Myomucosal island flap of the buccinator Muscle: An anatomical study

Abstract

IntroductionDespite its ease of dissection and accessibility, the buccinator muscle has received little attention in the surgical literature as an island flap. This study aimed to clarify the detailed anatomy of the buccinator muscle and the important related structures for planning to use it as a myomucosal island flap. Materials and methodsThe study was carried out on 30 hemifaces from 15 adult cadavers (12 males and 3 females). The cadavers were injected with red latex through the external carotid artery. The buccinator muscle was carefully dissected, and the vessels and nerves reaching its surface, and their origins and points of entry into the muscle were observed. The facial vessels were separated from the superior and inferior labial as well as from the angular branches. Then, the buccinator muscle with its vascular pedicles was delivered alone. The extent of the pedicle was then evaluated for its potential reach. The distance of the vessels and nerves related to the muscle together with the parotid duct was measured in relation to two reference points, the labial commissure (LC) and the upper point of the zygomatic arch (Z) just in front of the auricle, and the dimensions of the muscle were estimated. ResultsThe present study showed that the anterior part of the muscle had an arterial supply from the facial artery and its venous blood drained into the facial vein. The posterior part of the muscle was supplied by the buccal and posterior superior alveolar arteries, and its venous blood drained into the pterygoid venous plexus. The nerve supply of the muscle was through the lower ramus of the buccal branch of the facial nerve. The mandibular rami of the facial nerve were found to lie superficial to the facial vein, but interlacing with the facial artery (superficial, deep, or superficial and deep). From the valuable measurements obtained, the facial artery crossed the reference line (LC-Z) at the meeting of the medial ¼ with the lateral ¾ of that line, and the facial vein was 0.8 cm posterior to the artery. It was also found that the buccinator island pedicle after its harvest reached the upper ends of the trachea and esophagus. In addition, rotation of the pedicle downward and forward until 180° did not form kinks of the pedicle. ConclusionsAccording to the present study, the buccinator island flap is safe, reliable, and provides mucosa; however, it has no sensation or motility.