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Carnevale C, Til Pérez G, Sarría Echegaray P, Morales Olavarría C. Myomucosal island flaps for oropharyngeal reconstruction. Eur Ann Otorhinolaryngol Head Neck Dis 2023:S1879-7296(23)00168-0. [PMID: 38135564 DOI: 10.1016/j.anorl.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/07/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023]
Abstract
The oropharynx represents one of the most challenging areas to reconstruct for the head and neck surgeon. The buccinator myomucosal island flaps pedicled on the facial artery [tunnelized facial artery myomucosal island flap (t-FAMMIF)] or the buccal artery [buccal artery myomucosal island flap (BAMMIF)] are an ideal reconstructive option for moderate size defects measuring up to 8-9cm. Two fresh specimens have been used to show the step-by-step surgical technique of both island flaps. Design and flap extension, dissection plane, identification of the vascular pedicle, flap rotation and insetting are described. Reconstructive indications and the pros and cons of each one are discussed in this article. Myomucosal island flaps represent a very useful and versatile option for the functional reconstruction of the oropharynx. A detailed knowledge of the vascular anatomy of the cheek is key to obtain a large flap while minimizing the risk of complications.
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Affiliation(s)
- C Carnevale
- Department of Otorhinolaryngology Head and Neck Surgery, Clínica Rotger, Quirón Salud, Palma de Mallorca, Spain; University of the Balearic Island, Palma de Mallorca, Spain.
| | - G Til Pérez
- Department of Otorhinolaryngology Head and Neck Surgery, Clínica Rotger, Quirón Salud, Palma de Mallorca, Spain; University of the Balearic Island, Palma de Mallorca, Spain
| | - P Sarría Echegaray
- Department of Otorhinolaryngology Head and Neck Surgery, Clínica Rotger, Quirón Salud, Palma de Mallorca, Spain; University of the Balearic Island, Palma de Mallorca, Spain
| | - C Morales Olavarría
- Department of Otorhinlaryngology Head and Neck Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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Lakhera KK, Singhal PM, Patel P, Babu A, Daima M, Chatterjee A, Singh S, Gora BS, Agarwal NK. Reconstructing Small-Medium Sized Oral Cavity Defects- Our Experience with the Versatile Famm Flap. Indian J Otolaryngol Head Neck Surg 2023; 75:3432-3438. [PMID: 37974893 PMCID: PMC10645677 DOI: 10.1007/s12070-023-03946-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/08/2023] [Indexed: 11/19/2023] Open
Abstract
Background Restoration of form and function of the oral cavity post resection for oral cavity malignancies is an enormous challenge in head and neck reconstructive surgery. The facial artery musculo-mucosal (FAMM) flap is an unexplored, underutilized yet an extremely versatile option for such defects. In this analysis we review the performance of the FAMM flap used to reconstruct tongue/floor of mouth (FOM) defects following tumor resection. Materials and Methods In this retrospective analysis, demographic and disease profiles of 15 patients with Tongue and Floor of Mouth carcinomas reconstructed with a FAMM flap between January 2019 to January 2021 were studied. Complications and functional outcomes were analyzed. Results Fifteen patients (10 men, 5 women) were reconstructed using a FAMM flap. Mean age of the study sample was 46.46 years (28-60 years). One flap was lost due to complete flap necrosis following venous congestion, two other flaps suffered distal tip necrosis. Three patients developed an Oro-cutaneous fistula, with one going on to develop a surgical site infection of the neck wound. Patients reconstructed for FOM defects had an excellent functional outcome. For patients reconstructed for a tongue defect, 33.33% of patients complained of restricted tongue mobility and 44.44% were dissatisfied with the quality of speech post operatively. Conclusion The versatile FAMM flap is a reliable, easy to harvest and scarless flap. It provides excellent cosmetic and functional results FAMM flap allowing early resumption of normal daily activities making it an ideal option to reconstruct small to medium sized oral cavity defects.
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Affiliation(s)
| | | | | | - Agil Babu
- SMS Medical College, Jaipur, Rajasthan India
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3
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Jalaeefar A, Saffar H, Shirkhoda M, Garajei A, Sharifi A. Reconstruction with facial artery musculo-mucosal flap (FAMM.F) after resection of upper lip pleomorphic adenoma: Case report. Int J Surg Case Rep 2023; 111:108822. [PMID: 37741079 PMCID: PMC10520520 DOI: 10.1016/j.ijscr.2023.108822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 09/25/2023] Open
Abstract
INTRODUCTION Although pleomorphic adenoma (PA) is the most common neoplasm of both minor and major salivary glands, its presence in the buccal surface of upper lip is rare. PRESENTATION OF CASE A 70-year-old male presented with a chief complaint of recent rapid growth of a mass in the buccal aspect of the upper lip. A well-circumscribed mass measuring 3 × 2 cm with intact overlying mucosa without regional lymphadenopathy was evident. Core needle biopsy report was suggestive of PA. Complete excision of the tumor was performed. The defect was large and primary closure was not possible. Reconstruction with FAMM flap was planned. After 4 weeks, the flap was covered with epithelia and created a satisfactory result. DISCUSSION The definite diagnosis of PA is based on histopathological examination. The following features help to differentiate PA from other tumors; tubuloalveolar and gland-like structures, islands of cuboidal or polygonal cells in a chondroid, hyalinized, fibroadipose or mucinous hypocellular stroma which are stained positively for periodic acid-Schiff and Alcian. Despite these characteristics, differentiation of PA from dermal mixed tumor may be challenging especially when the specimen is from the upper lip. The main advantages of FAMM.F are being thin and pliable flap, having wide arc of rotation; being suitable for reconstruction of mucosal defects; resistance against postoperative radiotherapy and easy harvesting. CONCLUSION The FAMM flap is a reliable reconstruction technique for medium-sized intraoral defects with limited morbidity to the donor site. It provides functional reconstruction of the oral cavity with a low risk of post-operative complications.
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Affiliation(s)
- Amirmohsen Jalaeefar
- Department of General Surgery, Subdivision of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hana Saffar
- Department of Anatomical and Clinical Pathology, Cancer Institute, Imam Khomeni Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shirkhoda
- Department of General Surgery, Subdivision of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ata Garajei
- Department of Oran and Maxillofacial Surgery, School of Dentistry, Iran; Department of Head and Neck Surgical Oncology and Reconstructive Surgery, Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirsina Sharifi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Fatani B, Alhilal AI, Alzahrani HH, Alkhattabi RR, Alhindi M. Facial Reconstruction Using Facial Artery Myomucosal Flap: A Comprehensive Review. Cureus 2023; 15:e42060. [PMID: 37602111 PMCID: PMC10433401 DOI: 10.7759/cureus.42060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
The facial artery myomucosal (FAMM) flap is a type of facial flap that is constructed with the buccal mucosa and submucosa along with a portion of the buccinator muscle, which is connected to nearby blood vessels to maintain its blood supply. It is a versatile and reliable option for head and neck reconstruction, particularly in oral cavity defects. This flap is employed in the reconstruction of the floor of the mouth, alveolar cleft surgery, and tongue defect repair. Previous studies have discussed the use of FAMM flaps for facial reconstructions. However, there are no current and updated comprehensive reviews discussing the use of FAMM flaps in facial reconstruction. In light of this, this study aimed to review all relevant studies that discuss the use of FAMM flaps in facial reconstruction.
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Affiliation(s)
- Bader Fatani
- Dentistry, College of Dentistry, King Saud University, Riyadh, SAU
| | | | - Hadeel H Alzahrani
- College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Raghad R Alkhattabi
- College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Mariam Alhindi
- Oral and Maxillofacial Surgery, King Saud University, Riyadh, SAU
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Quadri P, McMullen C. Oral Cavity Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00048-8. [PMID: 37164898 DOI: 10.1016/j.otc.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This summary provides a concise overview of oral cavity reconstruction to optimize functional outcomes in the modern era. Soft tissue and osseous reconstruction options for a wide range of oral cavity sites including lip, oral tongue, floor of mouth, buccal, hard palate, and composite oromandibular resections are reviewed. The appropriate applications of primary closure, secondary intention, skin grafts, and dermal substitute grafts are included. Anatomic considerations, indications, contraindications, and complications of local, regional, and free flaps in oral cavity reconstruction are discussed. Specific defects and the appropriate options for reconstruction of those defects are delineated.
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Affiliation(s)
- Pablo Quadri
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA
| | - Caitlin McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA.
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Khismatrao VN, Popat SP, Sharma P, Gupta A. Versatility of Facial Artery Musculomucosal (FAMM) Flap for Reconstruction of Oral Cavity Defects. J Maxillofac Oral Surg 2023; 22:44-50. [PMID: 37041950 PMCID: PMC10082859 DOI: 10.1007/s12663-023-01850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/08/2023] [Indexed: 01/22/2023] Open
Abstract
Background and Purpose The Facial Artery Musculomucosal (FAMM) flap for reconstruction of oral cavity defects is being popularized in recent years due to its obvious advantages. The aim of our study is to evaluate the cases operated at our institute for the reconstruction of oral cavity defects using FAMM flap and assess their outcomes. Method In this retrospective study, we included all patients in whom the FAMM flap was used to reconstruct oral cavity defects operated at our institute from January 2017 to December 2020. From the available records, patients' data like age, sex, diagnosis, treatment plan, complications, flap viability, and need for pedicle revision were retrieved and tabulated. Results FAMM flap was used in ten patients (8 male, 2 female) with ages ranging from 40 to 54 years. In six patients with superior defects e.g., maxilla/palate, retrograde FAMM flap was used and in the other 4 patients with inferior defects e.g., tongue/ floor of the mouth, antegrade FAMM flap was used. None of the patients developed complications like flap failure/necrosis or dehiscence. The donor site healed uneventfully in all patients. Conclusion FAMM flap offers various advantages for oral cavity reconstruction including mucosa reconstruction with alike mucosal tissue, muscle portion providing bulk, minimal donor site morbidity along with easier harvesting approach. There are no associated significant long-term complications if the technique is properly followed. FAMM should be considered a viable option for the reconstruction of a variety of oral cavity defects.
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Affiliation(s)
- Viraj Nitin Khismatrao
- Oral Health Centre, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Shyam P. Popat
- Oral Health Centre, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Preeti Sharma
- Swami Devi Dyal Dental College and Hospital, Panchkula, Haryana India
| | - Anand Gupta
- Oral Health Centre, Government Medical College and Hospital, Sector 32, Chandigarh, India
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McIlwain W, Inman J, Namin A, Kazi A, Shumrick C, Ducic Y. Management of Palatal Defects after Free-Flap Reconstruction and Radiotherapy. Semin Plast Surg 2023; 37:39-45. [PMID: 36776801 PMCID: PMC9911226 DOI: 10.1055/s-0042-1759797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Palatal fistulas have significant effects on quality of life. Traditional prosthetic rehabilitation and surgical reconstruction of palate defects in radiation-naïve tissues are well described. However, palatal fistulas developing after initial tumor extirpation, free-flap reconstruction, and adjuvant radiation or chemoradiation are associated with challenging secondary tissue effects. In this review, we will discuss the management of palatal fistulas after surgical reconstruction and radiotherapy.
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Affiliation(s)
- Wesley McIlwain
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jared Inman
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Arya Namin
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Aasif Kazi
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Christopher Shumrick
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Assessment of Quality of Life in Head-and-Neck Oncologic Patients with Intraoral Soft-Tissue Defects Reconstructed with Buccinator Myomucosal Flap. J Clin Med 2022; 11:jcm11247458. [PMID: 36556074 PMCID: PMC9780850 DOI: 10.3390/jcm11247458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this study is to evaluate the functional outcomes and quality of life (QoL) in oncologic patients with intraoral defects reconstructed with the buccinator myomucosal flap. A retrospective study was performed involving 39 patients with intraoral soft-tissue defects, reconstructed with a buccinator myomucosal flap during a six-year period. Patients completed the European Organization for Research and Treatment of Cancer questionnaires, the standard questionnaire (QLQ-C30) and the head-and-neck specific module (QLQ-H&N35). Thirty-nine patients with a mean age of 61.23 ± 15.80 years were included in the study. Thirty-three patients were diagnosed with an oncological condition (84.61%). Six patients (15.38%) developed orosinusal communication and underwent extensive debridement. The median global-health-status score was 79.27 and emotional performance was the lowest scoring, with a mean score of 76.93. As for the symptom items, the most outstanding were dental problems (33.33), oral opening (31.62) and dry mouth (37.61), followed by sticky saliva (24.79), problems with social eating (21.15) and pain (19.87). The most significant symptoms were radiotherapy-related adverse effects such as pain, fatigue, dental problems and dry mouth. Patients reconstructed with the buccinator myomucosal flap develop a good quality of life for all types of activities, and a correct function and aesthetics. Postoperative radiotherapy is associated with a poorer quality of life, and can lead to impairment of several symptoms such as swallowing, oral opening and dry mouth.
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Obturator Manufacturing for Oronasal Fistula after Cleft Palate Repair: A Review from Handicraft to the Application of Digital Techniques. J Funct Biomater 2022; 13:jfb13040251. [PMID: 36412892 PMCID: PMC9680338 DOI: 10.3390/jfb13040251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
An oronasal fistula (ONF) is an abnormal structure between the oral and nasal cavities, which is a common complication of cleft palate repair due to the failure of wound healing. When some patients with ONF are unsuitable for secondary surgical repair, the obturator treatment becomes a potential method. The objectives of the obturator treatment should be summarized as filling the ONF comfortably and cosmetically restoring the dentition with partial function. The anatomy of patients with cleft palate is complex, which may lead to a more complex structure of the ONF. Thus, the manufacturing process of the obturator for these patients is more difficult. For performing the design and fabrication process rapidly and precisely, digital techniques can help, but limitations still exist. In this review, literature searches were conducted through Medline via PubMed, Wiley Online Library, Science Direct, and Web of Science, and 122 articles were selected. The purpose of this review was to introduce the development of the obturator for treating patients with ONF after cleft palate repair, from the initial achievement of the obstruction of the ONF to later problems such as fixation, velopharyngeal insufficiency, and infection, as well as the application of digital technologies in obturator manufacturing.
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Oropharyngeal reconstruction after transoral robotic surgery. Curr Opin Otolaryngol Head Neck Surg 2022; 30:384-391. [PMID: 36004787 DOI: 10.1097/moo.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Transoral robotic surgery (TORS) has experienced an evolution in recent years. This technique has proved to be a safe and effective method for extirpation of select oropharyngeal tumors. Advances in technology as well as improved surgeon experience allow for the resection of larger, more complex cancers. Although healing by secondary intention remains the current standard for limited oropharyngeal defects, larger resections demand reconstruction with vascularized tissue to minimize morbidity and optimize functional outcomes. The objective of this review is to evaluate recent literature regarding oropharyngeal reconstruction after TORS. RECENT FINDINGS A variety of reconstructive options to manage oropharyngeal defects exist. Several reconstructive algorithms have been suggested; however, careful consideration must be used to select the most ideal flap type. Locoregional flaps have shown excellent functional outcomes with limited morbidity. An increase in free flap reconstruction has been demonstrated, particularly among patients with larger TORS defects and following chemoradiation therapy. Despite limited data, robotic-assisted flap inset and microvascular anastomosis has recently shown promise. SUMMARY Reconstruction and flap selection following TORS should be tailored to the patient and unique oropharyngeal defect. Functional outcomes are promising with low complication rates among these patients.
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Giordano L, Familiari M, Galli A, Bright H, Bussi M. Trimming of Facial Artery Myomucosal Flap (FAMM) using Indocyanine Green Fluorescence Video-Angiography: Operative Nuances. Ann Surg Oncol 2022; 29:8361. [PMID: 35867210 DOI: 10.1245/s10434-022-12171-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Facial artery myomucosal flap (FAMM) is an intraoral flap pedicled on facial artery used for reconstruction of oral/oropharyngeal defects.1 Careful assessment of perfusion is essential to avoid flap necrosis, and several options are used for this purpose. Among these, indocyanine green (ICG) fluorescence video-angiography (ICG-VA) represents an innovative tool whose adoption in flap surgery is still at its early days.2 METHODS: In this multimedia article, we described the use of ICG-VA for perfusion assessment of a FAMM flap harvested for reconstruction of oral lining after ablation of a cT2cN0 floor-of-mouth (FOM) cancer. The use of ICG-VA was aimed at defining ischemic areas on the flap according to a flap-to-normal mucosa ICG ratio. RESULTS After transoral excision of the FOM cancer and subsequent harvesting of a FAMM flap, we used ICG-VA to intraoperatively assess its perfusion. The degree of flap perfusion was expressed point-by-point through flap-to-normal mucosa ICG ratio (percentage); a value of 25-27% was considered as threshold for ischemia.3 Perfusion was documented both with white light modality with "overlay fluorescence" and "black and white SPY fluorescence mode" designed to increase the sensitivity of ICG detection. Small, ischemic areas were detected in the distal part of the flap and were trimmed. At the end of the procedure, an adequate perfusion was evident throughout the whole flap, allowing its safe insetting for left FOM reconstruction. Postoperative course was uneventful. CONCLUSIONS ICG-VA represents a reliable tool for intraoperative detection-and trimming-of ischemic areas on reconstructive flaps.
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Affiliation(s)
- Leone Giordano
- Department of Otolaryngology-Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - Marco Familiari
- Department of Otolaryngology-Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Andrea Galli
- Department of Otolaryngology-Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Howardson Bright
- Department of Otolaryngology-Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology-Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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Beddok A, Guzene L, Coutte A, Thomson D, Yom SS, Calugaru V, Blais E, Gilliot O, Racadot S, Pointreau Y, Corry J, Jensen K, Porceddu S, Khalladi N, Bastit V, Lasne-Cardon A, Marcy PY, Carsuzaa F, Nioche C, Bourhis J, Salleron J, Thariat J. International assessment of interobserver reproducibility of flap delineation in head and neck carcinoma. Acta Oncol 2022; 61:672-679. [PMID: 35139735 DOI: 10.1080/0284186x.2022.2036367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/23/2022] [Indexed: 11/01/2022]
Abstract
Background: Several reports have suggested that radiotherapy after reconstructive surgery for head and neck cancer (HNC), could have deleterious effects on the flaps with respect to functional outcomes. To predict and prevent toxicities, flap delineation should be accurate and reproducible. The objective of the present study was to evaluate the interobserver variability of frequent types of flaps used in HNC, based on the recent GORTEC atlas.Materials and methods: Each member of an international working group (WG) consisting of 14 experts delineated the flaps on a CT set from six patients. Each patient had one of the five most commonly used flaps in HNC: a regional pedicled pectoralis major myocutaneous flap, a local pedicled rotational soft tissue facial artery musculo-mucosal (FAMM) (2 patients), a fasciocutaneous radial forearm free flap, a soft tissue anterolateral thigh (ALT) free flap, or a fibular free flap. The WG's contours were compared to a reference contour, validated by a surgeon and a radiologist specializing in HNC. Contours were considered as reproducible if the median Dice Similarity Coefficient (DSC) was > 0.7.Results: The median volumes of the six flaps delineated by the WG were close to the reference contour value, with approximately 50 cc for the pectoral, fibula, and ALT flaps, 20 cc for the radial forearm, and up to 10 cc for the FAMM. The volumetric ratio was thus close to the optimal value of 100% for all flaps. The median DSC obtained by the WG compared to the reference for the pectoralis flap, the FAMM, the radial forearm flap, ALT flap, and the fibular flap were 0.82, 0.40, 0.76, 0.81, and 0.76, respectively.Conclusions: This study showed that the delineation of four main flaps used for HNC was reproducible. The delineation of the FAMM, however, requires close cooperation between radiologist, surgeon and radiation oncologist because of the poor visibility of this flap on CT and its small size.
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Affiliation(s)
- Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris - Orsay, France
- Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Université Paris Saclay/Inserm/Institut Curie, Orsay, France
| | - Leslie Guzene
- Department of Radiation Oncology, University Hospital of Amiens, Amiens, France
| | - Alexandre Coutte
- Department of Radiation Oncology, University Hospital of Amiens, Amiens, France
| | - David Thomson
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, USA
| | - Valentin Calugaru
- Department of Radiation Oncology, Institut Curie, Paris - Orsay, France
| | - Eivind Blais
- Department of Radiation Oncology, Polyclinique Marzet, Pau, France
| | - Olivier Gilliot
- Department of Radiation Oncology, Polyclinique Marzet, Pau, France
| | - Séverine Racadot
- Department of Radiation Oncology, Centre Léon Bérard Lyon, France
| | - Yoann Pointreau
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | - June Corry
- Department of Radiation Oncology, GenesisCare. St Vincent's Hospital, Fitzroy, Australia
| | - Kenneth Jensen
- Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Danemark
| | - Sandro Porceddu
- Department of Radiation Oncology, Princess Alexandra Hospital Southside Clinical Unit, Australia
| | - Nazim Khalladi
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Vianney Bastit
- Department of Head and Neck Surgery, Centre François Baclesse, Caen, France
| | | | | | - Florent Carsuzaa
- Department of Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Christophe Nioche
- Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Université Paris Saclay/Inserm/Institut Curie, Orsay, France
| | - Jean Bourhis
- Department of Radiation Oncology, University Hospital of Vaudois, Lausanne, Swiss
| | - Julia Salleron
- Department of Statistics, Lorraine Cancer Institute, Vandoeuvre-lès-Nancy, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
- Laboratoire de physique Corpusculaire IN2P3/ENSICAEN/CNRS UMR 6534 - Normandie Université, Caen, France
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Adamson S, Lyons B, Grinsell D. Facial artery myomucosal flap reconstruction of a hemilaryngectomy defect: a case report. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: A multitude of flaps have been used in post-laryngectomy reconstruction, involving different operative sites and histologically different donor tissue types.
Methods: Plastic surgeons have used the pedicled facial artery myomucosal (FAMM) flap to reconstruct a perilaryngeal defect following resection of a low-grade thyroid chondrosarcoma.
Results: On six-week postoperative review, the patient was eating and swallowing well, and speech was intelligible. On five-year review, the flap looked like normal mucosa and a patent airway was maintained.
Conclusion: The FAMM flap provided a novel solution with excellent functional results and no donor site morbidity, warranting its consideration for perilaryngeal defects.
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Koziej M, Bonczar M, Ostrowski P, Piątek-Koziej K, Bonczar T, Pasternak A, Dziedzic M, Walocha J. Termination points of the facial artery-A meta-analysis. Clin Anat 2021; 35:469-476. [PMID: 34851525 DOI: 10.1002/ca.23817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/28/2021] [Accepted: 11/28/2021] [Indexed: 11/11/2022]
Abstract
The facial artery (FA) is the main artery supplying the anterior face, making this artery a very important structure to consider while performing plastic and reconstructive procedures. The literature shows discrepancies in anatomical classifications and the frequency of occurrence of individual variations. Therefore, the goal of this meta-analysis is to provide surgeons with helpful knowledge about the variety of the termination of FA. Articles with data about the termination of the FA were found in major online medical databases such as PubMed, Scopus, Embase, Web Of Science, and Cochrane Library. A total of 1346 articles were initially evaluated by two independent reviewers. Out of those, 24 articles matched the required criteria, and were used in this meta-analysis. A total of 2119 studied FAs were included in this study. The FA termination patterns were divided into five previously classified types. The data show that the FA terminates most frequently as the lateral nasal or angular artery with the prevalence for this group being 69.81% (95% confidence interval [CI]: 59.83%-78.94%). Authors believe that this is the most accurate and up to date study regarding termination patterns and the prevalence of the FA. The results of this meta-analysis could provide a helpful tool for surgeons preforming plastic and cosmetic procedures, especially when injecting dermal fillers or choosing and preforming facial flaps. Detailed anatomical knowledge about the FA may prevent potential surgical complications.
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Affiliation(s)
- Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Tomasz Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Pasternak
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Martyna Dziedzic
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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15
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Ibrahim B, Rahal A, Bissada E, Christopoulos A, Guertin L, Ayad T. Reconstruction of medium-size defects of the oral cavity: radial forearm free flap vs facial artery musculo-mucosal flap. J Otolaryngol Head Neck Surg 2021; 50:67. [PMID: 34861896 PMCID: PMC8643000 DOI: 10.1186/s40463-021-00523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background The radial forearm free flap (RFFF) is the most commonly used flap for defects of the oral cavity. The facial artery musculomucosal (FAMM) is a safe and effective method to reconstruct medium sized defects of the oral cavity. No comparison exists between the FAMM flap and RFFF. Methods 1) Retrospective chart review from 2007 to 2016. 2) Cost difference analysis. Results Thirteen FAMM flap cases and 18 RFFF met inclusion criteria. The FAMM flap showed a tendency to lower rates of return to the operating room (p = 0.065) as well as lower rates of complications not requiring return to the OR with 1 complication in 1 patient as opposed to 10 patients with 15 complications (p = 0.008). Also, FAMM flap had shorter operative times compared to the RFFF group (7.2HR and 8.9 HR respectively, p = 0.002). The average operative room related costs for a FAMM flap were 6510 CAD vs 10,703 CAD for RFFF (p < 0.0005). Speech and swallowing outcomes were similar (p > 0.05). Conclusion The FAMM flap can be used for reconstruction of medium-size defects of the oral cavity with functional outcomes similar to the RFFF while decreasing the associated costs and morbidity. Graphical Abstract ![]()
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A Rare Case of Facial Artery Branching-A Review of the Literature and a Case Report with Clinical Implications. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111172. [PMID: 34833392 PMCID: PMC8625730 DOI: 10.3390/medicina57111172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/01/2022]
Abstract
Background and Objectives: Vascular variations appear as morphologically distinct patterns of blood diverging from the most commonly observed vessel patterns. The facial artery is considered to be the main vessel for supplying blood to the anterior part of the face. An anatomical understanding of the facial artery, its course, its topography, and its branches is important in medical and dental practice (especially in neck and face surgery), and is also essential for radiologists to be able to interpret vascular imaging in the face following angiography of the region. A profound knowledge of the arteries in the region will aid in minimizing the risks to the patient. Materials and Methods: In our publication a narrative literature review and a case report are presented. Results: A rare case of a facial artery pattern has been described anatomically for the first time with respect to its course and branching. This variation was found on the left side of a 60-year-old male corpse during anatomical dissection. The anterior branch of the facial artery arched in the direction of the labial angle, and there divided into the inferior and superior labial arteries. At the same time, the posterior branch coursed vertically and superficially to the masseter muscle. It here gave off the premasseteric branch, and continued towards the nose, where it ran below the levator labii superioris and the levator labii superioris alaeque nasi muscles and terminated at the dorsum nasi. Conclusions: Our review of the literature and the case report add to knowledge on the facial artery with respect to its topographical anatomy and its branching and termination patterns, as well as the areas of supply. An exact knowledge of individual facial artery anatomy may play an important role in the planning of flaps or tumor excisions due to the differing vascularization and can also help to prevent artery injuries during aesthetic procedures such as filler and botulinum toxin injections.
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Navarro Cuéllar C, Tousidonis Rial M, Antúnez-Conde R, Agea Martínez M, Navarro Cuéllar I, Salmerón Escobar JI, Navarro Vila C. Functional Outcomes with Facial Artery Musculo-Mucosal (FAMM) Flap and Dental Implants for Reconstruction of Floor of the Mouth and Tongue Defects in Oncologic Patients. J Clin Med 2021; 10:3625. [PMID: 34441924 PMCID: PMC8397211 DOI: 10.3390/jcm10163625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 11/22/2022] Open
Abstract
Optimal functional outcomes in oncologic patients with squamous cell carcinoma (SCCA) of the tongue and floor of the mouth require good lingual mobility, adequate facial competence, the cheek suction effect and dental rehabilitation with osseointegrated implants. In this study, twenty-two oncologic patients who had been diagnosed with intraoral SCCA affecting the tongue and the floor of the mouth and who had undergone wide resection of the tumor and immediate reconstruction with an inferiorly pedicled FAMM flap and immediate osseointegrated implants were assessed. Lingual mobility, speech articulation, deglutition, implant success rate, mouth opening, and aesthetic results were evaluated. All patients were staged as T2 and the defect size ranged from 3.7 × 2.1 cm to 6.3 × 4.2 cm. A selective neck dissection was performed in all patients as part of their oncologic treatment, either electively or for node positive disease. Thirteen patients (59%) were diagnosed with node positive disease and underwent adjuvant radiotherapy. A total of 101 osseointegrated implants were placed for prosthetic rehabilitation and 8 implants were lost (7.9%), of which 7 received radiotherapy (87.5%). The implant success rate was 92.1%. Mouth opening was reported as normal in 19 patients (86.3%). Tongue tip elevation was reported as excellent in 19 patients (86.3%) and good in 3 patients (13.6%). Lingual protrusion was referred to as excellent in 15 patients (68.2%) and good in 6 patients (27.2%). Lateral excursion was reported as excellent in 14 patients (63.6%) and good in 7 patients (31.8%). In terms of speech articulation, 20 patients reported normal speech (90.9%). Regarding deglutition, 19 patients (86.3%) reported a regular diet while a soft diet was reported by 3 patients (13.7%). Aesthetic results were referred to as excellent in 17 patients (77.3%). FAMM flaps, immediate implants and fixed prostheses enable the functional rehabilitation of oncologic patients, optimizing aesthetics and functional outcomes even in patients undergoing irradiation, thus returning oncologic patients to an excellent quality of life.
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Affiliation(s)
- Carlos Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007 Madrid, Spain; (M.T.R.); (R.A.-C.); (M.A.M.); (I.N.C.); (J.I.S.E.); (C.N.V.)
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18
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The Upper Buccal Musculomucosal Flap for Nasal Lining and Columellar Defect Reconstruction. J Craniofac Surg 2021; 32:1850-1852. [PMID: 33235166 DOI: 10.1097/scs.0000000000007259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Restoring the nasal lining is a great challenge in the reconstruction of nasal defects. In this series, the authors present our experience in using the upper buccal musculomucosal (UBMM) flap for the reconstruction of full thickness columellar or nasal lining defects. Ten patients who underwent UBMM flap reconstruction of columellar or nasal lining defects, with or without composite grafting, were identified between December of 2014 and February of 2017. The records were retrospectively reviewed to determine the demographics, nasal deformity etiology, surgical technique, complications, flap survival rate and duration of follow-up. Of these ten patients, three were men, and seven were women; the average age was 48.1 years (range, 34-66 years). Four patients underwent bilateral UBMM flaps, and 6 patients underwent unilateral UBMM flap reconstruction. All of the donor sites were closed without complications, except for one small granuloma that occurred 8 months later. Of the total 14 flaps, 7 healed well, 6 healed well after minimal debridement in the clinic, and one failed and was replaced with a contralateral UBMM flap. The average follow-up time was 20.1 months (range, 8-38 months). All patients had satisfactory aesthetic and functional outcomes. Due to the limited availability of healthy local tissue for nasal lining reconstruction after multiple surgeries, the UBMM flap serves as an applicable choice to restore columellar or nasal lining defects, with minimal donor site morbidity and no visible external scarring.
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Gontarz M, Bargiel J, Gąsiorowski K, Marecik T, Szczurowski P, Zapała J, Wyszyńska-Pawelec G. Extended, Double-Pedicled Facial Artery Musculomucosal (dpFAMM) Flap in Tongue Reconstruction in Edentulous Patients: Preliminary Report and Flap Design. MEDICINA-LITHUANIA 2021; 57:medicina57080758. [PMID: 34440964 PMCID: PMC8401490 DOI: 10.3390/medicina57080758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022]
Abstract
Backgroundand Objectives: The reconstruction of tongue defects after cancer resection is challenging for reconstructive surgeons. The facial artery musculomucosal (FAMM) flap and the myomucosal buccinator flap (Bozola flap) are important tools in the reconstruction of intraoral defects. In this study, we describe the combination of both flaps—the extended, double-pedicled FAMM (dpFAMM) flap—and present clinical results of the reconstruction of moderate tongue defects in edentulous patients. Materials and Methods: a tongue defect, after squamous cell carcinoma excision, was reconstructed with the dpFAMM flap in 5 patients. Most of them received postoperative radiotherapy. Results: the healing process was uneventful in all patients. We did not observe flap necrosis or venous congestion. Tongue mobility, speech and swallowing were satisfactory. Conclusions: In conclusion, the dpFAMM flap is a good alternative in the reconstruction of moderate defects of the lateral part of the tongue. The flap is easy to harvest and has a good vascularity. This is a predictable method of reconstruction, especially for elderly patients with numerous comorbidities.
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Abstract
PURPOSE OF REVIEW The strain on healthcare resources in light of the COVID-19 pandemic has forced many head and neck surgeons to explore reconstructive options that may decrease length of stay. Here, we review three common and versatile regional flaps used in head and neck reconstruction that are comparable alternatives to free tissue transfer. RECENT FINDINGS Initial anatomic descriptions of the facial artery musculocutaneous (FAMM) flap, the supraclavicular artery island flap and the submental artery island flap were published decades ago. Since then, many have proposed modifications to these descriptions to improve technical ease and patient outcomes. Benefits of regional flaps include ease of harvest, comparable outcomes to free tissue microvascular flaps, shorter operative time and hospital length of stay. Drawbacks to regional flaps include limitations to size and reach, partial necrosis, wound dehiscence and surgeon experience. The integrity of the vascular pedicle is also contingent upon vessel preservation during the cancer ablation. SUMMARY Although a resurgence of regional flaps began well before the COVID-19 pandemic, many institutions began looking for alternatives to free flap reconstruction to conserve healthcare resources and minimize patient hospitalization time in the past year. There has been a revival of regional flaps such as the FAMM, supraclavicular and submental flaps that are valuable reconstructive options for many defects of the head and neck.
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21
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Le JM, Bosworth JW, Honeywell B, Ananthasekar S, Collawn SS. Adipose Grafting for Volume and Scar Release. Ann Plast Surg 2021; 86:S487-S490. [PMID: 34100804 DOI: 10.1097/sap.0000000000002873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Adipose fat grafting (AFG) is a popular technique used to add volume in the face, breasts, and other tissue deficient areas of the body. In terms of scar release, not only has fat provided additional soft tissue coverage but also the relief of pain in scars in those patients suffering from disease processes, such as complex regional pain syndrome with steroid-induced atrophy, burn scars, morphea, and lupus. The purpose of this article is to demonstrate the senior author's technique and outcomes of using AFG in the face and body for treating volume deficiency, atrophic scarring, and deformities.A retrospective chart review of 127 AFG procedures of the face and body from September 2006 to September 2019 was performed. Of these, 14 patients had scar releases performed with fat grafting of areas of scar contracture. Fat was harvested from the abdomen, thighs, and flanks using Toomey syringes or an enclosed power-assisted system with 3.7- or 3.0-mm cannulas. Grafting in small areas, such as the face, was performed with the 0.9-mm blunt cannula.The majority of AFG was completed in the face (45%), followed by breasts (22%), and scar contracture (16%). The mean volume of fat grafted in procedures involving the breasts, buttocks, and face was 102, 182, and 21 mL, respectively. For scar contracture, the mean volume was 38 mL and for deformations, 27 mL. Sixteen percent of the cohort required at least 1 additional AFG procedure to achieve satisfactory results. There were no major complications, such as skin loss, vascular injury, embolization, or blindness. Minor complications, such as erythema, edema, and hematoma at the fat harvest or graft site, did occur and were managed with local measures.Autologous fat grafting has consistently resulted in volume correction. In addition, in patients with autoimmune disorders, burn scars, and retracted scars, not only has there been volume correction but also decreased pain in the area of treatment. In our series of patients, we described our technique of AFG for the face, body, and scar contracture. Our results demonstrate that AFG remains an inexpensive, safe, and effective treatment option to achieve volume.
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Affiliation(s)
| | - Jeremy W Bosworth
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Sherry S Collawn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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22
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Modified Buccal Myomucosal Flap Closure of Large Anterior Palatal Oronasal Fistulas. Plast Reconstr Surg 2021; 147:94e-97e. [PMID: 33370062 DOI: 10.1097/prs.0000000000007496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY Large oronasal palatal fistulas can be challenging to reconstruct. The authors present a modified buccal myomucosal flap repair technique and review intermediate-term outcomes. In this technique, large anterior palatal fistulas are closed in two layers. First, apposing nasal turnover flaps of vomer mucosa medially and nasal wall mucosa laterally are approximated. Second, a posteriorly based buccal flap incorporating full-thickness buccinator muscle and overlying mucosa is transposed with interposition of the flap in the retromolar trigone and lateral palate to preserve dental occlusion. Consecutive patient cases performed in low-resource settings were reviewed and outcomes reported. Among eight subjects aged 3 to 22 years, with average defect size of 2.5 cm2 (range, 0.8 to 3.5 cm2), the flap was viable in all cases and required revision or pedicle division in only two patients (25 percent); all patients showed symptom improvement. The modified buccal myomucosal flap shows promising intermediate-term results as a single-stage reconstruction suitable to a wide patient age range, low airway/anesthetic risk, reliable functional outcomes, and low comorbidity.
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23
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Mannino EA, Rubinstein BJ, Dobratz EJ. Facial Artery Musculomucosal Flap for Nasopharyngeal and Oropharyngeal Reconstruction. Facial Plast Surg Aesthet Med 2020; 22:449-455. [DOI: 10.1089/fpsam.2019.0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elizabeth A. Mannino
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Benjamin J. Rubinstein
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Eric J. Dobratz
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Colella G, Rauso R, De Cicco D, Boschetti CE, Iorio B, Spuntarelli C, Franco R, Tartaro G. Clinical management of squamous cell carcinoma of the tongue: patients not eligible for free flaps, a systematic review of the literature. Expert Rev Anticancer Ther 2020; 21:9-22. [PMID: 33081545 DOI: 10.1080/14737140.2021.1840359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The management of squamous cell carcinoma (SCC) of the tongue represents the most demanding treatment planning in head and neck surgery. Ablation followed by free flap reconstruction is considered the gold standard, but not all patients are suitable for this strategy. The aim of this review is to provide a comprehensive view of surgical reconstruction possibilities in patients not eligible for free flaps. METHODS Following PRISMA recommendations, a systematic literature review was conducted searching for original papers that investigated outcomes of patients treated by surgical ablation for tongue SCC followed by reconstruction with local or pedicled flaps. Selected papers were read and data extracted for qualitative analysis. RESULTS Twenty articles met the inclusion/exclusion criteria. The study design was case series in sixteen papers, cohort study in the remaining four. Four different local flaps (BMM, FAMM, NLIF, SMIF) and four regional flaps have been discussed in included studies (IHF, SFIF, SCM, PMMC). CONCLUSION The improved anatomical knowledge makes local flaps a reliable alternative to free tissue transfer in cases requiring small-/medium-sized defects. Regional flaps still represent cornerstones in reconstruction of the tongue. Ease of execution, costs-to-benefit ratio, low-rate complications, minimal donor site morbidity represent the best advantages choosing local/regional flaps.
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Affiliation(s)
- Giuseppe Colella
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Raffaele Rauso
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Davide De Cicco
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Ciro Emiliano Boschetti
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Brigida Iorio
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Chiara Spuntarelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II" , Naples, Italy
| | - Renato Franco
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Gianpaolo Tartaro
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" , Naples, Italy
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25
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Akali NR, Jaya AC, Balasubramanian D, Iyer S, Thankappan K. Islanded facial artery musculo‐mucosal flap for partial pharyngeal defect reconstruction after total laryngectomy: Case report. Head Neck 2020; 43:E1-E6. [DOI: 10.1002/hed.26522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Nisha Rajrattansingh Akali
- Department of Head and Neck Surgery and Oncology Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi Kerala India
| | - Arya Chandrababu Jaya
- Department of Head and Neck Surgery and Oncology Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi Kerala India
| | - Deepak Balasubramanian
- Department of Head and Neck Surgery and Oncology Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi Kerala India
| | - Subramania Iyer
- Department of Head and Neck Surgery and Oncology Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi Kerala India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery and Oncology Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi Kerala India
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Koziej M, Trybus M, Hołda M, Polak J, Wnuk J, Brzegowy P, Popiela T, Walocha J, Chrapusta A. Anatomical Map of the Facial Artery for Facial Reconstruction and Aesthetic Procedures. Aesthet Surg J 2019; 39:1151-1162. [PMID: 30721996 DOI: 10.1093/asj/sjz028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The facial artery (FA) is the main blood vessel supplying the anterior face and an understanding of its anatomy is crucial in facial reconstruction and aesthetic procedures. OBJECTIVES The aim of this study was to assess the many anatomical features of the FA utilizing a multidimensional approach. METHODS Head and neck computed tomographic angiographies of 131 patients (255 FAs) with good image quality were evaluated. The FA was classified according to its termination pattern, course, and location with reference to soft tissue/bone surrounding structures. RESULTS In total, each branch was present as follows: the submental artery (44.8%), the inferior labial artery (60%), the superior labial artery (82.2%), the lateral nasal artery (25.1%), and the angular artery (42.5%). The most common FA course was the classic course, situated medially to the nasolabial fold (27.1%). In total 65.5% of the arteries were located medially to the nasolabial fold, and only 12.3% of them were totally situated lateral to the nasolabial fold. The median distance (with quartiles) from the inferior orbital rim reached the FA after the superior labial artery branched off in 50.2% of cases and was 36.6 mm (33.4; 43.3). The angle between the FA and the inferior border of the mandible was 49.8o (31.9; 72.4). The horizontal distances between the oral commissure and naris to the FA were 8.5 ± 4.0 mm and 12.1 ± 6.7 mm, respectively. CONCLUSIONS An anatomical map summarizing the major measurements and geometry of the FA was generated. The detailed anatomy and relative positioning of the FA should be considered to avoid any unexpected complications in plastic surgery.
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Affiliation(s)
- Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, The Ludwik Rydygier Hospital, Krakow, Poland
- The Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
| | - Marek Trybus
- Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Hołda
- Department of Anatomy, Jagiellonian University Medical College
| | - Jakub Polak
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Jakub Wnuk
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Paweł Brzegowy
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Tadeusz Popiela
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College
| | - Anna Chrapusta
- Head of The Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
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27
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Facial artery musculomucosal flaps in oropharyngeal reconstruction following salvage transoral robotic surgery: a review of outcomes. The Journal of Laryngology & Otology 2019; 133:884-888. [PMID: 31475640 DOI: 10.1017/s002221511900183x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There has been little reported on the transoral reconstructive options following salvage transoral robotic surgery. This paper describes the facial artery musculomucosal flap as a method to introduce vascularised tissue to a previously irradiated resection bed. METHODS A facial artery musculomucosal flap was used to reconstruct the lateral pharyngeal wall in 13 patients undergoing salvage transoral robotic surgery for oropharyngeal squamous cell carcinoma. Outcomes recorded include flap and donor site complications, length of stay, and swallowing and speech outcomes. RESULTS There were no immediate or late flap complications, or cases of delayed wound healing in this series. There were two facial artery musculomucosal related complications requiring surgical management: one bleed from the facial artery musculomucosal donor site and one minor surgical revision. Healing of the flap onto the resection bed was successful in all cases. CONCLUSION The facial artery musculomucosal flap provides a suitable transoral local flap option for selected patients undergoing salvage transoral robotic surgery for oropharyngeal malignancies.
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28
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desJardins-Park HE, Mascharak S, Chinta MS, Wan DC, Longaker MT. The Spectrum of Scarring in Craniofacial Wound Repair. Front Physiol 2019; 10:322. [PMID: 30984020 PMCID: PMC6450464 DOI: 10.3389/fphys.2019.00322] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/11/2019] [Indexed: 12/11/2022] Open
Abstract
Fibrosis is intimately linked to wound healing and is one of the largest causes of wound-related morbidity. While scar formation is the normal and inevitable outcome of adult mammalian cutaneous wound healing, scarring varies widely between different anatomical sites. The spectrum of craniofacial wound healing spans a particularly diverse range of outcomes. While most craniofacial wounds heal by scarring, which can be functionally and aesthetically devastating, healing of the oral mucosa represents a rare example of nearly scarless postnatal healing in humans. In this review, we describe the typical wound healing process in both skin and the oral cavity. We present clinical correlates and current therapies and discuss the current state of research into mechanisms of scarless healing, toward the ultimate goal of achieving scarless adult skin healing.
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Affiliation(s)
- Heather E. desJardins-Park
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Shamik Mascharak
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Malini S. Chinta
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Derrick C. Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael T. Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States
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Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, Roh JL, Park YM, Park IS, Park JJ, Shin SC, Ahn SH, Won S, Ryu CH, Yoon TM, Lee G, Lee DY, Lee MC, Lee JK, Lee JC, Lim JY, Chang JW, Jang JY, Chung MK, Jung YS, Cho JG, Choi YS, Choi JS, Lee GH, Chung PS. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2019; 12:107-144. [PMID: 30703871 PMCID: PMC6453784 DOI: 10.21053/ceo.2018.01816] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient’s treatment goals.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Bon Seok Koo
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Innchul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jung Je Park
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjun Won
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Tae Mi Yoon
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Giljoon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Chul Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Joon Kyoo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeon Yeob Jang
- Department of Otorhinolaryngology Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yuh-Seok Jung
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong-Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University School of Medicine, Incheon, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Phil-Sang Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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The Arterialized Facial Artery Musculo-Mucosal Island Flap for Post-Oncological Tongue Reconstruction. J Craniofac Surg 2019; 29:2021-2025. [PMID: 29771835 DOI: 10.1097/scs.0000000000004610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In 1992, Pribaz described the facial artery musculomucosal flap (FAMM), an axial musculomucosal flap based on the facial artery. The FAMM flap, a modification of the nasolabial and buccal mucosal flaps, is widely used in the reconstruction of defects in the oral cavity. Many modifications of this flap have been described in the literature. Here we aimed to explore the use of an arterialized tunnelized FAMM island flap (a-FAMMIF) for the reconstruction tongue defects after tumor resection. METHOD From January 2015 to December 2016, five cases of tongue cancer were selected for the use of arterialized FAMMIF flap to reconstruct defects after tumor resection. RESULTS Reconstruction was successful in all cases, except one case of total flap necrosis; partial necrosis of the flap occurred in two patients, which were solved with medications. CONCLUSION The authors consider the a-FAMMIF an unreliable flap in the reconstruction of tongue defects.The authors recommend avoiding tunneling and island modification when the vein is not included in the pedicle.
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Comini LV, Spinelli G, Mannelli G. Algorithm for the treatment of oral and peri-oral defects through local flaps. J Craniomaxillofac Surg 2018; 46:2127-2137. [DOI: 10.1016/j.jcms.2018.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/23/2018] [Accepted: 09/19/2018] [Indexed: 02/07/2023] Open
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Wang S, Zhang Z, Xu Z, Duan W. Reconstruction of a subtotal upper lip defect with a facial artery musculomucosal flap, kite flap, and radial forearm free flap: a case report. World J Surg Oncol 2018; 16:194. [PMID: 30266089 PMCID: PMC6162940 DOI: 10.1186/s12957-018-1492-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 09/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For reconstructive surgeons, massive midface defects, including large, full-thickness wounds on the upper lip, can be very challenging. Although there are many methods for reconstruction of upper lip defects, it is difficult to obtain satisfactory restoration of oral functions and good cosmetic results. CASE PRESENTATION This case report presents a man with massive midface defects, including upper lip, left nose, and cheek defects. Over the previous 2 years, the patient had three reconstructions with sequential free flaps for the resection of recurrent tumors, the first of which was in March of 2016; this resulted in the patient having massive midface defects, including an upper lip defect, a defect on the left side of the nose, and one on the left cheek. The defects were reconstructed using a radial forearm free flap (RFFF), a facial artery musculomucosal (FAMM) flap, and a kite flap. In June 2016, he underwent a second reconstruction, this time of the left nose defect, using a left anterolateral thigh (ALT) flap. In March of 2017, the patient underwent a third reconstruction with the use of a free ALT on the left intraoral cheek and the defects on the neck. All flaps survived. No complications were encountered postoperatively. The patient regained good oral sphincter function with no reports of drooling. Although the patient underwent three surgeries, the reconstruction results were acceptable. CONCLUSIONS For massive midface defects, including large, full-thickness wounds on the upper lip, the combination of a FAMM flap, kite flap, and RFFF promotes the reconstruction of the complex midface structure and improves the resulting functionality.
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Affiliation(s)
- Shuai Wang
- Department of Oromaxillofacial-Head and Neck Surgery, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.,Department of Oral Maxillofacial Surgery School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China
| | - Zeliang Zhang
- Department of Oromaxillofacial-Head and Neck Surgery, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.,Department of Oral Maxillofacial Surgery School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China
| | - Zhongfei Xu
- Department of Oromaxillofacial-Head and Neck Surgery, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.,Department of Oral Maxillofacial Surgery School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China
| | - Weiyi Duan
- Department of Oromaxillofacial-Head and Neck Surgery, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China. .,Department of Oral Maxillofacial Surgery School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
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Clinical Application of Foci Contralateral Facial Artery Myomucosal Flap for Tongue Defect Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1669. [PMID: 29616169 PMCID: PMC5865938 DOI: 10.1097/gox.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022]
Abstract
This study aims to investigate the clinical efficacy of foci contralateral facial artery myomucosal flap (FAMF) in repairing the defect of tongue after tumor resection. There were 10 cases who received the operation to repair tongue tissue defects caused by tumor resection from January 2010 to January 2016. FAMF flap size ranged from 2.5 × 3 cm to 5 × 5 cm. All flaps survived after surgery, and no local necrosis occurred. For the donor and receptor sites of 10 cases, 8 cases got wounds healed at stage I, wound dehiscence of donor site occurred in 2 cases, and the dehisced wounds were healed after local cleaning. All 10 patients were followed up for 13 months to 5 years, with an average of 2 years and 4 months. No obvious deformity appeared on face after surgery, and there was no mouth floor leakage. After surgery, 3 cases had clinical manifestations of facial nerve marginal mandibular branch injury and returned to normal in 3 months. All patients had a limitation for mouth opening after surgery, 9 cases returned to normal after 1 year, and 1 case still had a mild limitation for mouth opening. There was no impact on patients’ eating, swallowing, language, or other functions. The foci contralateral FAMF surgery is simple and brings ideal plastic effect, high survival rate of flap, less donor site lesion, simple postoperative care, no breaking after surgery, and no impact on radical cure of tumor, which is suitable for repairing defect of tongue.
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Chen J, Li W. [Research progress of pedicled flaps for defect repair and reconstruction after head and neck tumor resection]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:369-376. [PMID: 29806291 DOI: 10.7507/1002-1892.201710098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the current status of pedicled flaps for defect repair and reconstruction after head and neck tumor resection, and to present its application prospects. Methods Related literature was reviewed, and the role evolution of pedicled flaps in the reconstruction of head and neck defects were discussed. The advance, anatomical basis, indications, advantages, disadvantages, and modification of several frequently used pedicled flaps were summarized. Results The evolution of pedicled flaps application showed a resurgence trend in recent years. Some new pedicled flaps, e.g., submental artery island flap, supraclavicular artery island flap, submandibular gland flap, and facial artery musculomucosal flap, can acquire equivalent or even superior outcome to free flaps in certain cases. Technological modification of some traditional pedicled flaps, e.g., nasolabial flap, pectoralis major myocutaneous flap, latissimus dorsi musculocutaneous flap, temporalis myofascial flap, and temporoparietal fascial flap, can further broaden their indications. These traditional flaps still occupy an irreplaceable role, especially in patients with poor condition and institution with immature microsurgical techniques. Conclusion The pedicled flaps still plays an important role in head and neck reconstruction after tumor resection. In certain cases, they demonstrate some advantages over free flaps, e.g., more convenient harvest, more rapid recovery, less expenditure, and better functional and aesthetic effect.
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Affiliation(s)
- Jian Chen
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Wuhan Hubei, 430079, P.R.China
| | - Wei Li
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Wuhan Hubei, 430079,
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Ibrahim B, Rahal A, Bissada E, Christopoulos A, Moubayed SP, Guertin L, Tabet J, Olivier M, Ayad T. Decreasing Revision Surgery in
FAMM
Flap Reconstruction of the Oral Cavity: Traditional Versus Modified Harvesting Technique. Laryngoscope 2018; 128:1802-1805. [DOI: 10.1002/lary.27150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/14/2018] [Accepted: 01/29/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Badr Ibrahim
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Centre Hospitalier de l'Université de MontréalMontreal Quebec Canada
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Hôpital Maisonneuve‐RosemontMontreal Quebec Canada
| | - Akram Rahal
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Hôpital Maisonneuve‐RosemontMontreal Quebec Canada
| | - Eric Bissada
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Centre Hospitalier de l'Université de MontréalMontreal Quebec Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Centre Hospitalier de l'Université de MontréalMontreal Quebec Canada
| | - Sami P. Moubayed
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Hôpital Maisonneuve‐RosemontMontreal Quebec Canada
| | - Louis Guertin
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Centre Hospitalier de l'Université de MontréalMontreal Quebec Canada
| | - Jean‐Claude Tabet
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Centre Hospitalier de l'Université de MontréalMontreal Quebec Canada
| | - Marie‐Jo Olivier
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Centre Hospitalier de l'Université de MontréalMontreal Quebec Canada
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Hôpital Maisonneuve‐RosemontMontreal Quebec Canada
| | - Tareck Ayad
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Centre Hospitalier de l'Université de MontréalMontreal Quebec Canada
- Division of Otolaryngology–Head and Neck SurgeryUniversité de Montréal, Hôpital Maisonneuve‐RosemontMontreal Quebec Canada
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Ahn D, Lee GJ, Sohn JH. Reconstruction of oral cavity defect using versatile buccinator myomucosal flaps in the treatment of cT2–3, N0 oral cavity squamous cell carcinoma: Feasibility, morbidity, and functional/oncological outcomes. Oral Oncol 2017; 75:95-99. [DOI: 10.1016/j.oraloncology.2017.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/16/2017] [Accepted: 11/04/2017] [Indexed: 12/01/2022]
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Berania I, Lavigne F, Rahal A, Ayad T. Superiorly based facial artery musculomucosal flap: A versatile pedicled flap. Head Neck 2017; 40:402-405. [DOI: 10.1002/hed.24997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/13/2017] [Accepted: 09/26/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ilyes Berania
- Department of Otolaryngology - Head and Neck Surgery; Centre Hospitalier de l'Universite de Montreal; Montreal Quebec Canada
| | - François Lavigne
- Department of Otolaryngology - Head and Neck Surgery; Centre Hospitalier de l'Universite de Montreal; Montreal Quebec Canada
| | - Akram Rahal
- Department of Otolaryngology - Head and Neck Surgery; Centre Hospitalier de l'Universite de Montreal; Montreal Quebec Canada
- Department of Otolaryngology - Head & Neck Surgery; Hôpital Maisonneuve-Rosemont; Montreal Quebec Canada
| | - Tareck Ayad
- Department of Otolaryngology - Head and Neck Surgery; Centre Hospitalier de l'Universite de Montreal; Montreal Quebec Canada
- Department of Otolaryngology - Head & Neck Surgery; Hôpital Maisonneuve-Rosemont; Montreal Quebec Canada
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Massarelli O, Vaira LA, Biglio A, Gobbi R, Piombino P, De Riu G. Rational and simplified nomenclature for buccinator myomucosal flaps. Oral Maxillofac Surg 2017; 21:453-459. [PMID: 28936552 DOI: 10.1007/s10006-017-0655-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Reconstruction of moderate-sized mucosal defects of the oral cavity or oropharynx represents a surgical challenge. Buccinator myomucosal flaps seem to provide "ideal reconstruction" of oral/oropharyngeal defects because they carry a thin, mobile, well-vascularized, and sensitive tissue, like that excised or lost. Nevertheless, these flaps are not immediately popular because of confusion surrounding the complex terminology used to name them. METHODS After a retrospective study on our experience and a literature review, the authors propose a new rational and simplified nomenclature for the classification of buccinator myomucosal flaps, which clarifies the source vessel, the composition of the flap, and the type of transfer. RESULTS According to this nomenclature, six types of buccinator myomucosal flaps are described. CONCLUSIONS This proposed nomenclature may bring a consensus on the classification of buccinator myomucosal flaps and can help their spread.
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Affiliation(s)
- Olindo Massarelli
- Department of Maxillofacial Surgery, Sassari University Hospital, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Luigi Angelo Vaira
- Department of Maxillofacial Surgery, Sassari University Hospital, Viale San Pietro 43B, 07100, Sassari, Italy.
| | - Andrea Biglio
- Department of Maxillofacial Surgery, Sassari University Hospital, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Roberta Gobbi
- Department of Maxillofacial Surgery, Sassari University Hospital, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Pasquale Piombino
- Department of ENT, University of Campania "Luigi Vanvitelli" Hospital, Via Pansini 5, 08131, Naples, Italy
| | - Giacomo De Riu
- Department of Maxillofacial Surgery, Sassari University Hospital, Viale San Pietro 43B, 07100, Sassari, Italy
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Massarelli O, Vaira L, De Riu G. Islanded facial artery musculomucosal flap for tongue reconstruction. Int J Oral Maxillofac Surg 2017; 46:1060-1061. [DOI: 10.1016/j.ijom.2017.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/10/2017] [Indexed: 11/25/2022]
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40
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Patel UA, Hartig GK, Hanasono MM, Lin DT, Richmon JD. Locoregional Flaps for Oral Cavity Reconstruction: A Review of Modern Options. Otolaryngol Head Neck Surg 2017; 157:201-209. [DOI: 10.1177/0194599817700582] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To review state-of-the-art modifications and advances in soft tissue local and regional flap reconstruction of the oral cavity and to determine the role these techniques play in current practice. Data Sources Review of the literature regarding oral cavity reconstruction. Review Methods The authors describe advances in locoregional reconstructive options and assimilate data from the literature that compare recent advances to the historic standards. Conclusions Modern advances in regional reconstruction of the oral cavity offer outstanding results and demonstrate potential advance over free tissue transfer. These modifications demonstrate the prominent role that regional reconstruction can play in oral cavity reconstruction. Implications for Practice With a more complete understanding of these options, the surgeon is better able to tailor the reconstruction to the needs of the patient to provide high-quality cost-effective care.
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Affiliation(s)
- Urjeet A. Patel
- Department of Otolaryngology–Head and Neck Surgery, Northwestern University, Chicago, Illinois, USA
| | - Gregory K. Hartig
- Division of Otolaryngology–Head and Neck Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Matthew M. Hanasono
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Derrick T. Lin
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Jeremy D. Richmon
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Pan M, Mao J, Ma T, Qin X, Li B. [Effect of facial artery musculo-mucosal flap in reconstructing defects of tongue and mouth floor]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:461-464. [PMID: 29798613 DOI: 10.7507/1002-1892.201611108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effect of facial artery musculo-mucosal (FAMM) flap to reconstruct tongue and floor of mouth defects. Methods Between January 2011 and January 2016, 24 cases of tongue and floor of mouth defects were repaired with FAMM flap after tumor resection. There were 16 males and 8 females, aged from 38 to 70 years with an average of 55 years. The disease duration was from 1 week to 6 months with an average of 4 months. The defect located at the floor of mouth in 4 cases, at the tongue in 15 cases, and both tongue and floor of mouth in 5 cases. There were 2 cases of carcinoma at the floor of mouth, 2 cases of adenoid cystic carcinoma at the floor of mouth, 14 cases of carcinoma at the tongue, 1 case of adenoid cystic carcinoma at the tongue, and 5 cases of carcinoma at the tongue and floor of mouth. The size of defect ranged from 4 cm×3 cm to 8 cm×7 cm. Three ipsilateral and 21 contralateral FAMM flaps were harvested (5 cases were repaired with FAMM flap and submental muscle island flap due to the large defect area). The size of FAMM flap ranged from 5 cm×4 cm to 5 cm×5 cm, the size of submental muscle island flap ranged from 4 cm×3 cm to 5 cm×4 cm. Results All flaps survived after operation, without local necrosis. Wound dehiscence at donor site occurred in 5 cases, and healed after cleaning; primary healing was obtained in the other 19 cases. All the patients were followed up 8 months to 5 years with an average of 2 years and 4 months. No obvious facial deformity or fistula of the floor of mouth occurred after operation. Injury of the submandibular branch of the facial nerve was observed in 16 patients, who returned to normal at 3 months. All 24 patients had limitation of mouth opening after operation, which disappeared after 12 months. The functions of speech, chewing, and swallowing were normal. Conclusion FAMM flap has many advantages of simple operation, good repair, high flap survival rate, and less injury at donor site for repairing tongue and floor of mouth defects.
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Affiliation(s)
- Mengxiong Pan
- Departmentof Oral and Maxillofacial Surgery, the Affiliated Hospital of Guilin Medical College, Guilin Guangxi, 541001, P.R.China
| | - Junwu Mao
- Departmentof Oral and Maxillofacial Surgery, the Affiliated Hospital of Guilin Medical College, Guilin Guangxi, 541001,
| | - Tao Ma
- Departmentof Oral and Maxillofacial Surgery, the Affiliated Hospital of Guilin Medical College, Guilin Guangxi, 541001, P.R.China
| | - Xiaorong Qin
- Departmentof Oral and Maxillofacial Surgery, the Affiliated Hospital of Guilin Medical College, Guilin Guangxi, 541001, P.R.China
| | - Bo Li
- Departmentof Oral and Maxillofacial Surgery, the Affiliated Hospital of Guilin Medical College, Guilin Guangxi, 541001, P.R.China
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Joseph S, Naveen B, Mohan T. Islanded facial artery musculomucosal flap for tongue reconstruction. Int J Oral Maxillofac Surg 2017; 46:453-455. [DOI: 10.1016/j.ijom.2016.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022]
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Frisch T. Versatility of the facial artery myomucosal island flap in neopharyngeal reconstruction. Head Neck 2016; 39:E29-E33. [PMID: 27704666 DOI: 10.1002/hed.24602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The facial artery myomucosal (FAMM) island flap is a cheek flap, pedicled on the facial artery and suitable for small to medium-sized reconstructions of the oral cavity and neighboring areas. A novel transposition of the flap to the hypopharynx after laryngectomy is presented in this report. METHODS A 58-year-old man, previously irradiated, was laryngopharyngectomized because of a new supraglottic carcinoma. An unexpected need for a flap was solved by tunneling a FAMM island flap lateral to the mandible. The reach and size of the flap were sufficient to close the defect. RESULTS Vitality of the flap was ascertained by fiber endoscopy. No donor-site morbidity was seen. Postoperatively, the patient had a minor stomal fistula with spontaneous healing. CONCLUSION The pedicled FAMM island flap may be considered for smaller reconstructions of the upper hypopharynx. Accessibility, low donor-site morbidity, and recipient tissue similarity count among the advantages. © 2016 Wiley Periodicals, Inc. Head Neck 39: E29-E33, 2017.
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Affiliation(s)
- Thomas Frisch
- Department of Otorhinolaryngology, Head and Neck Surgery, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Baek CH, Kim BY, Park WR, Lee GJ, Woo SH, Ryu JS, Chung MK. Modification of facial artery myomucosal flap: a novel perforator flap for upper aerodigestive tract reconstruction after head and neck cancer ablation. Clin Otolaryngol 2016; 42:880-885. [PMID: 27545296 DOI: 10.1111/coa.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- C H Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - B Y Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - W R Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - G J Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - S H Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University, Jinju, Korea
| | - J S Ryu
- Head and Neck Oncology Clinic, National Cancer Center, Ilsan, South Korea
| | - M K Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
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Spacer Facial Artery Musculomucosal Flap: Simultaneous Closure of Oronasal Fistulas and Palatal Lengthening. Plast Reconstr Surg 2016; 137:240-243. [PMID: 26710029 DOI: 10.1097/prs.0000000000001904] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED In this series, the authors describe a modification of the facial artery musculomucosal flap for oronasal fistula repair. The spacer facial artery musculomucosal flap technique is characterized by a pedicle inset into the retromolar trigone and palate, obviating a second operative stage. This was performed in 14 patients with a 5.2-cm mean fistula size. Average follow-up was 4.3 years, with one partial flap necrosis but no recurrent oronasal fistula. There was a mean decrease of 18 percent in the distance between the velum and the posterior pharyngeal wall. The spacer facial artery musculomucosal flap provides a single-stage reconstruction of oronasal fistula while lengthening the palate through a pushback mechanism. Although further study of velopharyngeal function is needed, the spacer facial artery musculomucosal flap may be beneficial for patients with a short velum and an oronasal fistula. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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The New Transverse-Facial Artery Musculomucosal Flap for Intraoral Reconstructions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e652. [PMID: 27257582 PMCID: PMC4874296 DOI: 10.1097/gox.0000000000000632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Farzal Z, Lemos-Rodriguez AM, Rawal RB, Overton LJ, Sreenath SB, Patel MR, Zanation AM. The Reverse-Flow Facial Artery Buccinator Flap for Skull Base Reconstruction: Key Anatomical and Technical Considerations. J Neurol Surg B Skull Base 2015; 76:432-9. [PMID: 26682122 DOI: 10.1055/s-0035-1551669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/08/2015] [Indexed: 10/23/2022] Open
Abstract
Objective To highlight key anatomical and technical considerations for facial artery identification, and harvest and transposition of the facial artery buccinator (FAB) flap to facilitate its future use in anterior skull base reconstruction. Only a few studies have evaluated the reverse-flow FAB flap for skull base defects. Design Eight FAB flaps were raised in four cadaveric heads and divided into thirds; the facial artery's course at the superior and inferior borders of the flap was measured noting in which incisional third of the flap it laid. The flap's reach to the anterior cranial fossa, sella turcica, clival recess, and contralateral cribriform plate were studied. A clinical case and operative video are also presented. Results The facial artery had a near vertical course and stayed with the middle (⅝) or posterior third (⅜) of the flap in the inferior and superior incisions. Seven of eight flaps covered the sellar/planar regions. Only four of eight flaps covered the contralateral cribriform region. Lastly, none reached the middle third of the clivus. Conclusions The FAB flap requires an understanding of the facial artery's course, generally seen in the middle third of the flap, and is an appropriate alternative for sellar/planar and ipsilateral cribriform defects.
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Affiliation(s)
- Zainab Farzal
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Ana M Lemos-Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Rounak B Rawal
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Lewis J Overton
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Mihir R Patel
- Department of Otolaryngology, Emory University, Winship Cancer Institute, Atlanta, Georgia, United States
| | - Adam M Zanation
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, United States ; Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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Head and Neck Reconstruction Using the Superiorly Based Reversed-Flow Facial Artery Myomucosal Flap. J Oral Maxillofac Surg 2015; 73:1008-15. [DOI: 10.1016/j.joms.2014.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/15/2014] [Accepted: 11/17/2014] [Indexed: 11/21/2022]
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