title: A novel use of the facial artery based buccinator musculo-mucosal island flap for reconstruction of the oropharynx.
abstract: The buccinator musculo-mucosal island or Zhao flap can be used to reconstruct a wide range of intra-oral defects including floor of mouth, tonsillar fossa and lateral tongue. We describe our experience with the inferiorly based facial artery buccinator musculo-mucosal flap for a novel use in the reconstruction of oropharyngeal tumours at the tongue base and lateral pharyngeal wall. We prospectively reviewed all patients who underwent buccinator musculo-mucosal island flap reconstruction examining indication, operative details, and post-operative outcomes. We describe our technique for its novel use in lateral pharynx/tongue base reconstruction through neck dissection access. Deeper flaps were adequately visualised and monitored using flexible nasoendoscopy. There were no flap failures with all patients achieving primary healing with minimal complications. All donor sites closed directly with minimal scarring. Two patients reported mild tightness on mouth opening and two patients reported transient weakness of the mandibular branch of the facial nerve. In our experience the buccinator musculo-mucosal island flap is an extremely versatile 'like for like' local flap option due to its long arc of rotation. As inset can be achieved via neck dissection access, this avoids lip/jaw split as per conventional oropharyngeal surgical management further minimising morbidity. We present the first series of its effective use in oropharyngeal reconstruction.
authors.affiliation: Head & Neck Unit, Oxford University Hospitals NHS Trust, Oxford, UK. khurram.khan@ouh.nhs.uk
authors.forename: K
authors.initials: K
authors.lastname: Khan
authors.forename: V
authors.initials: V
authors.lastname: Hinckley
authors.forename: O
authors.initials: O
authors.lastname: Cassell
authors.forename: P
authors.initials: P
authors.lastname: Silva
authors.forename: S
authors.initials: S
authors.lastname: Winter
authors.forename: M
authors.initials: M
authors.lastname: Potter
mesh_terms: D002610:Cheek / Q000098:blood supply / Q000601:surgery; D005152:Facial Muscles / Q000098:blood supply / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply / Q000601:surgery; D009061:Mouth Mucosa / Q000098:blood supply / Q000601:surgery; D037981:Neck Dissection; D009960:Oropharynx / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome
keywords: Buccinator musculo-mucosal flap; FAMM flap; Facial artery musculo-mucosal flap; Oropharynx; Zhao flap