Gingivobuccal cancers affect anatomically distinct yet confluent areas each varying in its ability to resist oncologic spread. Barriers such as periosteum and bone provide greater degree of resistance when compared to buccinator and buccal fat. Involvement of dentition and presence of potential spaces along the mandible and maxilla provide avenues of spread that may result in extensive defects with substantial functional sequalae following tumor extirpation. Owing to the complex 3-dimensional anatomy with varying tissue types preoperative imaging is of utmost importance in surgical planning to ensure negative margin resection.
Gingivobuccal cancer (GBC), a squamous cell carcinoma of the inner cheek and gum, accounted for more than 389,485 new lip and oral cavity cancer cases worldwide in 2022. Its incidence varies geographically, mainly due to endemic habits like smokeless tobacco and betel nut use. GBC is highly prevalent in South Asia compared to the West. In India, more than 30% of adults consume tobacco. Most cases in South Asia are diagnosed late, with 50% to 70% presenting in advanced stages. Males are predominantly affected, with a ratio up to 4:1, linked to higher tobacco, betel quid, and alcohol use.
The unilateral cleft lip deformity is characterized by uncoupled premaxillary growth leading to distinct nasolabial anatomic changes. Careful analysis of the cleft deformity is important for surgical design. Several techniques have been developed for cleft lip repair. The surgeon should select the method that compliments their style, working consistently in their hands. The best predictor of long-term outcome is the final appearance, balance, and harmony in the operating room. Meticulous photographic and anthropometric records will aid the developing surgeon in improving their technique.
Gingivobuccal complex cancers represent the most common oral cavity malignancy in the Indian subcontinent, constituting up to 40% of oral cancers in Southeast Asia. Despite surgery being the primary treatment modality, locoregional recurrence remains a significant challenge in locally advanced disease. Adjuvant radiotherapy improves locoregional control in patients with adverse pathologic features. Implementation of evidence-based dose constraints, comprehensive dental prophylaxis, and early supportive care measures are critical for minimizing treatment-related morbidity while maintaining oncological efficacy in this challenging subsite. Induction chemotherapy offers a valuable strategy for converting borderline resectable T4b tumors with infratemporal fossa involvement to surgically amenable disease.
Gingivobuccal sulcus cancers present unique surgical challenges due to their complex anatomic relationships and propensity for extension into the masticator space and infratemporal fossa. Traditional wide local excision approaches often result in positive margins and local recurrences. This article reviews the principles, techniques, and outcomes of compartmental resection in upper gingivobuccal cancers, with emphasis on anatomic considerations and surgical approaches. Compartmental resection offers superior oncological outcomes compared to conventional approaches, with improved margin clearance and reduced local recurrence rates. The article does not intent to discuss the lower gingivobuccal cancers in detail as it is discussed in a separate article.
Fistulas are the most consequential complication of cleft palate repair and have compounding effects on multiple functional domains. Successful reconstruction is critical to resuming the normal pathway of care. The nature of a fistula can be understood considering the multiple axes that define its presentation. Closure involves addressing nasal lining, oral lining, and velar muscle function and options can be organized according to a "reconstructive stepladder". Ultimately, the selection of a strategy considers the fistula, patient, and surgeon/resources; with the goal of robust closure that optimizes speech, growth, dental health, and treatment burden.
Surgical management of gingivobuccal cancers presents unique challenges due to complex anatomy and aggressive tumor behavior. This subset of oral cavity cancer frequently demonstrates extension into critical structures, submucosal spread, and bony invasion. This article reviews the general principles as well as surgical approaches associated with these cancers. En bloc resection remains the foundation of primary management, with individualized approaches based on tumor location, stage, and depth of invasion. Achieving negative surgical margins is critical for local control, with emerging evidence supporting dynamic margin assessment strategies and imaging-guided techniques.
Septorhinoplasty is complex, and it becomes more complex in the treatment of clefts. Septorhinoplasty may be the "finishing touch" at the completion of care or could be a major reconstructive endeavor following an unfavorable course through childhood. Practices vary widely, and data to guide decisions are limited. Although presentations are often unique, patterns are apparent when considering the multiple axes that define development through to maturity. Recent insights have clarified erroneous dogma and redefined universal goals. Based upon those goals and contemporary rhinoplasty techniques, a comprehensive approach of component septorhinoplasty is described to optimize form and function.
Secondary deformity following primary cleft lip repair is common. It is usually the result of the technique during the primary repair, sequelae from the original deformity, or poor scar formation. Minor deformities that involve 1 anatomic area such as the nose, cutaneous lip, vermillion, and mucosa can be addressed with a minor revision technique. Major deformities that involve more than 1 minor deformity require complete take down of the original repair and rerepair. Cleft septorhinoplasty involves addressing residual cleft nasal deformity and should ideally be performed at or approaching the completion of nasal growth.
The embryology, classification, evaluation, and reconstructive management of complex craniofacial clefts, a group of exceedingly rare and highly variable congenital anomalies, is presented. Using the Tessier system as a structural framework, the characteristic features of each cleft subtype and highlights, key diagnostic considerations, including assessment of soft-tissue deficiency, skeletal disruption, and associated functional concerns are described. Emphasis is placed on the application of fundamental reconstructive principles: respect for facial subunits, restoration of symmetry, and staged correction of bony deformities, that guide individualized surgical planning in the context of significant phenotypic heterogeneity.
Cleft palate repair is performed to support normal speech and feeding, but the optimal timing and technique remain debated. This article reviews relevant anatomy, surgical techniques, and controversies in primary palatoplasty. Ultimately, outcomes depend on surgeon experience, tailored surgical planning and execution, and multidisciplinary care coordination. Continued research and collaboration aim to improve speech outcomes, reduce complications, and guide best practices in treatment.
