Musculomucosal nasolabial island flaps for floor of mouth reconstruction

The Arterialized Facial Artery Musculo-Mucosal Island Flap for Post-Oncological Tongue Reconstruction

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.

The place of nasolabial flap in orofacial reconstruction: A review

BACKGROUND

The use of Nasolabial flap (NLF) to reconstruct orofacial soft tissue defects is one of the oldest methods for reconstruction in the medical literature. Despite widespread use of this invaluable flap, there are still controversies over the terms used for the description of this flap.

MATERIALS AND METHODS

A search was run in PubMed for articles in English language on nasolabial flap in oral cavity/facial reconstruction, between 1960 and 2016. Inclusion criteria was case series that focused on the anatomy, flap design, blood supply, composition, flap motion, and the reconstructed area and donor site complications.

RESULTS

560 articles were found in PubMed search for nasolabial flap (between 1960 and 2016). 84 articles with case series structure and available full text were included. The results of the search in this topic for anatomy, flap design, blood supply,NLF composition, flap motion, reconstructed area and donor site morbidity are presented.

CONCLUSION

Nasolabial flap is an old flap for reconstructive purposes. Over time different modifications have been introduced to expand its usage. Clear definition of the terms used with this flap is given.

Versatility of the facial artery myomucosal island flap in neopharyngeal reconstruction

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.

Facial artery musculomucosal flap in head and neck reconstruction: A systematic review

BACKGROUND

The facial artery musculomucosal (FAMM) flap has emerged as a popular option in head and neck reconstruction in the last decade. The purpose of this study was to conduct a literature review of the FAMM flap.

METHODS

We have conducted a search on PubMed using specific key words to identify all articles related to the FAMM flap. We reviewed the modifications of the FAMM flap, its indications, contraindications, complications, and outcomes.

RESULTS

Thirty-eight articles published from 1992 to 2013 were included for review. A total of 441 FAMM flaps were reported in the literature and the most commonly reconstructed site was the floor of the mouth. Functional and aesthetic outcomes were judged to be excellent.

CONCLUSION

The FAMM flap is a versatile reconstructive option for small and medium size defects in the head and neck. Recent studies have explored new applications for this flap, such as in skull base reconstruction.

Angular artery cutaneous flap for reconstruction of difficult oronasal fistulas

BACKGROUND

Oronasal fistulas after oromaxillary surgery may sometimes be encountered and remain a challenging problem. They can cause significant disabilities such as phonetic problems and food or liquid regurgitation while swallowing. A few methods are reported to solve this problem, including using a dental appliance, local tissue rotation, or even free-tissue transfer.

MATERIALS AND METHODS

An angular artery cutaneous flap was designed to repair the defect. The flap that included the skin and superficial fascia fed by the flow of angular artery was rotated through the buccal mucosa into the oral cavity to cover the palate defect.

CASE REPORTS

Two oronasal fistula cases were reported in this series. Case 1: A 71-year-old man had hard palate cancer and had received wide excision in our hospital 2 years previously. He had received adjuvant radiotherapy (28 times) and was transferred to the plastic surgery department for dealing with oronasal fistula. The palate defect was 2 × 2 cm. Case 2: A 72-year-old woman was a patient with left palate mucoepidermoid carcinoma. She had received an operation and adjuvant radiotherapy 10 years previously. For her oronasal fistula and hypernasality, she had received reconstructive operations 3 times with local rotation flap for left-side palate defect at a previous hospital. However, the local flap failed and the fistula persisted. She then approached our plastic surgery department for help. The palate defect was about 1 × 1 cm. We successfully reconstructed the oronasal fistula by using the angular artery cutaneous flap. The flap successfully sealed the oral cavity during the follow-up period.

CONCLUSION

Angular artery cutaneous flap is a good alternative for reconstruction of the oronasal fistula. Especially in elderly patients, donor-site comorbidities are fewer due to the redundant aging skin and the missing tooth.

[The orbitonasolabial flap. Anatomical and clinical study]

How to use the orbitonasolabial flap in vascular island thanks to his pedicle based an angular vessel. An anatomic study based on 11 cadavers allows to check the existence of a constant pedicle. This flap was used on 6 patients aged 62 to 90 years old on an average period of 16 months to fill up jugular, orbital, nasolabial and inner canthal defects. Two complications have occurred, a superficial necrosis of the lower part of the flap having spontaneously healed and an ectropion on a senile part. It has been necessary to degrease a second time in 50% of the cases. Nevertheless, the flap can be considered reliable and able to cover tissue defect in the central facial region with minor aesthetic and functional sequel on the donor site.

[Use of nasolabial flap for mouth floor reconstruction]

SUBJECT

Oral cavity cancers represent 30% of the cephalic extremity tumors. Their resection requires in the majority of the cases a reconstruction by soft tissue. The reconstruction must be simple by bringing some reliable, hairless, thin, resistant tissue to radiation therapy, with a limited morbidity and an acceptable scar ransom.

PURPOSE

The purpose of our study is to define the place and the limits of nasolabial flap in the reconstruction of the anterior floor of the mouth after tumoral resection compared to the other surgical and microsurgical techniques.

MATERIAL AND METHOD

We retrospectively studied patients with oral cancerous lesions of the anterior floor of the mouth reconstructed by nasolabial flap between 1997 and 2002. The patients benefited from a surgical resection of the tumor by respecting the safety margins, with an immediate reconstruction allowing the restoring of the oral functions. We tried to describe the limits of this flap and discussed its modalities of vascularization.

RESULTS

Fifty-three flap procedures were performed on 47 patients; forty-one have received a unilateral and 6 a bilateral nasolabial flap. The majority of tumors were squamous cell carcinomas (50 cases). The average age of patients were 64.8 years (45-78 years) with 40 men (75%) and 13 women (25%). A radical neck lymph nodes dissection with facial artery ligation was realized for 21 patients (15 ipsilateral and 3 bilateral) without affecting the outcome. As complications, we noted one complete necrosis and two partial necrosis of the flap, two postoperative wound complications with dehiscence as well as a massive local recurrence of initial tumor in one patient.

CONCLUSION

The nasolabial flap represents a simple functional and morphological option to other pedicled or microsurgically anastomosed flaps for the reconstruction of intermediate-sized mouth floor defects.

Anatomic study of the blood supply of perioral region

The use of flaps to reconstruct lip defects requires detailed knowledge of the local vasculature. New flaps for surgery around the mouth can be devised if the surgeon knows the distribution of the perioral arterial branches. Examination of the anatomy of perioral branches of the facial artery (FA) confirmed the consistent presence of septal and alar branches in the upper lip and a labiomental branch in the lower lip. Mucosal flaps from the upper lip based on the deep septal branch or the alar branch of the FA can be used to restore lower lip defects. A composite flap from the lower lip supplied by the labiomental branch of the FA can be used to restore combined defects of the upper lip and nose or partial defects of the lower lip. We studied the vascular anatomy of the perioral region in 25 cadaver dissections. Fixation was by 10% formaldehyde solution. Red latex was injected into the common carotid arteries before dissection. In the 50 specimens, the primary supplying vessels were identified and the size and distribution of the vessels were investigated. The FA was symmetrical in 17 (68%) of 25 heads. It terminated as an angular facial vessel in 11 (22%), as a nasal facial vessel in 30 (60%), as an alar vessel in six (12%), and as a superior labial vessel in two (4%) facial halves. It terminated as a hypoplastic type of FA in one (2%) facial half. The average external diameter of the superior labial artery (SLA) was 1.6 mm (min-max: 0.6-2.8 mm) at its origin. The origin of the SLA was superior to the angle of the mouth in 34 of 47 specimens (72.3%), and at the angle of the mouth in 13 of 47 specimens (27.7%). In two of the remaining three specimens, the SLA was the continuation of the FA and the other was of the hypoplastic type. The SLA supplied the columellar branches in all specimens except for the hypoplastic type (49 specimens). Columellar branches were classified according to their number and their type. In five specimens (10%) the inferior labial artery (ILA) was not found. In the other specimens, the site of origin of the ILA varied between the lower margin of the mandible and the corner of the mouth. Its external diameter measured min-max: 0.5-1.5 mm. The ILA arose from the FA above the angle of mouth in 4 specimens (8%), inferior to the angle of mouth in 11 specimens (22%), and at angle of mouth in 30 specimens (60%). We observed that the labiomental arteries, which formed anastomoses between the FA, ILA, and submental artery, showed variations in their course in the labiomental region. We suggest that knowledge of the location of arteries with respect to easily identifiable landmarks will help to avoid complications at surgery.

[The nasolabial flap and the buccinator flap. Anatomic study and 2 cases reports]

The authors present an anatomical study of the nasolabial flap and buccinator flap on 12 cadavers. This study was illustrated by 2 clinical cases: a case of reconstruction of the philtrum with a superiorly based nasolabial flap and a case of reconstruction combining an inferiorly based nasolabial flap and an ipsilateral anteriorly based musculomucosal buccinator flap.

Unilateral subcutaneous pedicled nasolabial island flap for anterior mouth floor reconstruction

PURPOSE

This article describes the successful use of unilateral subcutaneous pedicled flaps in the reconstruction of defects of the anterior floor of the mouth by raising the flaps as skin islands, relying on a pedicle of subcutaneous tissue.

PATIENTS AND METHODS

Nine flap procedures were performed on 9 patients for reconstruction of small defects of the anterior floor of the mouth. One patient underwent secondary reconstruction to release tongue that was functionally tethered anteriorly.

RESULTS

All flaps healed without evidence of infection, dehiscence, or necrosis. This particular choice of unilateral flap seems to provide improved functional integrity of the anterior floor of the mouth.

CONCLUSIONS

The unilateral inferiorly and subcutaneously based nasolabial island flap provides reliable coverage of small and intermediate-sized defects of the anterior floor of the mouth when used alone, improving the tongue mobility, articulation, and deglutition.

Use of facial artery musculomucosal flap for closure of soft tissue defects of the mandibular vestibule

We present the use of the inferiorly based facial artery musculomucous (FAMM) flap to repair a defect of the mandibular vestibule, and discuss the advantages and disadvantages of this procedure. The FAMM flap an effectively cover defects of the mandibular vestibule and other regions of the oral cavity, and its softness, toughness, and minimal shrinkage allow for the use of dental prostheses.

The nasolabial flap revisited as an adjunct to floor-of-mouth reconstruction

Composite free tissue reconstruction for floor-of-mouth defects are thought of as single-stage procedures. However, postoperative wound complications often require additional soft-tissue coverage to salvage the initial reconstruction. Nasolabial flaps interpolated into the oral cavity offer an expedient solution to soft-tissue deficits encountered during complicated floor-of-mouth reconstructions. The records of 39 patients undergoing free tissue reconstruction, from July 1995 to December 1999 at Shands Hospital and the Gainesville VA Medical Center, for floor-of-mouth defects were reviewed. Six patients developed postoperative wound complications that compromised the initial reconstruction. In all patients, inferiorly based nasolabial flaps were used to provide additional soft-tissue coverage and wound closure. Radiation therapy and facial artery ligation did not affect the outcome. Complete wound healing and salvage of the initial reconstruction was achieved in all 6 patients.

Anatomical basis and results of the facial artery musculomucosal flap for oral reconstruction

The facial artery musculomucosal (FAMM) flap is a newly designed buccal mucosal flap that was first described in 1992. The long rotational arc of this flap is particularly suitable for anterior palatal defects that are otherwise difficult to treat with local flaps. However, after the first clinical reports, some controversies arose about the reliability of this flap, so we conducted an anatomical study of the vascular pattern with a latex preparation in 10 cadavers. We studied the variations of the course of the facial artery and focused on the relationship between the facial artery and vein within the pedicle. We concluded that the flap is more an arterialized flap than an axial-pattern flap, and have given anatomical landmarks to optimize the survival rate. Our preliminary clinical results (five good results, one complete failure) are acceptable.

The inferiorly and superiorly based nasolabial flap for the reconstruction of moderate-sized oronasal defects

PURPOSE

The usefulness of the inferiorly or superiorly based nasolabial flap for the unilateral or bilateral reconstruction of local extraoral and intraoral defects was evaluated.

PATIENTS AND METHODS

In a 10-year period, 22 flaps were used in 15 patients to cover defects of the floor of the mouth, nose, and chin. Fourteen bilateral and two unilateral flaps were inferiorly based, and six unilateral flaps were superiorly based.

RESULTS

Dehiscence, which occurred in one case, and obstructive sialadenitis which occurred in another, were the main complications.

CONCLUSION

The nasolabial flap is a useful procedure for the reconstruction of moderate-sized oronasal defects because of its simple elevation, proximity to the defect, and versatility.