A still more extensive restoration of the cheek is shown in Figs. 275, 276, and 277, and the position of the skin grafts and replaced flap pedicles in Fig. 278. [Illustration: FIG. 275. FIG. 276. FIG. 277. FIG. 278. BARDENHEUER METHOD.] =Staffel Method.=—Staffel has also utilized pedunculated flaps taken from the forehead to correct defects of the cheeks and mouth. His method of procedure in an aggravated case resulting from mercurial stomatitis with resultant cicatricial trismus is shown in Figs. 279 and 280. Two pedunculated forehead flaps were employed in the above case as well as two flaps each attached by a broad pedicle from the skin under the chin Tripier fashion, and although the patient thus operated upon was only five years of age, an excellent result was obtained. [Illustration: FIG. 279. FIG. 280. STAFFEL METHOD.] EMPLOYMENT OF PROTHESES When the defect of the cheek due to the removal of a greater part of its structure is so large as to frustrate all attempts at its correction we may resort to the employment of protheses made for the purpose. In Fig. 281 a case of Morris is shown following the removal of a myeloid sarcoma involving a greater part of the upper cheek, the eye, and the palate. The operator had a prothesis constructed by Hayman, which provided not only an artificial cheek, but also an eye and the palate. [Illustration: FIG. 281.—CHEEK PROTHESIS, AFTER REMOVAL OF SARCOMA. (_British Medical Journal._)] How excellently this has been accomplished is depicted in Fig. 282. This prothetic contrivance not only improved the patient’s appearance, but also enabled him to speak intelligibly, which had been impossible, owing to the absence of a greater part of the soft palate. [Illustration: FIG. 282.—PROTHESIS APPLIED TO FACE. (_British Medical Journal._)] Hayman describes what he did as follows: “I obtained a model of the mouth, after which an ordinary plate was made, then a special obturator to correct the palatine defect. With the obturator in position a model of the remaining hollow was taken, and from this a silver plate was struck, which filled accurately into the hollow and under the right ala of the nose; a small tongue of silver was adjusted over the bridge of the nose, and on to this the spectacles were subsequently soldered. An artificial cheek and eye were then modeled in wax to match the other side of the face. A second silver plate was struck upon a metal cast taken from the model, soldered to the inner plate as a cover is fixed to a box. An artificial eye was then fixed to the plate in the proper situation, and the face portion painted flesh-color and japanned. In order to keep the mask in position, a strong wire, fixed to the posterior edge of the artificial cheek, passes around the right ear, and the ear pieces of the spectacles are joined behind the head by an elastic band.” [Illustration: FIG. 283.—CIRCULATION OF THE HEAD.