In cases where the whole thickness of the cheek is involved the cheek can be incised from the angle of the mouth as far as the border of the masseter muscle down to the adipose layer. A part of the fatty tissue is exsected and pushed aside, the thumb of the operator being introduced into the buccal cavity and pressed outward against the cheek to determine the position and extent of the pathological involvement. The diseased area is cut out with curved scissors, going well into the healthy tissues. The wound is then brought together by suture while the defect of the mucous membrane is tamponed for four or five days, when it can be covered with Thiersch grafts. The latter in a short time takes on the appearance of mucous membrane and overcomes the contraction of the ordinary sutured wound (Edward-Albert). =Serre Method.=—For still larger defects Serre makes the ablation in rectangular form, as shown at _A_, Fig. 258, and forms a longer flap of rectangular form from the tissue of the cheek and neck. This flap he dissects off from the margin of the maxillary bone to give it the proper mobility. The flap is drawn upward and sutured, as in Fig. 259. There is little retraction experienced in this method, and answers well for defects of medium extent. [Illustration: FIG. 258. FIG. 259. SERRE METHOD.] LARGE DEFECTS In larger defects the flaps to be utilized in overcoming the deformity must be taken from the cheek above as well as the anterior chin, as shown in Figs. 260 and 261. [Illustration: FIG. 260. FIG. 261. CORRECTION OF ANGLE OF MOUTH.] Another method is to cut the two flaps as in Fig. 262. These flaps are made of the entire thickness of the cheek tissue, and are slid down into position and sutured or approximated, as in Fig. 263. [Illustration: FIG. 262. FIG. 263. CORRECTION OF EXTENSIVE DEFECT AT ANGLE OF MOUTH.] As a rule the excised mucous membrane subsequently prevents a free opening of the mouth added to by the contraction of the flaps themselves. To overcome this a flap of skin with its epidermal surface turned inward is sutured into the defect, as will be shown presently, or a pedunculated flap formed at the wound surface before its transplantation into the defect may be covered with skin grafts (Thiersch). =Bayer Method.=—Bayer has successfully utilized a large flap from the mucous membrane of the palate and covered it externally with a flap of skin taken from the submaxillary region. =Kraske Method.=—Kraske forms the flap to be turned into the defect of the tissue immediately surrounding it, as shown in Fig. 264. This flap may heal into position, even though its pedicle is made up only of subcutaneous tissue, according to Gersuny. The epidermal surface of such flap is made to form the inner or mucous surface of the repaired cheek (see Fig. 265), while its external surface and the secondary wound are covered with Thiersch grafts, at one and the same sitting.