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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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Massarelli O, Vaira LA, Crimi S, Salzano G, Latini L, Bianchi A, Gennaro P, De Riu G. Tongue Reconstruction with Buccinator Myomucosal Island Flaps: Technical Considerations, Oncologic Safety, Functional Outcomes and QoL Assessment-A Retrospective Observational Study. J Pers Med 2023; 13:879. [PMID: 37373868 DOI: 10.3390/jpm13060879] [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: 05/01/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023] Open
Abstract
The objective of this study was to investigate the effectiveness of buccinator myomucosal island flaps for tongue reconstruction following malignant tumor resections. A retrospective study was performed on 52 patients who underwent tongue reconstructions with buccinator myomucosal island flaps between 2012 and 2020. We reviewed the flap type and size, harvesting time, recipient- and donor-site complications, postoperative oncologic outcomes, functional recovery and QoL assessment. All of the flaps were transposed successfully without any total flap loss. Neither in the primary site nor in the neck were cancer relapses observed. An evaluation of the sensitivity revealed that 96.1% of patients experienced a recovery of touch, two-point and pain sensations. There were significant differences between the flap and the native mucosa in terms of the tactile (p < 0.001), pain (p < 0.001) and two-point (p < 0.001) thresholds. The average swallowing score recorded was 6.1 out of 7, with only minor complaints. The quality of life assessments demonstrated high scores across physical (24.5 out of 28), social (25.8 out of 28), emotional (20.3 out of 24) and functional (25 out of 28) aspects. The present study showed how buccinator myomucosal island flaps represent an effective and functional tongue reconstructive option, requiring a short operative time with a low rate of donor site morbidity, and with evidence of long-term oncologic safety and high quality of life.
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Affiliation(s)
- Olindo Massarelli
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, 07100 Sassari, Italy
| | - Salvatore Crimi
- Maxillofacial Surgery Unit, University Hospital "Policlinico San Marco" of Catania, 95124 Catania, Italy
| | - Giovanni Salzano
- Maxillofacial Surgery Operative Unit, University Hospital of Naples "Federico II", 80131 Naples, Italy
| | - Linda Latini
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Alberto Bianchi
- Maxillofacial Surgery Unit, University Hospital "Policlinico San Marco" of Catania, 95124 Catania, Italy
| | - Paolo Gennaro
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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Gennaro P, Cioni S, Bracco S, Cascino F, Latini L, Abbagnato M, Massarelli O, Gabriele G. A Single-Center Retrospective Analysis of 14 Head and Neck AVMs Cases Treated with a Single-Day Combined Endovascular and Surgical Approach. J Pers Med 2023; 13:jpm13050757. [PMID: 37240927 DOI: 10.3390/jpm13050757] [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: 03/12/2023] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Arteriovenous malformations (AVMs) are rare congenital defects of vascular development whose treatment remains challenging. The paper presents a retrospective single-center study of 14 patients with AVMs of the head and neck region undergoing combined endovascular and surgical treatment in a single day. AVM architecture and therapeutic strategies were determined on the basis of angiographic studies, while the psychological involvement of each patient was assessed by means of a questionnaire. Most of the 14 patients achieved satisfactory clinical results with no recurrences, good aesthetic and functional results, and most patients reported improved quality of life. The combined endovascular and surgical approach is an effective treatment for AVMs of the head and neck and performing it on the same day is a possible option often accepted by patients which guarantees operative advantages for the surgeon.
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Affiliation(s)
- Paolo Gennaro
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Samuele Cioni
- Neuroimaging and Neurointervention Unit, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Sandra Bracco
- Neuroimaging and Neurointervention Unit, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Flavia Cascino
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Linda Latini
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Manfredi Abbagnato
- Neuroimaging and Neurointervention Unit, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Olindo Massarelli
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Guido Gabriele
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
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Superficial Temporal Artery Perforator Flap: Indications, Surgical Outcomes, and Donor Site Morbidity. Dent J (Basel) 2020; 8:dj8040117. [PMID: 33053764 PMCID: PMC7712319 DOI: 10.3390/dj8040117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/23/2020] [Accepted: 10/09/2020] [Indexed: 01/22/2023] Open
Abstract
The aim of this retrospective case series was to discuss indications, surgical outcomes, and donor site morbidity in the use of superficial temporal artery perforator (STAP) flaps in intra-oral or extra-oral facial reconstruction. This study involved 9 patients treated with a STAP flap at the Maxillo-Facial Surgery Unit of the University of Campania “Luigi Vanvitelli”, Naples. A STAP flap was used alone or in combination with other local flaps, for the coverage of facial soft tissue defects, after the resection of craniofacial malignant tumors (n = 7) or as a salvage flap, in partial or total microvascular flap loss (n = 2). The STAP flap was proven to be a valuable surgical option despite it not being frequently used in facial soft tissue reconstruction nor was it chosen as the first surgical option in patients under 70 year’s old. Donor site morbidity is one of the major reasons why this flap is uncommon. Appropriate patient selection, surgical plan, and post-surgical touch-ups should be performed in order to reduce donor site scar morbidity.
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Vaira LA, Massarelli O, Gobbi R, Biglio A, De Riu G. Tactile recovery assessment with shortened Semmes-Weinstein monofilaments in patients with buccinator myomucosal flap oral cavity reconstructions. Oral Maxillofac Surg 2018; 22:151-156. [PMID: 29396784 DOI: 10.1007/s10006-018-0682-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The sensitive restoration is a primary aim of oral reconstructive surgery. The Semmes-Weinstein monofilament test is the "Gold Standard" to assess the threshold of tactile sensitivity on the skin but its use in the oral cavity is limited due to the size of the tools. We adopted half-cut Semmes-Weinstein monofilaments to evaluate the threshold of tactile sensitivity in oral reconstructions with buccinator myomucosal flaps. MATERIALS AND METHODS Monofilaments were half-cut and recalibrated. Fifty-seven oral reconstructions were considered at 4-year minimum follow-up. Test was conducted both on the reconstructive flap and on the non-operated contralateral side. RESULTS All of the considered flaps (100%) showed a recovery of tactile sensitivity. The overall average tactile threshold value assessed on this sample was 0.76 ± 1.58 g/mm2 overall. CONCLUSIONS Shortened monofilaments allow easily assessment of tactile sensitivity in all the oral cavity areas, even in operated patients which often present lockjaw or microstomia.
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Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy.
| | - Olindo Massarelli
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Roberta Gobbi
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Andrea Biglio
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
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