material colonized by numerous bacteria (Figure 3). Results from periodic acid-Schiffstain revealed no fungal elements. The diagnosis of oral frictional hyperkeratosis was established based on the clinical and microscopic findings. It was concluded that the hyperkeratosis was likely caused by bite trauma or grinding of the teeth while the patient was asleep. Triamcinolone 0.1% ointment in Orabase and tretinoin 0.05% gel were ineffective. The patient found that rinsing with hydrogen peroxide solution was most helpful in reducing the lesions. A bite guard was recommended by an oral and maxillofacial surgeon, but the patient has yet to use it.     

Laparoscopic resection of an intra-abdominal cystic mass: a cystic mesothelioma

The clinical features of a patient with an intra-abdominal cystic mass do not lead to a specific diagnosis. Aspiration is usually ineffective because the mass recurs and cytologic investigation is often non-diagnostic. Conservative management is unsuccessful because symptoms often persist. Surgical management of cystic masses is required for definitive management and pathologic diagnosis. A laparoscopic approach to the diagnosis and treatment can provide essential anatomic information and a complete resection with minimal morbidity. A laparoscopic technique using 3 trocars and maintaining the integrity of the mass allows complete excision and removal of large intra-abdominal cystic masses as reported in a 43-year-old patient with a large intra-abdominal cystic mass identified as a benign cystic mesothelioma.