Answer:
From a reconstructive standpoint, the cheek can be divided into three zones: suborbital (Zone 1), preauricular (Zone 2), and buccomandibular (Zone 3). Large defects are often corrected using tissue expanders. They are considered to offer the best match of color and texture with the least number of additional wounds for skin flap harvesting. Expansion is conducted over a 6-8 week period. Wieslander recommends the following guidelines for expansion: orienting the incision for expander placement to be perpendicular to the expander, choosing an expander whose length and width is at least as large as the defect, filling the expander intraoperatively to the safest maximum level to reduce hematoma and seroma formation, delaying expansion for about 2 weeks and then filling the expander at least once a week, overexpanding to a volume 30-50% more than necessary to compensate for flap contraction, and incising the capsule as needed to increase the stretch of the expanded flap but avoiding capsulectomy. Large cheek defects in Zones 1 and 2 can also be closed with cervicofacial flaps (with or without expanders). Extensive lower cheek defects (Zone 3) may require a cervicopectoral flap for closure (see following question).