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Facial artery musculomucosal flap to oropharyngeal defect

jackflash22
Posts: 504
Joined: Aug 2013
J Plast Reconstr Aesthet Surg. 2013 Oct;66(10):1365-8. doi: 10.1016/j.bjps.2013.05.029. Epub 2013 Jun 10.

A novel use of the facial artery based buccinator musculo-mucosal island flap for reconstruction of the oropharynx.

Source

Head & Neck Unit, Oxford University Hospitals NHS Trust, Oxford, UK. Electronic address: khurram.khan@ouh.nhs.uk.

These are my surgeons at the Churchill Hospital I must have been one of their guinea pigs

 

 

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.

Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All

rights reserved.

KEYWORDS:

Buccinator musculo-mucosal flap, FAMM flap, Facial artery musculo-mucosal flap, Oropharynx, Zhao flap

PMID:

 

23764322

 

[PubMed - in process]
Grandmax4's picture
Grandmax4
Posts: 709
Joined: Dec 2011

I love reading about modern technology and the improvments of  treatments, I was sorta a guinea pig too when my surgeon used the di vinci robot to remove my epiglottis..please everyone continue to give to the Cancer Society , maybe someday this beast will be slain for all

jackflash22
Posts: 504
Joined: Aug 2013

I had this op where they construct a flap from the inside cheek. It took straight away and I was talking, swallowing, eating within 2 weeks. At first pureed food but now I can eat proper meals. Yesterday ( 8 weeks later) I had a green bean and lamb and tomato casserole with sweet mashed potato. Today I had a quickie tea, baked beans on toast with 2 poached eggs on top.  I have two little grumbles, I have started to bite my inside mouth towards the back teeth, a piece of the cheek has started to get between my teeth if I'm not careful, also my mouth is weak one side. I went to my doc today he suggested getting a shield made to wear at night in bed so I dont bite myself and after the rad he will get me an appointment for a bit of cosmetic work, for the mouth if it doesn't strengthen. Dr Potter who did the  surgery to the tongue  said it should be hardly noticable in 6 months. He's a cosmetic surgeon. The neck dissection was done by Dr Silva (both mentioned doing the research above). I'm lucky as this was  done by the National Health Service free, all my medical procedures are free, dentist, docs prescriptions etc. I'm a senior so I dont pay for prescriptions any more. For younger people they are about £8 a prescription but the hospitals etc are free.  If I lived in the states I wouldn't be able to afford insurance, one of the reasons I dont stay more than a month with my sister in Florida, she'd love me to move there.

braymack
Posts: 7
Joined: Oct 2009

I'm glad to hear you've had a good experience with this surgery.  I am having it done myself in a couple of weeks.  I have two failed attempts at local flaps from my palate and I'm hoping this third surgery is a sucess. 

Rachsavagesam
Posts: 5
Joined: Aug 2017

Hi.  I am new to this group.  I have received a famm flap and am not to happy.  I received it January 2017.  I am still on a liquid diet.  I have seen several dentists to try to get my bottom partial in.  None of them could help me because my famm flap has been sewn in the area where a tooth would have resided.   In other words, some of my cheek has been sewn where a tooth should be.  so now my bottom partial cannot go in my mouth for it can't fit because the cheek muscle is there.  And you cannot put the partial on top of the cheek muscle.   In other words I have no space (vestibule) or gum line.  Plus they sewed the cheek so tight upward the gum lines are pulled up.  And on the inside top of the mouth they sewed it so tightly over my upper dental implants.  it's driving me crazy.   No room for a tooth brush.   The left side of my face is numb.  I have a electric shooting feeling at the corner of the left mouth.  You can see two little bulges at the corner of left mouth.   There are so many sensations I feel like it is driving me mad.  There is a vacumm like suction feeling going on.  So many feelings.   Even eating puree food is frustrating for the food has to be dug out of the mouth.  I have on back tooth that is buried under cheek skin.  I am constantly biting my new tongue and cheek s.  And now on my left side of my outer face I have 3 long lines...like wrinkles.   So now I am walking around making facial faces to get some relief.   Along with front and some bottom teeth missing.  And one side of the face looking wrinkled but actually it is being stretched downwards and upwards because how they sewed it.  Furthermore,  they were to remove the flap (pedicle) in 3 weeks but left it in for 3 MONTHS.   I was told the flap was to be rotated but it was bunched.  They told me to remove the flap I would have to be put back to sleep.  It was right after the flap came out everything got worse.  Doctors told me beforehand that I would have no problems with my cheeks or dentures. 

Now these doctors have really gave me the run around.  Oh in my first surgery they knocked out two of my upper implants.  Two teeth fell out.  And they gave me medication which they were not suppose to.  They gave me ritalin a upper with Dialude.   I complained in the hospital. ...Finally a staff member looked into it.  Was a frightening experience to communicate your needs by pen and paper....and one nurse taking your pen and paper away because it was irritating her.  I had to because I knew they were giving me the wrong meds.

So now I don't know what to do.  These sensations in the mouth are making me crazy.

Note  the surgery to have famm flap was on January 10th 2017.  I has to have the flap removed February 6th 2017 but they did not do it for they said I needed to be put to sleep.  So the flap was removed in April 11th 2o17  Now August 31 2017 and I am frustrated and can't take the sensations and on liquids for food.

 

Any advise would be appreciated.

,

rsp
Posts: 95
Joined: Feb 2017

Hi,

You are adding to a post from 2014.  You may want to start a new post (just go to the main page and click on ADD A NEW POST at the top).  I am sure you will get more responses.

I am a caregiver to my husband.  He hasn't had any of the problems you mentioned, so I am sorry I can't help you.

Best of luck.

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