Oral Maxillofac Surg Clin North Am
· 2026 Aug · PMID 42387835
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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...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.
Oral Maxillofac Surg Clin North Am
· 2026 Aug · PMID 42225516
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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 bu...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.
Oral Maxillofac Surg Clin North Am
· 2026 Aug · PMID 42225515
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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...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.
Tevlin R, Wu R, Berry C
… +2 more, Birgfeld C, Ettinger RE
Oral Maxillofac Surg Clin North Am
· 2026 May · PMID 42140741
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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 tech...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.
Balasubramanian D, Patel T, Krishnadas A
… +3 more, Subash P, Thankappan K, Iyer S
Oral Maxillofac Surg Clin North Am
· 2026 Aug · PMID 42062186
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Gingivobuccal defects are one of the most challenging defects for the reconstructive surgeon. Great strides have been made to improve the reconstructive outcomes and quality of life of the patient with a combination of m...Gingivobuccal defects are one of the most challenging defects for the reconstructive surgeon. Great strides have been made to improve the reconstructive outcomes and quality of life of the patient with a combination of more sophisticated surgical techniques and more advanced technology. New methods provide better accuracy, shorter surgical times, better functional results, lesser complication rates, and overall better quality of life. This article provides a brief overview of the advances that have been made in the field of reconstruction and rehabilitation postoncological resections of the gingivobuccal complex and provides a glimpse of what the future holds.
Oral Maxillofac Surg Clin North Am
· 2026 Aug · PMID 41997757
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This review explores the epidemiology, molecular mechanisms, and immune interactions underlying gingivobuccal squamous cell carcinoma, a distinct oral cancer subtype strongly associated with tobacco and areca nut use. It...This review explores the epidemiology, molecular mechanisms, and immune interactions underlying gingivobuccal squamous cell carcinoma, a distinct oral cancer subtype strongly associated with tobacco and areca nut use. It highlights key genetic mutations, epigenetic alterations, and tumor microenvironment factors that drive carcinogenesis and influence prognosis. The role of oral potentially malignant disorders in early detection is emphasized, along with the importance of molecular subtyping for risk stratification. Advances in understanding tumor biology provide promising opportunities for developing targeted therapies and improving patient outcomes in this biologically complex and geographically prevalent disease.
Oral Maxillofac Surg Clin North Am
· 2026 Aug · PMID 41991464
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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, l...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.
Oral Maxillofac Surg Clin North Am
· 2026 May · PMID 41916815
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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 natur...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.
Enfinger CW, Caruso DP, Silva MM
… +2 more, Bunnell A, Fernandes R
Oral Maxillofac Surg Clin North Am
· 2026 Aug · PMID 41904021
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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,...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.
Oral Maxillofac Surg Clin North Am
· 2026 May · PMID 41876271
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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...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.
Oral Maxillofac Surg Clin North Am
· 2026 May · PMID 41876270
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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 palatop...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.
Oral Maxillofac Surg Clin North Am
· 2026 May · PMID 41876269
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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 unfavo...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.
Oral Maxillofac Surg Clin North Am
· 2026 May · PMID 41876268
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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...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.
Oral Maxillofac Surg Clin North Am
· 2026 May · PMID 41856813
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Orthognathic surgery is one of the most important interventions for patients with cleft palate (± cleft lip). Pre-surgical management prior to orthognathic surgery includes alveolar bone grafting to address maxillary con...Orthognathic surgery is one of the most important interventions for patients with cleft palate (± cleft lip). Pre-surgical management prior to orthognathic surgery includes alveolar bone grafting to address maxillary continuity defects and pre-surgical orthodontic treatment to optimize arch coordination in anticipation of skeletal movements of the midface ± mandible. Surgical approaches are selected based on patient-specific anatomy, functional goals (mastication, breathing), and facial proportions. Computer-assisted surgical planning and patient-specific guides and implants have improved the ability to address the complex skeletal dysmorphologies related to facial clefts.
Oral Maxillofac Surg Clin North Am
· 2026 May · PMID 41850973
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This article discusses management of cleft-related speech differences, stressing the need for differential diagnosis to distinguish between structural and functional etiologies. Structural differences, such as velopharyn...This article discusses management of cleft-related speech differences, stressing the need for differential diagnosis to distinguish between structural and functional etiologies. Structural differences, such as velopharyngeal insufficiency (VPI), require surgery or prosthetics. Functional differences, like velopharyngeal mislearning, are addressed with speech therapy. A specialized speech-language pathologist (SLP) uses perceptual evaluation to inform diagnosis. For VPI surgery, planning is key to individualize surgery for the patient. However, surgical planning should be deferred until VPI can be confirmed from correctly articulated pressure consonants. Management requires collaborative interpretation of functional and anatomic characteristics by the surgeon and SLP.
Oral Maxillofac Surg Clin North Am
· 2026 May · PMID 41850972
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Primary bilateral cleft lip repair is among the most complex procedures in cleft surgery. Presurgical infant orthopedics address the prominent premaxilla and align alveolar segments for an optimal primary repair. Princip...Primary bilateral cleft lip repair is among the most complex procedures in cleft surgery. Presurgical infant orthopedics address the prominent premaxilla and align alveolar segments for an optimal primary repair. Principles established by Mulliken have greatly increased the quality of bilateral cleft lip repair. These enduring principles emphasize symmetry, synchronous nasolabial repair, orbicularis continuity, proper philtral flap design, and median tubercle construction with lateral lip elements.
Oral Maxillofac Surg Clin North Am
· 2026 Aug · PMID 41826129
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Oral cancer represents a major public health issue in low-middle income countries (especially South East Asia) where its burden is disproportionately high. It predominantly affects the lower socioeconomic population and...Oral cancer represents a major public health issue in low-middle income countries (especially South East Asia) where its burden is disproportionately high. It predominantly affects the lower socioeconomic population and 70% of cases present at advanced stages that need multimodality treatment resulting in high expenditure and poor outcomes. The economic burden of oral cancer extends beyond the medical expenses to include nonmedical and indirect costs. Despite advances in treatment, high costs limit accessibility in resource-constrained settings. A resource-stratified approach is needed for effective and adequate management of the gingivobuccal cancer in these settings. Resource-stratified oral cancer management guidelines ensure uniform treatment.
Kim AY, Firriolo JM, Kreh CC
… +2 more, Magee WP, Hammoudeh JA
Oral Maxillofac Surg Clin North Am
· 2026 May · PMID 41820094
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This article synthesizes over a decade of institutional experience with more than 300 patients undergoing early cleft lip repair (ECLR) and presents a standardized, multidisciplinary framework encompassing patient select...This article synthesizes over a decade of institutional experience with more than 300 patients undergoing early cleft lip repair (ECLR) and presents a standardized, multidisciplinary framework encompassing patient selection, nutritional optimization, neonatal anesthesia, and refined operative technique. This article povides a practical, evidence-based roadmap for implementing neonatal cleft lip repair within a modern craniofacial program. By detailing selection criteria, perioperative workflows, and technical considerations, we offer a reproducible model that other institutions may adapt to their own resources and patient populations. ECLR has the potential to meaningfully reduce the cumulative surgical, financial, and psychosocial burden of cleft lip management.
Oral Maxillofac Surg Clin North Am
· 2026 May · PMID 41820093
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Alveolar cleft bone grafting is a critical component in the comprehensive surgical management of patients with cleft lip and palate. This article highlights the essential aspects of preoperative evaluation, optimal timin...Alveolar cleft bone grafting is a critical component in the comprehensive surgical management of patients with cleft lip and palate. This article highlights the essential aspects of preoperative evaluation, optimal timing, orthodontic and recipient site preparation, premaxillary osteotomy with repositioning, iliac crest harvest (anterior and posterior), alternative bone graft options, and postoperative management.