We read with great interest the technical note by Joseph et al. , concerning the use of a “technical modification to the FAMM flap” in order to reconstruct a post-ablative lingual side defect. This modification consists in the harvest of a buccinator myomucosal island flap pedicled on the facial vessels. The flap is then carried in the neck through a paramandibular passage and finally brought back into the oral cavity through a lingual tunnel. This modification allows the flap’s arc of rotation to be increased and avoids secondary pedicle section. Joseph et al. called this modified flap an “islanded FAMM flap”.
We would like to congratulate the authors for reporting this technique, which has been developed and performed routinely in over 100 patients in our department since 2005. A description of the flap harvesting technique and the results of several studies performed by our group have been published previously . We named this flap the tunnelized facial artery myomucosal island flap (t-FAMMIF).
Ayad and Xie , in an extensive review on the myomucosal flap that was cited by Joseph et al. , certified our authorship of the t-FAMMIF, reporting the references to our works and an image of flap harvesting. We were somewhat surprised that the article by Joseph et al. refers to “propose a technical modification to the FAMM flap” that has already been described, and also to find that our papers were not cited in their references list. Their flap harvesting technique is absolutely identical to the technique that we have presented previously , and its application to tongue reconstruction, an area in which we have gained experience with more than 40 cases, was described in 2013 .
Nevertheless, we agree with Joseph et al. that this flap could serve as an excellent local flap for the reconstruction of small to medium-sized oropharyngeal defects, as we have concluded previously . Myomucosal flaps maintain mucous secretion and sensitivity, facilitating the rehabilitation of oral function and guaranteeing the like-with-like reconstruction principle. Furthermore, the tunnelization technique allows the rotation arc of the flap to be increased so that it can adequately reconstruct virtually any area of the oral cavity and pharynx. Concerning tongue reconstruction, in our opinion the t-FAMMIF represents the first-choice reconstructive option, while free flaps remain a suitable choice only in the case of pull-through hemiglossectomy, total glossectomy, or evidence of neck metastases.
We are, in fact, in the process of publishing the results of a large series study involving the functional assessment of myomucosal flaps in order to emphasize the quality of this type of reconstruction and promote its more widespread use.
For this reason, we encourage these and other authors to report their results on the use of this technique in larger series in order to widen its application in oral cavity soft tissue reconstructions.