Versatility of the buccinator myomucosal flap in atypical palate reconstructions q Diogo Franco a, * , Diógenes Rocha b , Marcio Arnaut Jr. a , Renato Freitas c , Nivaldo Alonso b a Federal University of Rio de Janeiro, Brazil b University of São Paulo, Brazil c Federal University of Paraná, Brazil article info Article history: Paper received 17 November 2013 Accepted 20 March 2014 Keywords: Palate e surgery Palate e anatomy Mouth rehabilitation Mouth e anatomy abstract Initially described for the treatment of cleft palate, the anatomical bases of the buccinator myomucosal flap were described by Bozola et al. (1989). A meticulous search found several reports of its use for the correction of post-palatoplasty oronasal fistulas, with only a few reports of its use for other palate-related pathologies. A retrospective analysis was undertaken of patients treated by the Plastic Surgery Units at the Rio de Janeiro Federal University Hospital (HU-UFRJ) and the São Paulo University Hospital (HC-USP), suffering from palatal lesions not associated with a cleft palate and treated through the use of buccinator myo- mucosal flaps. The average age was 47 years, with 70% of the patients being male. Assorted aetiologies were noted for palatal defects. When there was significant damage to the soft palate, a superior base pharyngeal flap was used. Of this total, in 71% of the cases only the buccinator myomucosal flap was used. In all cases, the flaps were unilateral, adequately covering the defects in question. The buccinator myomucosal flap is a good option for reconstructing medium to large palate defects, as it is a flap with good vascularization and dimension, in addition to an ample arc of rotation, with primary closure of the donor site, without adding significant morbidity. Ó 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. 1. Introduction The buccinator myomucosal flap was initially described for the treatment of cleft palates (Kaplan, 1975), with its anatomical basis described by Bozola et al. (1989). Its use for closing cleft palates and addressing their sequelae is well known and has proven a good option for fistula correction (Nakakita et al., 1990). It is commonly used alone for construction of the oral cavity and nasal lining, and may also be associated with other flaps when reconstruction is needed on other planes. However, other diseases may develop or require larger palatal tissue resections, culminating in the formation of oronasal fistulas that require atypical reconstruction of damaged areas. In these cases, knowledge and familiarity of the harvesting and use of the buccinator myomucosal flap may contribute to obtaining satisfactory outcomes. Anatomical considerations and operating technique The principal posterior vascularization of the buccinator muscle is through the buccal artery (branch of the facial artery), pene- trating the muscle close to its origin, some 0.2 cm anterior and lateral to the pterygomandibular raphe. There is also reverse flow vascularization through branches of the facial artery that pene- trates the muscle through its anterior portion. The anatomical parameters for the dissection of the buccinator myomucosal flap are the corner of the mouth (anterior), the parotid duct outlet (superior) and the pterygomandibular raphe (poste- rior). Its width must allow the primary closure of the donor site. In adult patients, this flap usually measures around 2.5 cm in width and 6.5 cm in length (Fig. 1A). The flap is normally fusiform and is dissected from the corner of the mouth in a posterior direction. After the incision into the q Study performed at: Federal University of Rio de Janeiro, University of São Paulo and Federal University of Paraná. * Corresponding author. Rua Ramon Franco, 98 e Urca, CEP 22290-290 Rio de Janeiro, RJ, Brazil. Tel./fax: þ55 21 22954635. E-mail address: contato@diogofranco.com (D. Franco). Contents lists available at ScienceDirect Journal of Cranio-Maxillo-Facial Surgery journal homepage: www.jcmfs.com http://dx.doi.org/10.1016/j.jcms.2014.03.016 1010-5182/Ó 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. Journal of Cranio-Maxillo-Facial Surgery xxx (2014) 1e5 Please cite this article in press as: Franco D, et al., Versatility of the buccinator myomucosal flap in atypical palate reconstructions, Journal of Cranio-Maxillo-Facial Surgery (2014), http://dx.doi.org/10.1016/j.jcms.2014.03.016