Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Facial Plast Surg Aesthet Med. 2020 Nov/Dec;22(6):449-455. doi: 10.1089/fpsam.2019.0001. Epub 2020 May 12.
The facial artery musculomucosal (FAMM) flap is a well vascularized axial flap which has been described for mucosal reconstructions throughout the oral cavity. There are limited data regarding its efficacy in secondary repair of nasopharyngeal stenosis and velopharyngeal insufficiency due previous surgery and scar tissue formation. This study seeks to demonstrate the efficacy of FAMM flap procedure in patients with nasopharyngeal stenosis and velopharyngeal insufficiency. A retrospective case series included patients treated for nasopharyngeal stenosis or velopharyngeal insufficiency with a FAMM flap at an academic medical center from January 1, 2012 to November 1, 2017. Patients included in the study were those who underwent a FAMM flap procedure by the senior author during the specified time period. Functional outcomes included nasopharyngeal airway patency, nasal regurgitation, and speech quality. Any postoperative complications were recorded, including flap necrosis, infection, flap failure, dehiscence, trismus and need for revision surgery. A total of 6 FAMM flap procedures were performed by the senior author over the study period for the indications of this case series. Three patients had nasopharyngeal stenosis and three had velopharyngeal insufficiency. All had successful, sustained nasopharyngeal airway patency or restored velopharyngeal function. The only postoperative complication noted was trismus at the cheek donor site. There were no patients who suffered flap failure or need for revision surgery of the FAMM flap. The FAMM flap is useful for secondary reconstruction of nasopharyngeal stenosis and velopharyngeal insufficiency due to previous surgery and scarring. This study demonstrates the efficacy and reliability of FAMM flaps for repair of complete/near complete nasopharyngeal stenosis and cases of velopharyngeal insufficiency due to scarring of the pharynx.
面部动脉黏膜肌皮（FAMM）瓣是一种血供良好的轴形皮瓣，已被用于口腔内的黏膜重建。由于先前的手术和瘢痕形成，关于其在治疗鼻咽狭窄和软腭功能不全方面的疗效的资料有限。本研究旨在证明 FAMM 皮瓣在治疗鼻咽狭窄和软腭功能不全患者中的疗效。本回顾性病例系列研究纳入了 2012 年 1 月 1 日至 2017 年 11 月 1 日期间在学术医疗中心因鼻咽狭窄或软腭功能不全而接受 FAMM 皮瓣治疗的患者。纳入研究的患者是在指定时间段内由资深作者进行 FAMM 皮瓣手术的患者。功能结果包括鼻咽气道通畅、鼻反流和语音质量。记录了所有术后并发症，包括皮瓣坏死、感染、皮瓣失败、裂开、牙关紧闭和需要再次手术。在研究期间，资深作者共进行了 6 次 FAMM 皮瓣手术，适应证为该病例系列。3 例患者有鼻咽狭窄，3 例患者有软腭功能不全。所有患者均成功维持了鼻咽气道通畅或恢复了软腭功能。唯一注意到的术后并发症是颊部供区的牙关紧闭。没有患者出现皮瓣失败或需要再次手术修复 FAMM 皮瓣。FAMM 皮瓣对于因先前手术和瘢痕形成导致的鼻咽狭窄和软腭功能不全的二次重建是有用的。本研究证明了 FAMM 皮瓣修复完全/接近完全性鼻咽狭窄和因咽瘢痕形成导致的软腭功能不全的疗效和可靠性。
