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Facial artery musculomucosal flap for reconstruction of skull base defects: a cadaveric study
Liyue Xie1, François Lavigne, Akram Rahal
1Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada.
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 cm(2) . 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.
Insights
The facial artery musculomucosal (FAMM) flap is a promising alternative for skull base reconstruction, offering a viable option when other methods are unavailable. Modified FAMM flaps provide adequate coverage for defects, enhancing skull base repair possibilities.
Area of Science:
- Otolaryngology
- Neurosurgery
- Plastic Surgery
Background:
- Skull base defects following tumor resection pose risks like meningitis and pneumocephaly.
- The nasoseptal flap is effective for cerebrospinal fluid leak prevention but has limited availability.
- The superiorly pedicled facial artery musculomucosal (FAMM) flap is established for head and neck defect reconstruction.
Purpose of the Study:
- To evaluate the facial artery musculomucosal (FAMM) flap as a novel alternative for skull base reconstruction.
- To assess the feasibility and efficacy of modified FAMM flaps in covering skull base defects.
Main Methods:
- A cadaveric study involving bilateral FAMM flap dissection on thirteen specimens.
- Development of two novel modifications to the traditional FAMM flap.
- Endoscopic skull base dissection and maxillectomy in four specimens to assess flap transfer feasibility.
Main Results:
- Modified FAMM flaps yielded a mean surface area of 15.90 cm² suitable for reconstruction.
- Flaps demonstrated capacity to cover simulated defects in the frontal sinus and fovea ethmoidalis.
- Modifications were essential for tension-free coverage of the planum sphenoidale and sella turcica.
Conclusions:
- The FAMM flap shows significant potential as an alternative vascular flap for skull base reconstruction.
- Modified FAMM flaps may offer improved defect sealing compared to the traditional flap.
- This technique is a potential option when other reconstructive methods are not feasible, though not yet used in patients.
