title: Facial artery musculomucosal flap for reconstruction of skull base defects: a cadaveric study.
abstract: OBJECTIVE
  Failure in skull base defects reconstruction following tumor resection can have serious consequences such as ascending meningitis and pneumocephaly. The nasoseptal flap showed a very low incidence of cerebrospinal fluid leak but is not always available. The superiorly pedicled facial artery musculomucosal (FAMM) flap has been successfully used for reconstruction of head and neck defects. Our objective is to show that the FAMM flap can be used as a new alternative in skull base reconstruction.
  
  
  METHODS
  Cadaveric study. Feasibility.
  
  
  METHODS
  Thirteen specimens underwent bilateral FAMM flap dissection. Two new modifications of the traditional FAMM flap have been developed. Feasibility in FAMM flap transfer to the skull base was investigated through endoscopic skull base dissection and maxillectomy in four specimens. Measurements were recorded for each harvested flap.
  
  
  RESULTS
  The mean surface area of the modified FAMM flap efficient for reconstruction was 15.90 cm(2) . The flaps easily covered the simulated defects of the frontal sinus and the fovea ethmoidalis areas. Modifications of the traditional FAMM flap were necessary for a tension-free coverage of the planum sphenoidale and sella turcica.
  
  
  CONCLUSIONS
  The FAMM flap holds high potential as a new alternative vascular flap in skull base reconstruction. However, it has not been used in patients yet and should be considered only when other options are not available. New modifications developed in this article can elongate the traditional FAMM flap, potentially contributing to a tighter seal of the skull base defect than FAMM flap alone.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada.
authors.forename: Liyue
authors.initials: L
authors.lastname: Xie
authors.forename: François
authors.initials: F
authors.lastname: Lavigne
authors.forename: Akram
authors.initials: A
authors.lastname: Rahal
authors.forename: Sami Pierre
authors.initials: SP
authors.lastname: Moubayed
authors.forename: Tareck
authors.initials: T
authors.lastname: Ayad
mesh_terms: D001158:Arteries / Q000601:surgery*; D002102:Cadaver; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005145:Face / Q000098:blood supply*; D005240:Feasibility Studies; D006801:Humans; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply
keywords: FAMM flap; Skull base reconstruction; cerebrospinal fluid leak; facial artery; musculomucosal flap