Gileva K.S., Mironova E.A. New method of elimination of secondary localized defects and cicatrical deformations in mouth floor soft tissues and tongue body with the use of FAMM-flap and Permacol xenomembrane. Head and neck = Head and neck. Russian Journal. 2019;7(1):10–18 (in Russian).
The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.
Purpose: to improve the aesthetic and functional results of surgical treatment of patients with secondary localized defects of the tongue body and mouth floor soft tissues using the FAMM flap technique and Permacol xenomembrane. Material and methods. From September 2016 to July 2018, 5 surgical interventions were performed to eliminate cicatricial deformity of the mouth floor and tongue body with the mandibular-lingual groove (MLG) anatomical reconstruction using a FAMM-flap and Permacol xenomembrane. As preoperative preparation, MSCT-angiography of the face and neck vessels with the buccal area and the floor of the mouth tissues perfusion, volumetric assessment of MLG parameters before and after surgery, comparison of the results, and the alginate casts removal were performed. On the 30th day after operation a histological analysis and the examination of the implanted Permacol membrane with subsequent repair processes study were performed.
Results. An original technology for elimination of secondary localized defects on the floor of the mouth and the tongue body was developed using FAMM-flap and Permacol xenomembane. In order to avoid a “pulling leg” defect and mouth opening restriction, a new modification of the FAMM-flap was elaborated, using transverse direction and convenient rotation angle through the retromolar region to the bottom of the oral cavity. According to the results of a volumetric assessment of changes in the MLG parameters, a threefold increase in the width and a fivefold increase in the MLG depth were observed. Morphological analysis on the 30th day showed a multi-layered squamous epithelium (specific for this area) and a strong collagen basis formation. MSCT-angiography of the external carotid artery peripheral branches demonstrated that even in patients who underwent oncoplasty, including microsurgical reconstruction, blood supply of the buccal flap was sufficient.
Conclusions: Functional and aesthetical benefits were achieved due to the cicatricial contracture elimination and the MLG anatomical reconstruction. Pronunciation and saliva evacuation were also improved and obstacles for further dental prosthesis were removed. A combination of factors such as shortened operation time, relatively small donor damage, and blood supply reliability, is an argument in favor of this method choice among the other alternative reconstructive techniques.
Keywords: tumors of the oral cavity, defects of the tongue body and mouth floor soft tissues, FAMM-flap, Permacol xenomembrane