Extended, Double-Pedicled Facial Artery Musculomucosal (dpFAMM) Flap in Tongue Reconstruction in Edentulous Patients: Preliminary Report and Flap Design

FAMM flap in oral cavity and tongue defect reconstruction: A systematic review and meta-analysis

BACKGROUND

The facial artery musculomucosal (FAMM) flap is a versatile flap based on the facial artery. It can be used to reconstruct the floor of the mouth, palate, tongue and alveolar ridge. The flap can be designed in various orientations and modified as an islanded or tunnelised flap. This study aimed to review the application of FAMM flap in the reconstruction of defects of the tongue and oral cavity, with specific focus on success rates and total complications.

METHODS

A literature search was conducted by 2 independent reviewers on PubMed, Dynamed, DARE, EMBASE, Cochrane and British Medical Journal (BMJ) electronic databases (Registry CRD42024529989).

RESULTS

Twenty-seven studies fulfilled the search criteria and data on 407 FAMM flaps performed on 402 patients were extracted for analysis. Overall, 1.7% (n=7) of flaps failed because of total necrosis (n=3), partial necrosis requiring surgical intervention and flap abandonment (n=2), total failure (n=1) and fistula formation (n=1). Overall, 26.0% (n=106) of patients experienced non-functional complications. The most reported complications were partial necrosis (n=23, 5.7%), wound dehiscence (n=18, 4.4%) and venous congestion (n=13, 3.2%). The pooled success rate in all studies using FAMM flaps for oral cavity and tongue reconstruction was 99.47% (95% CI, 98.26 to 100.00, P = 1.00; I2 = 0%;). Pooled total complication rates were 30.18% (95% CI, 16.97 to 43.38, P < 0.01; I2 = 91%). Only 35 flaps required re-operation.

CONCLUSIONS

With low complication and failure rates, FAMM flaps are a safe and versatile option to consider in oral cavity and tongue reconstruction.

The Sublingual Gland Flap for Oral Reconstruction: Insights From a Single Institutional Experience

Background: Following ablative surgery, the reconstruction of oral cavity defects is essential to ensure optimal function and aesthetically acceptable outcomes. The purpose of this study was to retrospectively analyze the effectiveness and complication rates of the sublingual gland flap (SGF) in oral soft tissue reconstruction. The procedure for harvesting SGF and the strengths and limitations of the flap are discussed. Materials and Methods: The study group consisted of 13 patients suffering from oncological diseases who underwent soft tissue reconstruction with SGF. The patient's medical charts were evaluated based on histopathological aspects, postoperative complications, and outcomes. Reconstruction of the floor of the mouth was performed in 8 patients (61.5%) and lower gingiva in 5 patients (38.5%), respectively. Results: Complete epithelialization with closure of the defect was achieved within an average of 2 weeks. The observation period ranged from 1 to 33 months, with an average duration of 11.5 months. Partial flap necrosis and ranula occurred in one patient (7.7%). Furthermore, postoperative bleeding was observed in one patient (7.7%), and wound dehiscence and abscess formation were noted in another (7.7%). Locoregional recurrence of the cancer was observed in one case (7.7%). Conclusions: The SGF is effective for achieving successful reconstruction of small- and medium-sized defects in the lower gingiva and floor of the mouth. The complication rate is relatively low.

Facial Reconstruction Using Facial Artery Myomucosal Flap: A Comprehensive Review

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.

Intraoral flaps for oral cavity and oropharyngeal reconstruction

PURPOSE OF REVIEW

Oral cavity reconstruction using local flaps is an area of head and neck surgery that has been overshadowed since the introduction of free flaps. Here, we discuss new developments, predominantly modifications to existing techniques for intraoral reconstruction, the utility of different local flaps and a review of functional outcomes.

RECENT FINDINGS

The facial artery musculomucosal (FAMM) flap has seen the greatest number of modifications to technique, most notably the extended double-pedicled, kite-shaped tunnelized and osseous myomucosal approaches. The tunnelled buccal fat pad flap has gained popularity as well as the use of combining two flaps such as the buccal fat pad and palatal island flap to reconstruct oral cavity defects with good effect. There is still a paucity of literature surrounding functional outcomes post reconstruction. Despite this, the complication rate for local flaps remains low.

SUMMARY

The value of intraoral flaps for oral cavity reconstruction is undisputed. However, they are potentially underutilised in the modern era of expanding availability and indications for free tissue transfer. As many practices see greater numbers of aging patients, often with multisystem comorbidities, local flaps are an important tool that can provide the surgeon with a greater number of reconstructive options.

Buccal Myomucosal Flap for Reconstruction of Red Lip Defects Close to Mouth Angle

BACKGROUND

Owing to the special esthetic and functional role in the face, red lip reconstruction presents a challenge to plastic surgeons. Various reconstructive techniques can be employed to fix the red lip defects close to the mouth angle. The purpose of this study was to demonstrate that the buccal myomucosal flap could be an available option to repair red lip defects with preservation of its esthetics and function.

METHODS

A single-center, retrospective study of 7 patients with red lip defects who were treated with buccal myomucosal flap was conducted between June 2017 and March 2022. All patients were followed up for at least 6 months including questionnaires and photography.

RESULTS

Of these 7 patients, 2 were women, and 5 were men. The average age was 14.3 years (range, 1-32 y). All the buccal myomucosal flaps survived well. All the donor sites were closed directly without complications. The average follow-up time was 33.4 months (range, 6-57 mo). All patients were satisfied with the aesthetic and functional results.

CONCLUSION

The buccal myomucosal flap is versatile and reliable, with the advantages of rich vascularity, flexible design, and easy access. This study was presented to highlight that the flap could be a good candidate to treat red lip defects close to the mouth angle.

Feasibility of dpFAMM flap in tongue reconstruction after facial vessel ligation and radiotherapy—case presentation

Background

Salvage surgery with reconstruction of the second and next primary tongue cancer remains difficult, especially after earlier neck dissection and radiotherapy. In the current report, we describe the feasibility of the extended, double-pedicled facial artery musculomucosal (dpFAMM) flap in the reconstruction of the patient with second primary tongue squamous cell carcinoma, after facial vessel ligation and radiotherapy.

Case presentation

An 81-year-old female patient was operated on due to tongue squamous cell carcinoma (SCC) on the left side T3N1M0 in 2019. Bilateral selective neck dissection with tongue reconstruction was performed by island FAMM flap. The patient also suffered from synchronous mucinous breast carcinoma treated with tamoxifen. The second primary SCC of the tongue on the opposite (right) side was detected in 2020. The patient did not agree to surgical treatment; therefore, radiotherapy was performed. The local recurrence of the tongue cancer of the right side was treated surgically in 2021. Salvage surgery comprised hemiglossectomy and dpFAMM flap reconstruction with uneventful postoperative follow-up.

Conclusions

This case presentation proved that dpFAMM flap can be used in salvage surgery and reconstruction even in patients after ligation of facial vessels, irradiation, and in the course of hormone therapy. The flap is easy to handle, has good vascularity, and comprises a predictable method of reconstruction, especially for patients with severe comorbidities.