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Tunnelling Versus Non-tunnelling Techniques in Posterior-based Buccinator Myomucosal Flap Reconstruction - A
Hamdan Saadi Abbas1, Ahmed Omar Mahmoud Abdallah2, Diaa El-Dein Saber Ahmed1
1Department of General Surgery, Maxillofacial Unit, Faculty of Medicine, Assiut University, Assiut, Egypt.
Introduction:
The posterior-based buccinator myomucosal flap is a reliable option for reconstructing posterior oral defects, though pedicle transfer methods vary. This prospective study compared functional outcomes, complications and burden of care between tunnelling and non-tunnelling techniques.
Materials And Methods:
Patients were randomised into Group A (tunnelling, n = 20; single-stage) and Group B (non-tunnelling, n = 20; two-stage). Primary outcomes were flap survival and need for secondary surgery. Secondary outcomes included trismus, oral opening and mobility. Data were analysed using independent t-tests and Fisher's exact test.
Results:
Flap survival was comparable (95% vs. 100%, P = 1.000). However, the non-tunnelling group required a second surgery and had significantly longer hospital stays (4.0 vs. 2.0 days; P = 0.002). At 6 months, the tunnelling group achieved substantially greater maximum oral opening (39 mm vs. 33 mm, P = 0.008), despite higher rates of venous congestion (25% vs. 5%) and trismus (15% vs. 5%).
Discussion:
The tunnelling technique is superior for operative efficiency, offering a single-stage reconstruction that avoids the morbidity and cost of a second operation. While simpler initially, the non-tunnelling technique necessitates a second stage and results in greater long-term limitation of mouth opening.