J Korean Assoc Oral Maxillofac Surg 2017; 43(3): 186~190
Tumor resection from retromolar trigone, posterolateral maxilla, and anterior mandibular ramus using lower cheek flap approach: a case report and review of literature
Young-Hoon Kang1,2, June-Ho Byun1, Su-Jin Sung2, Bong-Wook Park1,2
1Department of Dentistry, School of Medicine and Institute of Health Science, Gyeongsang National University, Jinju,
2Department of Oral and Maxillofacial Surgery, Changwon Gyeongsang National University Hospital, Changwon, Korea
Bong-Wook Park
Department of Dentistry, School of Medicine and Institute of Health Science, Gyeongsang National University, 501 Jinju-daero, Jinju 52828, Korea; Department of Oral and Maxillofacial Surgery, Changwon Gyeongsang National University Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea
TEL: +82-55-214-3885 FAX: +82-55-214-3265 E-mail: parkbw@gnu.ac.kr ORCID: http://orcid.org/0000-0002-2699-9188
Received September 26, 2016; Accepted December 21, 2016.; Published online June 30, 2017.
© Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
A surgical approach involving the retromolar trigone, posterolateral maxilla, and pterygoid region is the most challenging in the field of maxillofacial surgery. The upper cheek flap (Weber-Ferguson incision) with subciliary extension and the maxillary swing approach have been considered as alternatives; however, neither approach provides sufficient exposure of the pterygoid region and the anterior portion of the mandibular ramus. In this report, we describe two cases in which a lower cheek flap approach was used for complete tumor resection in the retromolar trigone and the anterior mandibular ramus. This approach allows full exposure of the posterolateral maxilla and the pterygoid region as well as the retromolar trigone without causing major sensory disturbances to the lower lip. A mental nerve anastomosis after tumor resection was performed in one patient and resulted in approximately 90% sensory recovery in the lower lip. The lower cheek flap approach provides adequate exposure of the posterolateral maxilla, including the pterygoid, retromolar trigone, and mandibular ramus areas. If the mental nerve can be anastomosed during flap approximation, postoperative sensory disturbances to the lower lip can be minimized.
Keywords: Lower cheek flap, Retromolar trigone, Posterolateral maxilla, Anterior mandibular ramus, Surgical approach


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