title: Pedicled facial buccinator (FAB) flap: a new flap for reconstruction of skull base defects.
abstract: BACKGROUND
  The expansion of endoscopic endonasal skull base surgery has resulted in an increased demand for reconstructive options. Reconstruction with vascularized tissue has proven indispensable for reliably separating the cranial contents from the paranasal sinuses following extended endoscopic endonasal approaches (EEA). The introduction of the Hadad-Bassagasteguy flap (vascular pedicle nasoseptal flap, HBF) at our institution decreased our postoperative cerebral spinal fluid (CSF) leak rates from more than 20% to less than 5%. The HBF is not always available, as the nasoseptal area or its vascular supply can be compromised by tumor or prior surgery. In an attempt to keep pace with rapidly expanding reconstructive requirements, we present the anatomic and cadaveric foundations for novel modifications of the facial artery musculo (-mucosal) (FAM[M]) and buccinator flaps to allow vascularized reconstruction of the skull base.
  
  
  METHODS
  Feasibility. Cadaveric study.
  
  
  METHODS
  Using cadaver dissections and measurements, we investigated the feasibility of transposing pedicled buccinator myo/myomucosal flaps into the nasal cavity and skull base. Both muscular and myomuscular flaps were raised, and techniques for transposition into the nasal cavity were investigated. Three fresh and six preserved human specimens were dissected.
  
  
  RESULTS
  Pedicled facial buccinator flaps with and without mucosa were transposed into the nasal cavity using a variety of maxillary osteotomies. No facial incisions were required. It was demonstrated that the flaps reach the anterior skull base and planum sphenoidale.
  
  
  CONCLUSIONS
  The transposition of pedicled buccinator muscle flaps with and without mucosa into the nasal cavity could reach the anterior skull base and planum sphenoidale, if the appropriate surgical technique is used. The pedicled Facial Buccinator Flap holds significant potential as a reconstructive alternative for a variety of skull base defects, alone or in combination with existing reconstructive options. 2010.
authors.affiliation: Department of Otolaryngology, University off Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Rivera-Serrano
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Oliver
authors.forename: John
authors.initials: J
authors.lastname: Sok
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Prevedello
authors.forename: Paul
authors.initials: P
authors.lastname: Gardner
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
authors.forename: Amin B
authors.initials: AB
authors.lastname: Kassam
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Carrau
mesh_terms: D002102:Cadaver; D004724:Endoscopy; D005240:Feasibility Studies; D006801:Humans; D009296:Nasal Cavity / Q000601:surgery*; D010027:Osteotomy; D019651:Plastic Surgery Procedures / Q000379:methods*; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps