The Buccal Myomucosal Flap for Reconstruction of the Oral Cavity Cancers

Objective: We aimed to review our data about the functional outcomes of the buccinator myomucosal flap used for head and neck reconstruction after oncologic ablative surgery. Methods: Retrospective chart analysis was performed of 15 patients between the ages 52 and 78 years (mean age 66 years) who had buccinator myomucosal flaps for oral cavity reconstruction after tumor ablation. All the resections and reconstructions were performed by the first author (BK) at two tertiary referral centers. The demographic feature of the patients, anatomical subsites of the cancer, operation type, flap raising time, total operation time, blood loss during flap harvesting, wound problems and other postoperative complications, decannulation time and postoperative oral feeding time were collected from the patients` medical charts. Results: One patient had minimal distal flap loss. There was no need for additional surgery for this patient. Two patients had partial wound dehiscence, which was resutured in the operating theatre. The donor sites were closed primarily in all cases. One of the patients had wound dehiscence in donor site which healed by secondary intention. Mean flap size was 7x3.2 cm. All flaps needed a second operation for pedicle separation due to the pedicled flap nature. All separations of pedicles were performed using sedation and adequate analgesia in operating theatre without general anesthesia. Mean separation time was 12 days after the first surgery. Three patients had tracheostomy and the mean decannulation time was three days for those. Soft diet was started in the postoperative 2nd day in all patients. However, mean postoperative oral feeding time without any nasogastric tube assistance was five (3–9 days) days. Mean flap harvesting time was 35 minutes (25–49 minutes). Mean intraoperative blood loss during flap harvesting was 25 ml (20–40 ml). Conclusion: Buccinator myomucosal flap should be in the armamentarium of every head and neck surgeon for oral cavity reconstruction.

Oral Kavite Tümörlerinde Rekonstrüktif Amaçlı Bukkal Miyomukozal Flep Kullanımı

Amaç: Kliniğimizde oral kavite kanseri nedeni ile cerrahi yapılan ve rekonstrüksiyonda bukkal miyomukozal flep kullanılan hastaların dosya kayıtları incelenerek flebin fonksiyonel sonuçları incelendi. Gereç ve Yöntem: Kliniğimizde 2016 Temmuz–2020 Şubat dönemi içerisinde oral kavite skuamöz hücreli kanseri nedeni ile ameliyat edilen ve bukkal miyomukozal flep rekonstrüksiyonu yapılan 15 hastanın dosya kayıtları incelendi. Hastaların demografik özellikleri, tümörün yerleşim yeri ve evresi, flebin hazırlanma süresi, flebe bağlı intraoperatif kanama miktarı ameliyat sonrası yaşanılan komplikasyonlar, varsa dekanülasyon süreleri, nazogastrik sonda ile yardım olmaksızın oral beslenme süreleri kayıtlarda araştırıldı. Bulgular: Hastalarımızın yaş ortalaması 66 idi (dağılım, 52–78 yıl). On beş hastanın 13’ü erkek ikisi kadın idi. Oral kavite tümörlerinin 11’i dil, ikisi ağız tabanı ve ikisi de sert damak kaynaklı idi. Ortalama flep uzunluğu 7x3.2 cm idi. Üç hastaya trakeostomi açıldı ve hepsi ameliyat sonrası üçüncü günde dekanüle edildi. Tüm hastalara ameliyat sonrası ikinci günde yumuşak diyet başlandı. Ameliyat sonrası ortalama beşinci günde hastalar nazogastrik sonda yardımı olmaksızın beslenmeye başlandı. Flep kaldırma süresi ortalama 35 dakika (25–49 dakika) idi. Ortalama kanama miktarı 25 ml (20–40 ml) idi. İki hastada flepte parsiyel yara yeri açılması ve bir hastada parsiyel kısmı flep kaybı gözlendi. Sonuç: Bu bulgular ışığında bukkal miyomukozal flep özellikle oral kavite kanser defektlerinin rekonstrüksiyonunda baş boyun cerrahlarının akılda tutması gereken seçeneklerden birisidir. Flebin primer cerrahi sahada olması, teknik olarak hızlı ve basit hazırlanabilmesi avantajları pediküllü bir flep olması nedeni ile yaklaşık iki hafta sonra pedikülünün kesilmesinin gerekliliği dezavantajları içerisinde sayılabilir.

Kaynakça

1. Bozola AR, Gasques JA, Carriquiry CE, Cardoso de Oliveira M. The buccinator musculomucosal flap: anatomic study and clinical application. Plast Reconstr Surg 1989;84:250–7.

2. Carstens MH, Stofman GM, Hurwitz DJ, Futrell JW, Patterson GT, Sotereanos GC. The buccinator myomucosal island pedicle flap: anatomic study and case report. Plast Reconstr Surg 1991;88:39–52.

3. Szeto C, Yoo J, Busato GM, Franklin J, Fung K, Nichols A. The buccinator flap: a review of current clinical applications. Curr Opin Otolaryngol Head Neck Surg 2011;19:257–62.

4. Zhao Z, Zhang Z, Li Y, Li S, Xiao S, Fan X, et al. The buccinator musculomucosal island flap for partial tongue reconstruction. J Am Coll Surg 2003;196:753–60.

5. Woo SH, Jeong HS, Kim JP, Park JJ, Ryu J, Baek CH. Buccinator myomucosal flap for reconstruction of glossectomy defects. Otolaryngol Head Neck Surg 2013;149:226–31.

6. Van Lierop AC, Fagan JJ. Buccinator myomucosal flap: clinical results and review of anatomy, surgical technique and applications. J Laryngol Otol 2008;122:181–7.

7. Rahpeyma A, Khajehahmadi S. The posterior-based buccinator myomucosal flap (Bozola’s flap). Eur Ann Otorhinolaryngol Head Neck Dis 2017;134:293–4.

8. Bardazzi A, Beltramini GA, Autelitano L, Bazzacchi R, Rabbiosi D, Pedrazzoli M, et al. Use of Buccinator Myomucosal Flap in Tongue Reconstruction. J Craniofac Surg 2017;28:1084–7.

9. Ahn D, Lee GJ, Sohn JH. Reconstruction of oral cavity defect using versatile buccinator myomucosal flaps in the treatment of cT2-3, N0 oral cavity squamous cell carcinoma: Feasibility, morbidity, and functional/oncological outcomes. Oral Oncol 2017;75:95–9.

Kaynak Göster

Southern Clinics of Istanbul Eurasia
  • ISSN: 2587-0998
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2017

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