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Facial nerve palsy has both a physical and a psychological bearing on the patient. The treating physician should therefore be aware of the milieu of differential diagnosis possible. Mindfulness of the various clinical diagnosis and their investigations is essential as not only the treatment but the prognosis also depends on the cause.

<p class="abstract">Reconstruction of full-thickness buccal defect involving oral commissure which demanding, it requires restoring competency of commissure besides providing lining for two surfaces simultaneously. Such defects prerequisites a pedicled flap each for mucosal and cutaneous surfaces else a free flap with double-paddle skin is needed. We present a case of a 45-year-old gentleman with bilateral buccal mucosa lesions; left side proliferative squamous cell carcinoma (T4N0M0) infiltrating into the cheek and right-sided large verrucous lesion. Reconstruction of verrucous lesion defect was done with buccal fat pad flap following wide local excision, while the SCC lesion resulting defect was reconstructed with de-epithelized bipaddle submental artery island flap (SAIF). Postoperatively patient had an uneventful recovery. The bipaddled SAIF has emerged as innovative modification of the conventional submental flap for reconstruction of composite oro-facial wounds provides lining for both surfaces, requires a shorter operative time than a free flap and avoids donor site deformity associated with double paddled Pectoralis cutaneous flap. The complexity of bilateral buccal defects and utilization of bipaddled design for reconstruction warrants submission of this case with just two cases reported in the literature.  </p>

<p class="abstract">Management of head and neck cancer defects has been challenging owing to the complexity of the created defects. Various local and regional flaps to free flaps have been described in the reconstruction of cancer defects, each of them having it’s own merits and limitations, therefore none of them appears as an ideal one. A Submandibular gland flap (SMGF) technique has emerged as a versatile flap having advantages of a regional and a free flap. In this study, eleven patients (four tongue, six buccal mucosa defects and one retromolar trigone defect) underwent reconstruction of oral cavity cancer defects with SMGF. The outcomes of the SMGF were evaluated in terms of the ease of harvest, functional outcome, and postoperative complications. The mean defect size and the flap dimensions were 4.4×3.9 cm and 3.6×3.3 cm respectively. One patient suffered wound infection resulting in partial flap necrosis with wound dehiscence. In the follow-up period one patient developed contra nodal recurrence and another patient developed a second primary on the contralateral base of the tongue. This study showed that SMGF is an excellent flap for the reconstruction of oral cavity cancer defects because of its reliability, versatility and its relative ease of application.</p>