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Facial artery musculomucosal flap for reconstruction of skull base defects: A cadaveric study

Authors

  • Liyue Xie MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Université de Montréal, Hôpital Notre–Dame, Montreal, Quebec, Canada
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  • François Lavigne MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Université de Montréal, Hôpital Notre–Dame, Montreal, Quebec, Canada
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  • Akram Rahal MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Université de Montréal, Hôpital Maisonneuve–Rosemont, Montreal, Quebec, Canada
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  • Sami Pierre Moubayed MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Université de Montréal, Hôpital Notre–Dame, Montreal, Quebec, Canada
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  • Tareck Ayad MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Université de Montréal, Hôpital Maisonneuve–Rosemont, Montreal, Quebec, Canada
    • Department of Otolaryngology–Head and Neck Surgery, Université de Montréal, Hôpital Notre–Dame, Montreal, Quebec, Canada
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  • Presented at the 8th International Conference on Head and Neck Cancer, American Head and Neck Society, Toronto, Ontario, Canada, July 21–25 2012.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

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

Abstract

Objectives/Hypothesis

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.

Study Design

Cadaveric study. Feasibility.

Methods

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.

Results

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.

Conclusion

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.

Level of Evidence

N/A. Laryngoscope, 123:1854–1861, 2013

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