Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jul;42(4):453-60.
doi: 10.5999/aps.2015.42.4.453. Epub 2015 Jul 14.

Lateral Oropharyngeal Wall Coverage with Buccinator Myomucosal and Buccal Fat Pad Flaps

Bok Ki Jung  1 , Seung Yong Song  1 , Se-Heon Kim  2 , Young Seok Kim  3 , Won Jai Lee  1 , Jong Won Hong  1 , Tai Suk Roh  3 , Dae Hyun Lew  1
Affiliations

Lateral Oropharyngeal Wall Coverage with Buccinator Myomucosal and Buccal Fat Pad Flaps

Bok Ki Jung et al. Arch Plast Surg. 2015 Jul.

Abstract

Background: Reconstruction of oropharyngeal defects after resection of oropharyngeal cancer is a significant challenge. The purpose of this study is to introduce reconstruction using a combination of a buccinator myomucosal flap and a buccal fat pad flap after cancer excision and to discuss the associated anatomy, surgical procedure, and clinical applications.

Methods: In our study, a combination of a buccinator myomucosal flap with a buccal fat pad flap was utilized for reconstruction after resection of oropharyngeal cancer, performed between 2013 and 2015. After oropharyngectomy, the defect with exposed vital structures was noted. A buccinator myomucosal flap was designed and elevated after an assessment of the flap pedicle. Without requiring an additional procedure, a buccal fat pad flap was easily harvested in the same field and gently pulled to obtain sufficient volume. The flaps were rotated and covered the defect. In addition, using cadaver dissections, we investigated the feasibility of transposing the flaps into the lateral oropharyngeal defect.

Results: The reconstruction was performed in patients with squamous cell carcinoma. The largest tumor size was 5 cm×2 cm (length×width). All donor sites were closed primarily. The flaps were completely epithelialized after four weeks, and the patients were followed up for at least six months. There were no flap failures or postoperative wound complications. All patients were without dietary restrictions, and no patient had problems related to mouth opening, swallowing, or speech.

Conclusions: A buccinator myomucosal flap with a buccal fat pad flap is a reliable and valuable option in the reconstruction of oropharyngeal defects after cancer resection for maintaining functionality.

Keywords: Oropharyngeal neoplasms; Reconstructive surgical procedures; Surgical flap.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Case 1
A 32-year-old woman presented squamous cell carcinoma (T2N2M0) of the left tonsil: (A, B) a oropharyngeal defect after lateral oropharyngectomy, (C) flap design, (D) elevation of the flap, and (E, F) immediate postoperative view.
Fig. 2
Fig. 2. Postoperative intraoral view
The entire surface of the flap was completely re-epithelialized, and no infection or flap resorption was observed after ten months of follow-up.
Fig. 3
Fig. 3. Anatomy of facial vessels and buccal fat pad
(A) Facial artery and vein, and (B) buccal fat pad is sufficiently large to cover the lateral oropharyngeal cavity.
Fig. 4
Fig. 4. The elevation of flaps in the cadaver
(A) Intraoral incision: the muscle fiber of the buccinator flap was noted, (B) elevation of the buccinator myomucosal flap, (C) elevation of the buccal fat pad flap, and (D, E) extent of the buccinator myomucosal flap and the buccal fat pad flap.
See this image and copyright information in PMC

References

    1. Park YM, Lee JG, Lee WS, et al. Feasibility of transoral lateral oropharyngectomy using a robotic surgical system for tonsillar cancer. Oral Oncol. 2009;45:e62–e66. - PubMed
    1. Pollei TR, Hinni ML, Moore EJ, et al. Analysis of postoperative bleeding and risk factors in transoral surgery of the oropharynx. JAMA Otolaryngol Head Neck Surg. 2013;139:1212–1218. - PubMed
    1. Squaquara R, Kim Evans KF, Spanio di Spilimbergo S, et al. Intraoral reconstruction using local and regional flaps. Semin Plast Surg. 2010;24:198–211. - PMC - PubMed
    1. Szeto C, Yoo J, Busato GM, et al. The buccinator flap: a review of current clinical applications. Curr Opin Otolaryngol Head Neck Surg. 2011;19:257–262. - PubMed
    1. Van Lierop AC, Fagan JJ. Buccinator myomucosal flap: clinical results and review of anatomy, surgical technique and applications. J Laryngol Otol. 2008;122:181–187. - PubMed