Mucosal Facial Perforosome: An Ideal Flap Donor Site for Oral Cavity and Oropharynx Reconstruction?

Background. Oropharyngeal reconstruction after ablative surgery is a difficult challenge. Sensory recovery of the oral cavity and oropharyngeal mucosa should be one of the primary aims of reconstructive surgery in patients with post-traumatic or post-ablative defects. Mucosal sensitivity plays a key role in vital functions such as chewing, swallowing and speech, which impairment strongly affects the patient’s QoL (1). The ideal reconstruction should be accomplished with the same or similar type of tissue as the original one. Buccinator myomucosal flaps, based either on the facial or buccal artery, seem to conform to this premise, because they carry a thin, mobile, well vascularized, and sensitive tissue, like the one excised or lost (2). Materials and Methods. In an experience of over 150 buccinator myomucosal flaps, a retrospective study on 23 patients, who underwent total or sub-total soft palate reconstructions with Facial Artery Myo Mucosal Islad Flaps (FAMMIF) (3) between 2008 and 2016, has been performed. We reviewed flaps type and size, harvesting time and postoperative complications. Patients underwent a standardized test assessing sensitivity recovery, deglutition, quality of life and donor site morbidity, at least 6 months after surgery or the end of adjuvant therapy, if performed (4). Results. All the flaps, raised on mucosal facial perforosome (5), were transposed successfully. Only minor donor - or recipient site complications occurred. Sensitivity assessment showed that touch, two-point and pain sensations were recovered in all of the patients. Significant differences, between the flap and the native mucosa, were reported for tactile (p=0.004), pain (p=0.001) and two-point (p=0.001) thresholds. Average deglutition score reported was 6.1/7 with only minimal deglutition complaints. Quality of life assessment showed high physical (24.6/28), social (25/28), emotional (19.1/24) and functional (24.6/28) scores. In all cases, no donor-site complications were noted with an average score of 8.1/9 . Conclusions. Facial artery myomucosal island flaps, harvested on a mucosal facial perforosome, represent a valuable functional oropharyngeal reconstructive option, which requires a short operating time and presents a low rate of donor site morbidity. REFERENCES 1. Kapur K, Garret N, Fischer E. Effects of oral anesthesia on food manipulation during mastication. Arch Oral Biol. 1990;36:397-403 2. Massarelli O, Baj A, Gobbi R et al. Cheek mucosa: a versatile donor site of myomucosal flaps. Technical and functional considerations. Head Neck 2012;35:109-117 3. Massarelli O, Vaira LA, Figlio A et al. Rational and simplified nomenclature for buccinator myomucosal flaps. Oral and Maxillofacial Surgery 2017; 40, 427–434. 4. Massarelli O, Vaira LA, Biglio a et al. Sensory recovery of myomucosal flap oral cavity reconstruction. Head Neck. 2018 Mar;40(3):467-474. 5. Coronel-Banda ME, Serra-Renom JM, Lorente M et al. Cheek mucosa territories perfused by perforators from the facial artery. Int. J. Oral Maxillofac. Surg. 2015; 44: 29–33