Download PDF
J Neurol Surg Rep 2016; 77(02): e98-e101
DOI: 10.1055/s-0036-1579630
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Modified Facial Artery Musculomucosal Flap for Reconstruction of Posterior Skull Base Defects

Liyue Xie
1   Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, CHUM-Hôpital Notre-Dame, Montreal, Quebec, Canada
2   Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
,
Philippe Lavigne
1   Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, CHUM-Hôpital Notre-Dame, Montreal, Quebec, Canada
2   Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
,
François Lavigne
1   Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, CHUM-Hôpital Notre-Dame, Montreal, Quebec, Canada
,
Tareck Ayad
1   Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, CHUM-Hôpital Notre-Dame, Montreal, Quebec, Canada
2   Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
› Author Affiliations
Further Information

Publication History

15 July 2015

30 December 2015

Publication Date:
20 June 2016 (online)

Also available at
   Permissions and Reprints

Abstract

Objectives The superiorly pedicled facial artery musculomucosal (FAMM) flap has been successfully used for reconstruction of head and neck defects since 1992. Common sites of defects include the oral cavity and oropharynx. This article presents a clinical case in which we have successfully used a newly developed modification of the FAMM flap for bulky nasopharyngeal and skull base reconstruction.

Results Our patient is a 71-year-old man who presented with a large parapharyngeal and clival chordoma. After tumor removal through combined endoscopic and cervical approach, the internal carotid artery (ICA) in the nasopharyngeal portion was left exposed. A modified superiorly based FAMM flap measuring up to 10 cm in length and 2.5 cm in width was successfully harvested and used to completely cover the defect and the ICA. The flap survived local radiation therapy at the long-term follow-up.

Conclusion We have developed a new modification of the FAMM flap, using the fascia of the masseter muscle. This is the first reported case in the literature using a modified FAMM flap for the reconstruction of nasopharyngeal and skull base defect.

Keywords

skull base - reconstruction - facial artery musculomucosal flap - chordoma
 

  • References

  • 1 Pribaz J, Stephens W, Crespo L, Gifford G. A new intraoral flap: facial artery musculomucosal (FAMM) flap. Plast Reconstr Surg 1992; 90 (3) 421-429
    CrossrefPubMedSearch in Google Scholar
  • 2 Ayad T, Kolb F, De Monès E, Mamelle G, Tan HK, Temam S. [The musculo-mucosal facial artery flap: harvesting technique and indications]. Ann Chir Plast Esthet 2008; 53 (6) 487-494
    CrossrefPubMedSearch in Google Scholar
  • 3 Dolderer JH, Hussey AJ, Morrison WA. Extension of the facial artery musculomucosal flap to reconstruct a defect of the soft palate. J Plast Surg Hand Surg 2011; 45 (4–5) 208-211
    CrossrefPubMedSearch in Google Scholar
  • 4 Massarelli O, Gobbi R, Raho MT, Tullio A. Three-dimensional primary reconstruction of anterior mouth floor and ventral tongue using the ‘trilobed’ buccinator myomucosal island flap. Int J Oral Maxillofac Surg 2008; 37 (10) 917-922
    CrossrefPubMedSearch in Google Scholar
  • 5 Xie L, Lavigne F, Rahal A, Moubayed SP, Ayad T. Facial artery musculomucosal flap for reconstruction of skull base defects: a cadaveric study. Laryngoscope 2013; 123 (8) 1854-1861
    CrossrefPubMedSearch in Google Scholar
  • 6 Hadad G, Bassagasteguy L, Carrau RL , et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
    CrossrefPubMedSearch in Google Scholar