Facial artery musculomucosal flap for reconstruction of skull base defects: A cadaveric study
Identifieur interne : 006D44 ( Istex/Corpus ); précédent : 006D43; suivant : 006D45Facial artery musculomucosal flap for reconstruction of skull base defects: A cadaveric study
Auteurs : Liyue Xie ; François Lavigne ; Akram Rahal ; Sami Pierre Moubayed ; Tareck AyadSource :
- The Laryngoscope [ 0023-852X ] ; 2013-08.
English descriptors
- KwdEn :
- August, Cadaveric, Cadaveric study, Carrau, Color figure, Complete coverage, Defect, Distal famm, Donor site, Endocranial view, Endoscopic, Endoscopic skull base reconstruction, Endoscopic view, Ethmoid areas, Ethmoidalis, Extension length, Facial, Facial artery, Facial artery musculomucosal flap, Facial vein, Famm, Famm flap, Famm flaps, Fascia, Flap, Flaps, Fovea, Fovea ethmoidalis, Frontal sinus, Harvesting technique, Inferior border, Inlay layer, Laryngoscope, Mandibular, Mandibular periosteum, Marginal mandibular branch, Masseter, Masseter muscle, Masseteric fascia, Maxillary, Maxillary sinus, Middle turbinate, Musculomucosal, Nasal cavity, Nasoseptal, Nasoseptal flap, Online issue, Oral maxillofac surg, Pedicle, Pedicled, Periosteum, Periosteum extension, Planum sphenoidale, Plast, Plast reconstr surg, Plast surg, Sella, Sella turcica, Sinus, Skull, Skull base, Skull base defects, Skull base reconstruction, Superiorly, Surface area, Surg, Traditional famm flap, Turbinate, Turcica.
- Teeft :
- August, Cadaveric, Cadaveric study, Carrau, Color figure, Complete coverage, Defect, Distal famm, Donor site, Endocranial view, Endoscopic, Endoscopic skull base reconstruction, Endoscopic view, Ethmoid areas, Ethmoidalis, Extension length, Facial, Facial artery, Facial artery musculomucosal flap, Facial vein, Famm, Famm flap, Famm flaps, Fascia, Flap, Flaps, Fovea, Fovea ethmoidalis, Frontal sinus, Harvesting technique, Inferior border, Inlay layer, Laryngoscope, Mandibular, Mandibular periosteum, Marginal mandibular branch, Masseter, Masseter muscle, Masseteric fascia, Maxillary, Maxillary sinus, Middle turbinate, Musculomucosal, Nasal cavity, Nasoseptal, Nasoseptal flap, Online issue, Oral maxillofac surg, Pedicle, Pedicled, Periosteum, Periosteum extension, Planum sphenoidale, Plast, Plast reconstr surg, Plast surg, Sella, Sella turcica, Sinus, Skull, Skull base, Skull base defects, Skull base reconstruction, Superiorly, Surface area, Surg, Traditional famm flap, Turbinate, Turcica.
Abstract
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.
Url:
DOI: 10.1002/lary.23939
Links to Exploration step
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<front><div type="abstract">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.</div>
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<affiliation><orgName>Department of Otolaryngology–Head and Neck Surgery</orgName>
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<address><settlement type="city">Montreal</settlement>
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<affiliation>Send correspondence to Tareck Ayad, MD, FRCSC, Hôpital Notre–Dame, 1560 Sherbrooke Street East, Montreal, Quebec, Canada, H2L 4M1. E‐mail: tareck.ayad@umontreal.ca</affiliation>
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Objectives/Hypothesis
<p>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.</p>
Study Design
<p>Cadaveric study. Feasibility.</p>
Methods
<p>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.</p>
Results
<p>The mean surface area of the modified FAMM flap efficient for reconstruction was 15.90 cm<hi rend="superscript">2</hi>
. 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.</p>
Conclusion
<p>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.</p>
Level of Evidence
<p>N/A. Laryngoscope, 123:1854–1861, 2013</p>
</abstract>
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<correspondenceTo>Send correspondence to Tareck Ayad, MD, FRCSC, Hôpital Notre–Dame, 1560 Sherbrooke Street East, Montreal, Quebec, Canada, H2L 4M1. E‐mail: <email>tareck.ayad@umontreal.ca</email>
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<p>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.</p>
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<p>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.</p>
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<p>The mean surface area of the modified FAMM flap efficient for reconstruction was 15.90 cm<sup>2</sup>
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<p>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.</p>
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<noteGroup><note xml:id="lary23939-note-0001"><p>Presented at the 8th International Conference on Head and Neck Cancer, American Head and Neck Society, Toronto, Ontario, Canada, July 21–25 2012.</p>
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<abstract>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.</abstract>
<abstract>Cadaveric study. Feasibility.</abstract>
<abstract>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.</abstract>
<abstract>The mean surface area of the modified FAMM flap efficient for reconstruction was 15.90 cm2. 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.</abstract>
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<abstract>N/A. Laryngoscope, 123:1854–1861, 2013</abstract>
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