Pedicle length in the inferiorly based buccinator myomucosal island flap: a cadaveric study

Abstract

The inferiorly based buccinator myomucosal island flap is a useful reconstructive option for medium-sized intraoral mucosal defects. The pedicle length of this flap has not yet been determined. Thirteen fresh cadavers (26 sides) with intact faces were studied. An inferiorly based buccinator myomucosal island flap was elevated. Various measurements were taken, including pedicle length, paddle area, and pedicle length after dissection of the facial artery through the submandibular salivary gland; the presence of the facial artery or vein in the pedicle and the number of perforators were also evaluated. The mean pedicle lengths in the right and left sides were 4.8 ± 0.6 cm and 4.9 ± 0.6 cm, respectively. The mean pedicle lengths after dissection of the facial artery through the submandibular salivary gland were 7.8 ± 0.7 cm (right side) and 7.7 ± 0.6 cm (left side). The pedicle contained only the facial artery in six sides. There were two to three perforator branches from the facial artery to the mucosal paddle. Paddle sizes of the flap were in the range of 2.2 × 2.1 cm to 3.5 × 3 cm. This flap is suitable for the reconstruction of the floor of the mouth and tongue. Pedicle length can be increased significantly by dissecting the facial artery through the submandibular salivary gland.

The reconstruction of oral cavity defects has so far remained a challenge. Pedicle flaps are the most common means of overcoming this problem. Many flaps from adjacent regions, such as the temporalis muscle, temporoparietal fascia, cervical platysma, and submentum, have been introduced for this purpose. Selecting an appropriate flap for the reconstruction requires basic information, including paddle area, flap thickness, and pedicle length. The inferiorly based buccinator myomucosal island flap has previously been introduced as a useful flap for intraoral reconstruction, and has been used for medium-sized defects of the floor of the mouth and tongue. To date there are no published data on the pedicle length in this type of flap. Therefore the present study was designed to survey pedicle length in the inferiorly based buccinator myomucosal island flap.

Materials and methods

This study was done on 13 fresh cadavers (26 sides) with intact faces; the study was granted approval by the Iranian Forensic Medicine Ethics Committee. An extraoral incision, 1 cm below and parallel to the mandibular inferior border, was applied and continued for 5 cm. The depression anterior to the masseter muscle was palpated and this area was considered to be the middle of the skin incision. The skin and subcutaneous fat was sharply incised and the platysma muscle was penetrated with a hemostat with great caution in order to preserve the facial artery and vein. The marginal mandibular branch of the facial nerve was protected during this procedure. After identifying these elements, blunt dissection was continued in the fat plane over these vessels towards the zygoma and corner of the mouth. A vertical intraoral incision was applied 1 cm behind the oral commissure. The mucosa and buccinator muscle were sharply incised until the fatty tissue behind the buccinator muscle was exposed ( Fig. 1 ). Blunt dissection in this plane connected the intraoral incision to the previously created subcutaneous tunnel. A second intraoral incision was applied perpendicular to the first incision, 5 mm below the Stensen duct and extended to the pterygomandibular raphe. The third intraoral incision was applied from the end of the second incision, inferiorly, parallel with the first vertical incision. By applying all these incisions, three sides of the flap were incised. The facial artery and vein were cut when the horizontal intraoral incision bellow the Stensen duct (the second intraoral incision) was completed. In order to convert the flap to the island variant with scissors, a blade was placed in the oral cavity and another in the subcutaneous plane, and adjusted under the facial artery and the vein; the fourth incision was then completed.

Fig. 1
Vertical intraoral incision through the buccal mucosa and buccinator muscle.

The following measurements were made and features assessed: (1) Pedicle length: distance from the lower part of the mandibular inferior border to the beginning of the mucosal paddle, in the right and left sides ( Fig. 2 ). (2) Pedicle length after dissection of the facial artery through the submandibular salivary gland, in the right and left sides ( Fig. 3 ). (3) Paddle area (maximum length × width of the mucosal paddle). (4) Presence of facial vein, artery, or both in the tissue behind the mucosal paddle ( Figs. 2 and 3 ). (5) Number of perforators from the facial artery that penetrate the buccinator muscle ( Fig. 4 ).

Jan 19, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Pedicle length in the inferiorly based buccinator myomucosal island flap: a cadaveric study
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