Evaluation of Facial Artery Musculomucosal Flap for Reconstruction of Small Tongue Defects

Abstract

Background

Partial glossectomy defects can be managed by different methods, ranging from primary closure to pedicled or free flaps. The facial artery musculomucosal (FAMM) flap provides an excellent match to lingual tissue and provides an inconspicuous donor site. This study aims to compare functional outcomes, especially speech, of patients with partial glossectomy defects (≤1/3rd of tongue) reconstructed by FAMM flap with those of similar defects closed primarily or healed by secondary intention. It also offers to resolve the question of whether defects of this size should be reconstructed at all.

Materials and Methods

A total of 25 patients with T1 or T2 oral tongue cancer undergoing resection and reconstruction with islanded FAMM Flap were included in the prospective limb of the study. Retrospective comparison was done with patients of similar defects who had primary closure (25 patients) or were allowed healing by secondary intention (25 patients). Their peri-operative parameters and functional outcomes were compared.

Results

The FAMM flap group required longer duration of nasogastric feeds and overall hospital stay. Speech intelligibility, as assessed by a speech therapist after 3 months, was satisfactory in all the groups of patients. Results of subjective assessment of speech-related problems did not demonstrate any advantage to the flap group.

Conclusion

Patients with small tongue defects, irrespective of method of repair, have good speech outcomes. There was no significant difference between flap and non-flap groups in objective speech intelligibility outcomes. The benefit of reconstructing defects less than or equal to one-third of the tongue is questionable.

Keywords

tongue - glossectomy - speech intelligibility - facial artery musculomucosal flap

Patients' Consent

Informed consent was obtained from all the participants of the study.

Ethical Approval

Ethical clearance was granted by the Institutional Review Board (IRB-AIMS-2020-027).

Publikationsverlauf

Artikel online veröffentlicht:
29. Oktober 2025

• References

• 1 Joseph ST, Naveen BS, Mohan TM. Islanded facial artery musculomucosal flap for tongue reconstruction. Int J Oral Maxillofac Implants 2017; 46 (04) 453-455
• 2 Massarelli O, Baj A, Gobbi R. et al. Cheek mucosa: a versatile donor site of myomucosal flaps. Technical and functional considerations. Head Neck 2013; 35 (01) 109-117
• 3 Stell PM, Maran AGD, Watkinson JC, Gilbert RW. Stell and Maran's Textbook of Head and Neck Surgery and Oncology. London: Hodder Arnold; 2012: 564
• 4 Moyer JS, Chepeha DB, Teknos TN. Reconstruction of the tongue. In: Oral Cancer: Diagnosis, Management and Rehabilitation. Stuttgart, Germany: Georg Thieme Verlag; 2007: 200-208
• 5 Joseph ST, B. S N, Mohan MT, Tharayil J. Comparison of islanded facial artery myomucosal flap with fasciocutaneous free flaps in the reconstruction of lateral oral tongue defects. Int J Oral Maxillofac Implants 2020; 49 (08) 1000-1006
• 6 Carstens MH, Stofman GM, Hurwitz DJ, Futrell JW, Patterson GT, Sotereanos GC. The buccinator myomucosal island pedicle flap: anatomic study and case report. Plast Reconstr Surg 1991; 88 (01) 39-50 , discussion 51–52
• 7 Pribaz J, Stephens W, Crespo L, Gifford G. A new intraoral flap: facial artery musculomucosal (FAMM) flap. Plast Reconstr Surg 1992; 90 (03) 421-429
• 8 Zhao Z, Li S, Yan Y. et al. New buccinator myomucosal island flap: anatomic study and clinical application. Plast Reconstr Surg 1999; 104 (01) 55-64
• 9 Dokhe Y, Thankappan K, Sood R. et al. Validation of an intelligibility assessment tool in an Indian language for perceptual speech analysis in oral cancer patients. Indian J Surg Oncol 2021; 12 (01) 100-107
• 10 Belafsky PC, Mouadeb DA, Rees CJ. et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 2008; 117 (12) 919-924
• 11 Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil 2005; 86 (08) 1516-1520
• 12 Dwivedi RC, St RoseS, Roe JW. et al. First report on the reliability and validity of speech handicap index in native English-speaking patients with head and neck cancer. Head Neck 2011; 33 (03) 341-348
• 13 Lee DY, Ryu Y-J, Hah JH, Kwon T-K, Sung M-W, Kim KH. Long-term subjective tongue function after partial glossectomy. J Oral Rehabil 2014; 41 (10) 754-758
• 14 Regezi JA, Sciubba JJ, Jordan RCK. Oral Pathology: Clinical, Pathologic Correlations. 5th ed.. St Louis, MO: Saunders Elsevier; 2008
• 15 Shin YS, Koh YW, Kim S-H. et al. Radiotherapy deteriorates postoperative functional outcome after partial glossectomy with free flap reconstruction. J Oral Maxillofac Surg 2012; 70 (01) 216-220
• 16 Chuanjun C, Zhiyuan Z, Shaopu G, Xinquan J, Zhihong Z. Speech after partial glossectomy: a comparison between reconstruction and nonreconstruction patients. J Oral Maxillofac Surg 2002; 60 (04) 404-407
• 17 Zhao Z, Zhang Z, Li Y. et al. The buccinator musculomucosal island flap for partial tongue reconstruction. J Am Coll Surg 2003; 196 (05) 753-760
• 18 Ayad T, Kolb F, De Monés E, Mamelle G, Temam S. Reconstruction of floor of mouth defects by the facial artery musculo-mucosal flap following cancer ablation. Head Neck 2008; 30 (04) 437-445
• 19 Benjamin M, Aliano K, Davenport T, Frank D. Functional outcomes regarding facial artery musculomucosal flap for reconstruction of partial glossectomy defects. Ann Plast Surg 2020; 85 (S1, suppl 1): S76-S79
• 20 Joseph ST, Mohan MT, Naveen BS, Anand A, Tharayil J. Facial artery-based islanded myomucosal and bone flaps in head and neck reconstruction. J Plast Reconstr Aesthet Surg 2021; 74 (06) 1269-1278
• 21 Møller MN, Sørensen CH. Risk of marginal mandibular nerve injury in neck dissection. Eur Arch Otorhinolaryngol 2012; 269 (02) 601-605