Lower Cheek Flap Approach for Oral Cavity Tumor

The lower cheek flap approach:
- Requires a midline lip–splitting incision that is continued laterally into the neck for exposure
  and neck dissection
This approach provides excellent exposure
for nearly all tumors of the oral cavity:
- Except those of the upper gum and hard palate
Mandible resection (marginal or segmental)
and reconstruction:
- Require the lower cheek flap approach in
  most instances
The lower cheek flap approach is required for
marginal or segmental mandibulectomy of tumors adjacent to the body of the mandible
Key Aspects of the Lower Cheek Flap Approach:
- Technique:
  - The incision starts by dividing the lower lip in the midline, extending down the chin to the symphysis of the mandible
  - It then continues down to the level of the thyrohyoid membrane and turns into the neck, usually following a skin crease
- Exposure:
  - The flap is raised in the subplatysmal plane, allowing broad access to the mandibular arch, oral diaphragm, and floor of the mouth
- Reconstruction / Closure:
  - The incision is closed with special attention to the vermilion border of the lip to minimize deformity
  - The mylohyoid muscle and orbicularis oris muscle are reapproximated
- Indications:
  - Used for advanced oral cancers (T3 to T4) where broad exposure is required:
    - Particularly for tumors involving the gingivobuccal sulcus or anterior tongue
  - Disadvantages / Complications:
    - Anesthesia:
      - Sacrifices the mental nerve, resulting in lower lip numbness
    - Nerve Damage:
      - Risk of injury to the marginal mandibular nerve
    - Cosmesis:
      - The lip-splitting incision can create a visible scar
Comparison to Other Approaches:
- Visor Flap:
  - An alternative, similar approach that avoids the lower lip-splitting incision but may provide less exposure
- Mandibulotomy:
  - Often used for more posterior oral cavity or oropharynx tumors to allow access by dividing the jaw
- Transoral Approach:
  - Preferred for smaller, localized tumors, avoiding facial incisions, but often insufficient for advanced disease
This approach is highly effective for large tumors when adequate, wide margins are essential