FAMM FLAP in Head and Neck Surgery

Abstract

Objective: Facial artery mucosa musclar (FAMM) flap is mainly used in head and neck oncologic surgery for primary reconstruction after resection in oral cavity and in surgical treatment of osteoradionecrosis of the mandible. Some benefits are ease of use, good vitality, and no aesthetic prejudice. Recently, robotic surgery has made removal of the flap inside the mouth cavity easier, thanks to a wider field of view and smaller surgical instruments.

Method: Retrospective study. Forty cases were analyzed in ENT and head and neck center of Brest University Hospital, between April 2007 and June 2011, in both indications primary reconstruction and surgical treatment of osteoradionecrosis. Complications such as infection, hematoma, necrosis, time within pedicle weaning, and resumption of feeding were studied.

Results: Eighteen cases for primary reconstruction and 22 cases for surgical treatment of osteoradionecrosis were analyzed. After radiotherapy, pedicle weaning was delayed (average of 11 more days) and enteral nutrition period lasted longer (average of 22 days vs 7 days). However, no infection and only 1 case of hematoma (2.5%) and 2 cases of necrosis (5%) were identified. Revision surgery for flap removal was necessary in 1 case (2.5%). After 1 month, oral feeding was possible in 35 cases (85%). Eighty percent of bad results occurred after radiotherapy.

Conclusion: Thanks to its reliability, the FAMM flap is a good solution in head and neck cancer surgery, even after radiotherapy. However, the size of this flap remains relatively small. For a medium size loss of substance, it is a good alternative between controlled wound healing and bigger flaps.