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Intraoral defect coverage with muscle flaps

K D Wolff1, D Dienemann, B Hoffmeister

  • 1Free University of Berlin, Benjamin-Franklin Medical Center, Germany.

Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
|June 1, 1995
PubMed
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Muscle flaps used for intraoral defects undergo significant atrophy but heal well. They are suitable for stable areas like the hard palate but not mobile zones like the tongue.

Area of Science:

  • Oral surgery
  • Microsurgery
  • Tissue engineering

Background:

  • Intraoral defects often require reconstructive surgery.
  • Muscle flaps are a common reconstructive option.
  • The long-term effects of muscle atrophy on flap viability and function are not fully understood.

Purpose of the Study:

  • To investigate the impact of muscle atrophy and lack of covering layer on wound healing after intraoral defect reconstruction using muscle flaps.
  • To evaluate the functional outcomes of intraoral reconstruction with muscle flaps.

Main Methods:

  • Experimental study in Lewis rats involving microsurgical transplantation of muscle flaps without nerve anastomosis.
  • Clinical study using free muscle transplants from various donor sites for intraoral defect coverage.

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  • Histological evaluation of epithelization and assessment of functional outcomes (speech, mobility, chewing, swallowing).

    • Main Results:

    • Experimental muscle flaps showed significant atrophy (67% weight loss, 71% surface area reduction) and myocyte loss after 20 weeks.
    • Clinical muscle flaps exhibited atrophy, leading to restricted mobility in mobile intraoral areas (tongue, floor of mouth, buccal plane).
    • Flaps on stable structures (bone, pharyngeal wall) adapted well, and epithelization occurred within 8 weeks without adverse events like infection or necrosis.

    Conclusions:

    • Muscle flaps undergo substantial atrophy and become cicatricial, reducing flexibility.
    • Despite atrophy, muscle flaps are suitable for reconstruction in the hard palate, alveolar crest, and pharyngeal wall.
    • Mobile intraoral areas (buccal plane, floor of mouth, tongue) are not ideal for muscle flap reconstruction due to potential constriction.