Article
The facial artery musculomucosal (FAMM) flap in floor of mouth reconstruction
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Published: | April 14, 2014 |
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Introduction: Large floor of mouth (FOM) ablative defects often necessitate the use of free flap reconstruction to achieve water tight closure and adequate post-operative tongue mobility. The facial artery musculomucosal (FAMM) flap, also known as the buccinator musculomucosal island flap, has consistent and reliable vascular anatomy, a large arc-of-rotation, relative ease of elevation, and minimal donor site morbidity. Despite these qualities, it is rarely used by head and neck surgeons for reconstruction of FOM defects. This study describes use of this flap and outcomes in patients presenting with T2 or small T3 FOM tumours who were not adequate candidates for microvascular reconstruction over a 12 month period at our institution.
Methods: Five patients met criteria and underwent the procedure. Two had received prior radiation therapy to the neck. All patients underwent concurrent neck dissection including ipsilateral level 1B with removal of the submandibular gland and preservation of the facial vessels.
Results: Defects ranged up to 9x4 cm in size. FAMM flaps with dimensions up to 9x3 cm were elevated. There were no instances of partial or total flap necrosis, fistula, hematoma, seroma, or sialocele. Cosmetic results were excellent in 3/5 patients. Two patients presented with mild post-operative contracture of the ipsilateral oral commissure. Long-term post-operative oral tongue mobility and articulation was excellent in all patients.
Conclusions: The FAMM flap is a viable and reliable option for reconstruction of T2 and small T3 defects of the FOM, and should be considered a workhorse flap for oral cavity defects. With careful dissection, a complete level 1B dissection may be concurrently performed with preservation of the facial vessels.
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