No funding support was required for the completion of this manuscript.
Article first published online: 7 SEP 2010
Copyright © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 120, Issue 10, pages 1922–1930, October 2010
How to Cite
Rivera-Serrano, C. M., Oliver, C. L., Sok, J., Prevedello, D. M., Gardner, P., Snyderman, C. H., Kassam, A. B. and Carrau, R. L. (2010), Pedicled facial buccinator (FAB) flap: A new flap for reconstruction of skull base defects. The Laryngoscope, 120: 1922–1930. doi: 10.1002/lary.21049
None of the authors have financial interests in companies or other entities that have an interest in the information in the contribution.
The authors have no conflicts of interest.
This material has never been published and is not currently under evaluation in any other peer-reviewed publication. This material was submitted to the Triological Society for presentation at the Eastern Sectional Meeting 2010.
- Issue published online: 7 JUL 2010
- Article first published online: 7 SEP 2010
- Accepted manuscript online: 19 AUG 2010 12:00AM EST
- Manuscript Accepted: 4 MAR 2010
- Cranial base;
- facial plastics/reconstructive surgery;
- head and neck;
- Level of Evidence: 4.
The expansion of endoscopic endonasal skull base surgery has resulted in an increased demand for reconstructive options. Reconstruction with vascularized tissue has proven indispensable for reliably separating the cranial contents from the paranasal sinuses following extended endoscopic endonasal approaches (EEA). The introduction of the Hadad-Bassagasteguy flap (vascular pedicle nasoseptal flap, HBF) at our institution decreased our postoperative cerebral spinal fluid (CSF) leak rates from more than 20% to less than 5%. The HBF is not always available, as the nasoseptal area or its vascular supply can be compromised by tumor or prior surgery. In an attempt to keep pace with rapidly expanding reconstructive requirements, we present the anatomic and cadaveric foundations for novel modifications of the facial artery musculo (-mucosal) (FAM[M]) and buccinator flaps to allow vascularized reconstruction of the skull base.
Feasibility. Cadaveric study.
Using cadaver dissections and measurements, we investigated the feasibility of transposing pedicled buccinator myo/myomucosal flaps into the nasal cavity and skull base. Both muscular and myomuscular flaps were raised, and techniques for transposition into the nasal cavity were investigated. Three fresh and six preserved human specimens were dissected.
Pedicled facial buccinator flaps with and without mucosa were transposed into the nasal cavity using a variety of maxillary osteotomies. No facial incisions were required. It was demonstrated that the flaps reach the anterior skull base and planum sphenoidale.
The transposition of pedicled buccinator muscle flaps with and without mucosa into the nasal cavity could reach the anterior skull base and planum sphenoidale, if the appropriate surgical technique is used. The pedicled Facial Buccinator Flap holds significant potential as a reconstructive alternative for a variety of skull base defects, alone or in combination with existing reconstructive options. Laryngoscope, 2010