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Facial Artery Musculomucosal Flap for Reconstruction of Partial Glossectomy Defects
Tommaso Addona1, John Layliev, M.D.2, Douglas Frank, M.D.2, Benjamin Saltman, M.D.2, Matthew Kilgo, M.D.1, Thomas A. Davenport, M.D.1.
1Long Island Plastic Surgical Group, P.C., Garden City, NY, NY, USA, 2Long Island Jewish Medical Center, New Hyde Park, NY, NY, USA.
BACKGROUND:The Facial Artery Musculomucosal (FAMM) flap has been used to reconstruct various intraoral and nasal defects. Small defects of the tongue traditionally are repaired by primary closure or skin grafting while free tissue transfer is utilized to reconstruct larger defects. We present the use of the FAMM flap for tongue reconstruction of defects less than 1/3 the size of the tongue to prevent tongue tethering associated with primary closure and skin graft.
METHODS:We reviewed the charts of all patients who had a FAMM flap procedure to reconstruct tongue in a one year period. Outcomes measured included operative time for reconstruction, status of the flap, postoperative complications, length of hospital stay, and functional results. Subjective functional results included tongue mobility, speech, and swallowing. Objective postoperative modified barium swallow study reports were also noted.
RESULTS:Ten patients underwent FAMM flap reconstruction following hemiglossectomy for squamous cell carcinoma. Tumor stages ranged from T1N0 to T3N1. Tongue defects ranged in size from 2.7 x 1.5 x 0.4 cm to as large as 8 x 4 x 2 cm. A proximally-based FAMM flap was utilized and other areas covered included the floor of mouth and alveolar ridge. All flaps had complete survival. Mean hospital stay was 6 days. Mean operative time for reconstruction was 1 hour and 43 minutes. All patients tolerated a regular diet with a mean postoperative follow up of 16 weeks and had good subjective speech and normal swallow as documented by swallow studies.
CONCLUSIONS:The FAMM flap has utility for the reconstruction of small to moderate size tongue. Traditional primary closure or skin graft reconstruction may be inadequate, resulting in tongue tethering and poor functional outcome. Free flap reconstruction for medium sized defects may be more than is required. The FAMM represents a good reconstructive alternative in these circumstances. Our technique and data is the first to explore the utility of this flap and early functional data suggests its safety and efficacy.
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