This document discusses a prospective study involving 12 patients aimed at evaluating the effectiveness of cervicofacial flaps for reconstructing cheek defects. It highlights the advantages of the technique, including reduced surgical risks for high-risk patients and short operative times, and also identifies potential complications such as flap dehiscence and ischemia. The study categorizes cheek defects based on their size and location, suggesting appropriate reconstruction methods for each category.

1. CERVICOFACIAL FALP : REVISTED
Dr Kundan
Department of Surgical oncology
Mahavir Cancer Sansthan

3. • Study design – Prospective study
• No of patients – 12
• Size of defect – 4x7 to 5x11 cm defect
Aims of study
- Effectiveiness of Cervicofacial flap in reconstruction of
cheek defects,
- To assess whether it gives cosmetically and functionally
good result without causing much deviations and deformity
- To study complications of Cervicofacial flaps and its safety
and benefits in high risk and debilitated patients.

7. • Large cutaneous defects of the cheek and
external ear present a reconstructive challenge.
• While free tissue transfer has been increasingly
used for such defects, many patients with these
malignancies are poor candidates for lengthy
reconstructive surgery.
• The use of a cervicofacial or cervicothoracic
advancement flap in head and neck surgery was
first described by Esser in 1918 and the technique
has since evolved considerably

8. classification system of Cabrera and Zide
• Zone 1 is bounded by the inferior orbital margin superiorly, the nasolabial
crease medially and the gingival sulcus inferiorly. The lateral border extends up
the medial border of the sideburn and joins the lateral canthus along an
imaginary line.
• Zone - 2 is bounded by the lateral border of the sideburn descending inferiorly
to the angle of the mandible following it medially, then curving superomedially
over the malar prominence, and finally extending superolaterally toward the
lateral canthus. Zone 2 refers to preauricular defects.
• Zone - 3 is bordered laterally by the midpoint of the mandible, the lower lip
medially, gingival sulcus superiorly, and extends out to its lateral border that
overlaps with zone 2. Zone 3 refers to buccomandibular defects and defines an
area in the lower cheek region.

9. classification system of Cabrera and Zide

10. • Reconstruction of cheek lesions will vary according to the
size and location of the defect.
• Small lesions less than 3 cm in diameter may be excised
and closed primarily.
• Lesions larger than this dimension if closed primarily would
cause distortion of the surrounding facial features impairing
cosmesis and perhaps function.
• Cheek defects from 3 to 5 cm in diameter may be closed
satisfactorily with local flaps from within the cheek unit. For
• cheek defects larger than 5 cm, however, one must
generally consider using regional flaps.

11. • Blood supply of subcutaneous
Cervicofacial flap is random pattern.
• multiple perforators to the skin which
arise from deep facial artery, transeverse
facial artery, and superficial temporal
artery supply to flap by forming vascular
channels.
• Anteriorly based flap derives its blood
supply from submental artery and
perforators of facial artery
• Cervicofacial flap carries dissection below
superficial musculoaponeurotic system in
the face and deep to platysma in the
neck.
• On occasion, a skin graft for the donor site
may be used.

12. Advantages
• Operative time is short.
• It causes minimum deviations in relations to
important structures around cheek.
• reduce surgical risk in high risk patients like
old age, diabetic patients, un-controlled
hypertension
• It can provide excellent skin colour and
texture match.

13. Complication
• Flap dehisence
• Flap ischemia
• Flap edema
• Ectropion

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