Buccinator myomucosal neurovascular Island flap: anatomic cadaveric study and clinical experience.

Abstract

Background: Utilization of peninsular buccal flaps for primary cleft palate repair is well-documented in the literature. However, there is no report on the application of an island flap for primary cleft palate repair. This study aims to reveal the clinical application of an axial neurovascular propeller buccinator myomucosal flap.

Methods: An anatomical study was performed by injection into the buccal pedicle of twenty-two fresh hemifacial cadavers. Additionally, we analyzed palatal healing and flap outcomes in twenty-five primary cleft palate reconstructions utilizing thirty-six pedicled propeller flaps.

Results: Cadaver study: the mean buccal artery diameter was 1±0.3 mm, the neurovascular pedicle entered the flap 11.4±2.9 mm anterior to the pterygomandibular raphe (1/6 th the length of the flap), and the buccal artery advanced inside the flap as much as 66.8%±6.0% of the total flap length. Clinical experience: all reconstructions were performed using a modified Furlow palatoplasty. Mean age of patients was 15.3 months and mean maximum cleft width was 11.7 mm. Eleven cases utilized bilateral flaps. The flap always reached the contralateral pillar, and the buccal nerve was always preserved. 11.11% flaps (4/36) underwent scar revision, and 5.56% flaps (2/36) were lost. Follow-up period was 11.3 months.

Conclusion: This study suggests the utilization of axial neurovascular pedicled propeller buccinator myomucosal flaps is a safe and reliable option in primary cleft palate reconstruction. Our anatomical dissections and clinical outcomes reveal the consistent and robust nature of buccal neurovascular pedicle, and our modified surgical technique allows for preservation of the buccal nerve.