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Calabrese L, Fazio E, Bassani S, Abousiam M, Dallari V, Albi C, Nucera G, Nebiaj A, Zanghi F, Accorona R, Gazzini L. Systematic review of minimally-invasive reconstructive options for oral cavity defects. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S42-S57. [PMID: 38745516 PMCID: PMC11098536 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/20/2024] [Indexed: 05/16/2024]
Abstract
The oral cavity is a primary site for malignant neoplasms of the head and neck region. Surgery, with or without adjuvant therapy, offers the highest probability of cure by focusing on radical tumour removal and organ function restoration. Reconstructive options are represented by local and free flaps, while small defects can be managed without reconstruction. For medium-sized defects without bone involvement, local flaps can be a good alternative to free flaps in selected patients. The purposes of this article are to analyse the main minimally-invasive reconstructive techniques in oral cancer surgery through a systematic review of the literature and develop a reconstructive algorithm based on the site and size of the defect. We defined minimally-invasive reconstruction as any reconstructive option not involving flap dissection from the neck or other distant areas from the oral cavity. Options considered include: local myo-mucosal or mucosal flaps (based on the facial or buccal arteries, and palatal flap), Bichat’s fat pad flap, and nasolabial flap. Use of biological or synthetic materials is also described. In selected patients with small to moderate-sized defects, the possibility of reconstruction with local flaps can be a viable option.
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Affiliation(s)
- Luca Calabrese
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Enrico Fazio
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Sara Bassani
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Monir Abousiam
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Virginia Dallari
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Cecilia Albi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Giuseppe Nucera
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Aurel Nebiaj
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Francesca Zanghi
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Remo Accorona
- Department of Otolaryngology-Head and Neck Surgery, Niguarda Hospital, Milan, Italy
| | - Luca Gazzini
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
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Raposo-Amaral CA, Monte TM, Raposo-Amaral CE. Treatment of Velopharyngeal Insufficiency Using Bilateral Myomucosal Buccinator Flaps. Plast Reconstr Surg 2024; 153:411e-414e. [PMID: 37053444 DOI: 10.1097/prs.0000000000010551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
SUMMARY The buccinator myomucosal flap, also referred to as a buccal myomucosal flap, is an effective technique to address velopharyngeal insufficiency after cleft palate repair. Challenges related to flap harvesting may deter plastic surgeons from incorporating this strategy as a first-line treatment. The primary objective of this study and accompanying video is to provide support regarding indications, planning, and surgical steps of the buccinator myomucosal flap technique, including important technical details for soft-palate dissection and flap harvesting.
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Affiliation(s)
- Cesar Augusto Raposo-Amaral
- From the Institute of Plastic and Craniofacial Surgery, Sobrapar Hospital
- Department of Neurology, University of Campinas
| | - Thais Miguel Monte
- From the Institute of Plastic and Craniofacial Surgery, Sobrapar Hospital
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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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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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Novel Local Chimeric Flap Based on Tunnelized Facial Artery Myomucosal Island Flap and Submandibular Gland Flap for Reconstructions After Oral Squamous Cell Carcinoma Surgery. J Craniofac Surg 2023; 34:76-82. [PMID: 36608097 PMCID: PMC9794126 DOI: 10.1097/scs.0000000000008862] [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: 02/01/2022] [Accepted: 06/15/2022] [Indexed: 12/31/2022] Open
Abstract
The reconstruction of oral tongue and floor of mouth defects after resections of squamous cell carcinoma is a challenging task in reconstructive surgery aiming for appropriate restoration of oral function and quality of life improvement. In this study, the authors introduce the innovative reconstruction technique of medium-sized defects consisting of tunnelized facial artery myomucosal island flap and submandibular gland flap as the local chimeric flap pedicled on facial vessels. A retrospective case series evaluation of 4 patients suffering from oral cavity cancer (stages III and IVa), who underwent transoral tumor excision with neck dissection and immediate reconstruction in the time period September 2020 to July 2021, was conducted. No flap losses or flap-related complications were identified. No recurrences occurred during the follow-up at 11.0±4.5 months (range: 6-16 mo, median=11 mo). Tunnelized facial artery myomucosal island flap and submandibular gland flap local chimeric flap expands the reconstruction options of medium-sized defects after ablative oral cancer surgery in carefully selected patients primarily not suitable for free flap reconstructions.
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Facial artery-based islanded myomucosal and bone flaps in head and neck reconstruction. J Plast Reconstr Aesthet Surg 2020; 74:1269-1278. [PMID: 33257300 DOI: 10.1016/j.bjps.2020.10.058] [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: 11/29/2019] [Revised: 08/25/2020] [Accepted: 10/22/2020] [Indexed: 11/22/2022]
Abstract
This article aims to illustrate various applications of facial artery-based islanded myomucosal (iFAMM) and osseous/osteo-myomucosal flaps (iFOMM) in head and neck reconstruction. A retrospective analysis of 75 patients who underwent the reconstruction of various head and neck mucosal defects with iFAMM/iFOMM in a tertiary head and neck cancer department from May 2015 to May 2019 was performed. The patients had surgery for cancer, which involved the oral tongue, floor of mouth, oropharynx, lower alveolus, larynx, hypopharynx, cricopharynx and trachea. iFOMM was used in 3 patients. Functional and esthetic outcomes, short-term and long-term complications were analyzed. The flap was successful in 74 out of 75 patients. Speech was intelligible in almost all patients and majority of patients could take oral feeds without any restrictions. The esthesis of reconstruction was scored high with a mean visual analog scale score of 8.4. The most commonly observed complication was marginal mandibular paresis, which improved with time. Mouth opening was >3 cm in 68/75 patients. Adjuvant radiation was a common factor in patients with <3 cm mouth opening. Flap was sensate by 4 months in majority of patients. The reach, pliability, and esthetics of the flap combined with recoverable morbidity of donor site present in the facial artery-based flap as a good option in the reconstruction of various head and neck subsites. Reduced operative time, lesser complication rates, less financial burden, and simplicity of the procedure make it a cost-effective alternate solution for reconstruction.
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Joseph S, B.S. N, Mohan M, Tharayil J. Comparison of islanded facial artery myomucosal flap with fasciocutaneous free flaps in the reconstruction of lateral oral tongue defects. Int J Oral Maxillofac Surg 2020; 49:1000-1006. [DOI: 10.1016/j.ijom.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 11/26/2022]
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Ferri A, Perlangeli G, Montalto N, Carrillo Lizarazo JL, Bianchi B, Ferrari S, Nicolai P, Sesenna E, Grammatica A. Transoral resection with buccinator flap reconstruction vs. pull-through resection and free flap reconstruction for the management of T1/T2 cancer of the tongue and floor of the mouth. J Craniomaxillofac Surg 2020; 48:514-520. [DOI: 10.1016/j.jcms.2020.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 01/26/2020] [Accepted: 02/14/2020] [Indexed: 01/18/2023] Open
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Use of a Versatile Buccinator Myomucosal Flap in the Palatal Defect. J Maxillofac Oral Surg 2019; 18:388-390. [PMID: 31371879 DOI: 10.1007/s12663-018-1143-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022] Open
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10
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Soft palate functional reconstruction with buccinator myomucosal island flaps. Int J Oral Maxillofac Surg 2017; 47:316-323. [PMID: 29225008 DOI: 10.1016/j.ijom.2017.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/02/2017] [Accepted: 11/23/2017] [Indexed: 11/22/2022]
Abstract
Oropharyngeal reconstruction after ablative surgery is a challenge. The results of a retrospective study of 17 patients who underwent total or sub-total soft palate reconstruction with a buccinator myomucosal island flap, between 2008 and 2016, are reported herein. An analysis of flap type and size, harvesting time, and postoperative complications was performed. Patients underwent standardized tests to assess the recovery of sensitivity, deglutition, quality of life (QoL), and donor site morbidity, at >6 months after surgery or the end of adjuvant therapy, if performed. All flaps were transposed successfully. Only minor donor and recipient site complications occurred. The sensitivity assessment showed that touch, two-point discrimination, and pain sensations were recovered in all patients. Significant differences between the flap and native mucosa were reported for tactile (P=0.004), pain (P=0.001), and two-point discrimination (P=0.001) thresholds. The average deglutition score reported was 6.1/7, with only minimal complaints regarding deglutition. The QoL assessment showed high physical (24.6/28), social (25/28), emotional (19.1/24), and functional (24.6/28) scores. No major donor site complications were noted in any patient; the average donor site morbidity score was 8.1/9. Buccinator myomucosal island flaps represent a valuable functional oropharyngeal option for reconstruction, requiring a short operating time and presenting a low donor site morbidity rate.
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Rahpeyma A, Khajehahmadi S. Donor site morbidity in buccinator-based myomucosal flaps: A retrospective study. Asian J Surg 2017; 40:210-214. [DOI: 10.1016/j.asjsur.2015.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/24/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022] Open
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Ferrari S, Ferri A, Bianchi B, Varazzani A, Giovacchini F, Sesenna E. Oncologic safety of facial artery myomucosal flaps in oral cavity reconstruction. Head Neck 2015; 38 Suppl 1:E1200-2. [PMID: 26286219 DOI: 10.1002/hed.24191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Buccinator myomucosal flaps are routinely used for oral cavity reconstruction and are indicated mainly in patients classified as having stage N0 cancer. This purpose of this study was to investigate whether preservation of the vascular pedicle of the flap (facial artery and vein) during stadiative neck dissection alters the oncologic safety in these patients. METHODS Fifty patients underwent resection of T1 to 3, N0 squamous cell carcinoma of the tongue or floor of the mouth, stadiative neck dissection, and reconstruction with a facial artery musculomucosal (FAMM) flap were retrospectively analyzed concerning rate of occult neck metastasis and recurrences. RESULTS Occult metastasis was detected in 10 patients. Mean follow-up was 41 months. The overall survival rate was 88%, and the disease-specific survival rate was 92%. CONCLUSION Neck dissection with preservation of the facial artery and vein does not alter the rate of regional recurrences, confirming the oncologic safety of myomucosal flaps in oral cavity reconstruction. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1200-E1202, 2016.
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Affiliation(s)
- Silvano Ferrari
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Andrea Ferri
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Bernardo Bianchi
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Andrea Varazzani
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Francesco Giovacchini
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
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Rahpeyma A, Khajehahmadi S. Inferiorly based buccinator myomucosal island flap in oral and pharyngeal reconstruction. Four techniques to increase its application. Int J Surg Case Rep 2015. [PMID: 26218177 PMCID: PMC4573210 DOI: 10.1016/j.ijscr.2015.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Reconstruction of oral and pharyngeal defects after pathologic resections with the same tissue is an optimal and ideal target. Islanded variety of inferiorly pedicled facial artery musculomucosal flap, in which facial artery and vein are skeletonized (referred to as inferiorly based BUMIF), is suitable for reconstruction of medium-sized mucosal defects. PRESENTATION OF CASES In this article, with four cases, modifications of this flap are demonstrated in reconstruction of large intraoral and oropharyngeal defects and coverage of alveolar ridge in the mandible. DISCUSSION In some situations, there is a need for more mucosal paddle, longer vascular pedicle and more adaptation to the recipient bed. CONCLUSION Relocating Stensen's duct increases the mucosal paddle with cranial extension of superior limit while differential incision of the mucosa and buccinator muscle in mandibular vestibule extend the lower limit of this flap. Bone suture is a good complementary technique when this flap is used for coverage of mandibular alveolar ridge. Inferiorly based BUMIF with added length is indicated for oropharyngeal and contralateral mouth floor reconstructions.
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Affiliation(s)
- Amin Rahpeyma
- Oral and Maxillofacial Diseases Research Center, Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Saeedeh Khajehahmadi
- Dental Research Center, Oral and Maxillofacial Pathology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
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Abdaly H, Omranyfard M, Ardekany MR, Babaei K. Buccinator flap as a method for palatal fistula and VPI management. Adv Biomed Res 2015; 4:135. [PMID: 26322283 PMCID: PMC4544118 DOI: 10.4103/2277-9175.161529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 06/15/2013] [Indexed: 11/30/2022] Open
Abstract
Background: Secondary palatal fistula and velopharyngeal insufficiency (VPI) are two major complications of palatoplasty. Various methods have been introduced for surgical repair of these complications; however, most of them are associated with a high recurrence rate and morbidity. This study was designed to evaluate the use of the buccinator myomucosal flap in the reconstruction of palatal fistula and velopharyngeal insufficiency following primary palatoplasty. Materials and Methods: This study was performed on 25 patients who had either secondary palatal fistula or velopharyngeal insufficiency. Their defects were repaired by buccinator myomucosal flaps (BMFs). Patients were followed for 8 weeks and follow-up visits were arranged at 1, 2, 4, and 8 weeks after discharge. Results: All BMFs were harvested and transposed successfully. The length of the soft palate increased 15.14 ± 1.13 mm postoperatively. One patient (4%) had flap dehiscence 6 days after the operation with no flap ischemia or necrosis. Another patient (4%) experienced recurrence of the palatal fistula with marginal necrosis of the BMF 6 weeks after the operation. Otherwise, no case of fistula recurrence, infection, flap ischemia or necrosis and donor-site morbidity was observed during follow-up sessions. Conclusion: This study demonstrated that using BMFs could be a safe, effective and promising method of treatment for post palatoplasty fistula and VPI. However, further investigations on a larger sample size with longer follow-up are recommended for more accurate conclusion.
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Affiliation(s)
- Hosein Abdaly
- Department of General and Plastic Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahmood Omranyfard
- Department of General and Plastic Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdy Rasty Ardekany
- Department of General and Plastic Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kamran Babaei
- Department of General and Plastic Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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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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17
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Versatility of the buccinator myomucosal flap in atypical palate reconstructions. J Craniomaxillofac Surg 2014; 42:1310-4. [DOI: 10.1016/j.jcms.2014.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/11/2014] [Accepted: 03/20/2014] [Indexed: 11/22/2022] Open
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18
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Rahpeyma A, Khajehahmadi S. Buccinator-based myomucosal flaps in intraoral reconstruction: A review and new classification. Natl J Maxillofac Surg 2014; 4:25-32. [PMID: 24163549 PMCID: PMC3800381 DOI: 10.4103/0975-5950.117875] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The buccinator-based myomucosal flaps are axial pattern flaps that are suitable in reconstruction of medium sized oral soft tissue defects; they are rich in blood supply, have appropriate thickness and considerable mucosal paddle, and they can secrete saliva. The present study describes surgical anatomy and blood supply of these flaps and demonstrates all possible modifications of these flaps (9 modifications). Many terms (> 10) have been used to refer to buccinator-based myomucosal flaps in the literatures. This report introduces a new classification system mainly based on the remaining attachments of buccinator muscle after flap elevation in pedicle variants and axial blood supply orientation in island variants.
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Affiliation(s)
- Amin Rahpeyma
- Oral and Maxillofacial Diseases Research Center, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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19
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Massarelli O, Gobbi R, Biglio A, Tullio A. Facial artery myomucosal free flap for cheek mucosa reconstruction: A case report. Microsurgery 2013; 33:401-5. [PMID: 23712929 DOI: 10.1002/micr.22113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/18/2013] [Accepted: 03/01/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Olindo Massarelli
- Maxillofacial Surgery Division; University Hospital of Sassari; Sassari Sardinia Italy
| | - Roberta Gobbi
- Maxillofacial Surgery Division; University Hospital of Sassari; Sassari Sardinia Italy
| | | | - Antonio Tullio
- Maxillofacial Surgery Division; University Hospital of Sassari; Sassari Sardinia Italy
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Woo SH, Jeong HS, Kim JP, Park JJ, Ryu J, Baek CH. Buccinator Myomucosal Flap for Reconstruction of Glossectomy Defects. Otolaryngol Head Neck Surg 2013; 149:226-31. [DOI: 10.1177/0194599813487492] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The use of the myomucosal flap from the buccinator muscle is a valuable reconstruction method for intraoral defects. We report the clinical advantages and pitfalls of using the buccinator myomucosal flap for tongue reconstruction after intraoral resection of tongue cancer. Study Design Prospective study. Setting University hospital. Subjects and Methods We used buccal artery–based buccinator myomucosal flaps for tongue reconstruction in 11 partial or total edentulous patients who underwent resection of tongue cancer. The size and site of the tongue defect ranged from one-third to one-half of the tongue in the lateral border. We analyzed the clinical features and oncologic and functional outcomes to define adequate indications. Results All flaps were successfully harvested and transposed, and the donor sites were primarily closed. The pedicles were safely divided 2 to 3 weeks postoperatively. In 8 of 11 patients, concurrent upper neck dissection was performed without compromising blood supply to the flap. The range of tongue motion and the volume of the reconstructed tongue were satisfactory, and the patients experienced no difficulties in swallowing or speech. Conclusion Particularly in edentulous patients, the buccal myomucosal flap can be a good option for reconstructing partial tongue defects after cancer surgery.
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Affiliation(s)
- Seung Hoon Woo
- Department of Otorhinolaryngology–Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Pyeong Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
| | - Jung Je Park
- Department of Otorhinolaryngology–Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
| | - Junsun Ryu
- Head and Neck Oncology Clinic, National Cancer Center, Ilsan, South Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Massarelli O, Gobbi R, Soma D, Tullio A. The Folded Tunnelized–Facial Artery Myomucosal Island Flap: A New Technique for Total Soft Palate Reconstruction. J Oral Maxillofac Surg 2013; 71:192-8. [DOI: 10.1016/j.joms.2012.03.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/06/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW This article reviews the buccinator flap, its relevant surgical anatomy, surgical technique, and applications in head and neck reconstruction. RECENT FINDINGS Reconstruction of defects after extirpation of head and neck neoplasms can be challenging and complex. Various reconstructive techniques, including skin grafts, regional flaps, and free tissue transfer, can be employed in restoration of form and function after ablative surgery. Although a wide array of reconstructive options is available, the technique employed will largely depend on the surgeon preference and experience. Commonly used pedicled flaps and free tissue transfer techniques can share several disadvantages, including prolonged operative time, poor cosmesis, donor site morbidity, functional limitations, and excessive tissue bulk for intraoral reconstruction. The ideal reconstructive method would adhere to the plastic surgery principle of replacement of 'like with like'. The ease of dissection and useful application makes the buccinator flap an excellent additional reconstructive option for the head and neck surgeon. SUMMARY The buccinator myomucosal flap is a versatile and dependable flap for head and neck reconstruction. Its minimal donor site morbidity, pliability, ease of elevation, and flexible usage while offering optimal functional and cosmetic results make it a viable option for select defects.
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Cheek mucosa: A versatile donor site of myomucosal flaps. Technical and functional considerations. Head Neck 2012; 35:109-17. [DOI: 10.1002/hed.22933] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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