47 - Oral Cavity Lower Cheek Flap Dissection: A Descriptive Study of a Practical Alternative to Bisection

Poster Board Number: 47
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Abstract Body : The oral cavity contains intricate structures and complex relationships and is often a difficult area of dissection for learners. Published methods of oral cavity dissection involve bisecting the skull to obtain an internal view of its structures. While this approach provides a complete view of midline structures, it has several limitations. Learners may find the act of bisecting the head distressing; this may limit their ability to interact with and learn from the dissection. Further, the bisection view can be disorienting as it does not provide the most clinically relevant perspective and disrupts the integrity of the relationships within the oral floor. Finally, long-term preservation of dissected specimens is difficult due to the many delicate structures that are exposed.
The goal of this project was to develop an efficient, straightforward, and minimally destructive approach for dissecting the oral cavity while maintaining its relationships with the soft tissue of the cheek, external carotid and its branches, the salivary glands and their ducts, and relevant branches of the trigeminal nerve. The proposed technique involves partial removal of the mandible and the superficial soft tissue of the ipsilateral cheek and neck to create a clear view of the oral cavity.
The project aimed for a lateral approach to maintain and visualize the continuity between the neck, oral cavity, and oral floor which are often disrupted by the classic approaches. Virtual anatomical models and existing techniques were consulted to determine how to maximally preserve the area. Following skin removal, the platysma overlaying the portion of the mandible and cheek area to be dissected was cleared. The buccal fat was removed and the masseter detached from the mandible and reflected medially and superiorly toward the zygomatic arch. An oscillating saw was used to cut through the mandibular ramus and body 2 cm proximal and distal to the mandibular angle, respectively. The soft tissue of the oral floor was removed using blunt dissection to expose relevant nerves and vessels, such as the hypoglossal nerve, eventually breaching the buccal mucosa and providing a clear view into the oral cavity.
This method provided a unique view of the oral cavity preserved as it exists in situ. It notably compares to current, standardized oral cavity surgical techniques such as the lower cheek flap and mandibulectomy, which provide a similar view of and access to the cavity. Muscles of mastication, submandibular gland and duct, and muscles of the tongue and their relationships with each other were all visualized. The nerves and vessels of the neck, face and oral cavity— such as the external carotid, facial artery, lingual artery, lingual nerve, inferior alveolar nerve, and hypoglossal nerve— were clearly distinguished and their courses followed.
Future directions include testing this dissection protocol for reproducibility and accessibility amongst other dissectors. Additionally, this method and the perspectives it brings should be compared to the other published methods to ascertain the benefits and drawbacks of each. Finally, while it preserved the oral floor, additional approaches that can be used in conjunction with this one should be explored in order to further highlight important anatomical relationships. Receiving feedback on the method and continuing to explore new approaches will be crucial in determining next steps for enhancing oral cavity dissection and understanding.