Pedicled facial buccinator (FAB) flap: A new flap for reconstruction of skull base defects

Abstract

The transposition of pedicled buccinator muscle flaps with and without mucosa into the nasal cavity could reach the anterior skull base and planum sphenoidale, if the appropriate surgical technique is used. The pedicled Facial Buccinator Flap holds significant potential as a reconstructive alternative for a variety of skull base defects, alone or in combination with existing reconstructive options. 2010.

Pedicled Extranasal Flaps in Skull Base Reconstruction

“…The pedicled facial buccinator flap (FAB) was recently described by Rivera-Serrano and colleagues [16]. This flap, as its name suggests, is pedicled upon the facial artery after it branches off the external carotid artery.…”

“…This flap, as its name suggests, is pedicled upon the facial artery after it branches off the external carotid artery. In cadaveric studies, the FAB had a length of 7–8cm from pedicle to tip and was able to reach the anterior skull base and planum sphenoidale [16]. Its size is limited by anatomical considerations in the area of harvest.…”

“…Its size is limited by anatomical considerations in the area of harvest. The parotid duct orifice creates a superior limit, although by extending the flap in an “L” or “Boot” configuration around this landmark, the potential size is increased [16]. …”

“…When mucosa is used, it becomes necessary to rotate the flap 180 degrees in order to place the mucosal surface within the nasal cavity [16]. Thus, the authors suggest that the FAMB flap is preferable for skull base reconstruction due to the potential for venous obstruction secondary to this rotation [16]. For either option, transposition of the FAB flap takes place through a maxillary window.…”

Endoscopic Resection of Sinonasal Malignancies

“…The authors considered the introduction of this flap as a major breakthrough for repair of cranial base defects, since it was associated with a significant decrease of postoperative CSF leak at a rate lower than 5% [25]. More recently, other pedicled flaps such as transfrontal pericranial flap [26], transpterygoid temporoparietal fascia flap [27], inferior turbinate flap [28], middle turbinate flap [29], palatal flap [30], and buccinator myo/myomucosal flap [31] have been added to the surgical armamentarium. However, some of these flaps are not viable in sinonasal malignancies either for oncologic reasons or for the sequelae of a previous surgery.…”