Background: Buccinator myomucosal flaps (BMFs) have been proposed as a reconstructive solution for defects of the tongue and oral floor; however, their harvest requires preservation of the facial artery and vein. This study aimed to evaluate the oncologic safety of this approach compared with free fasciocutaneous flaps (FFF). Methods: A retrospective multicenter case–control study including cT1–T3 cN0 tongue/oral floor squamous cell carcinoma was performed. Cases received BMFs while controls received FFFs. The primary endpoint was progression-free survival (PFS) tested for non-inferiority. Secondary endpoints were overall survival (OS), disease-specific survival (DSS), and cumulative incidence of local, regional, and distant recurrence using competing-risk methods. Results: A total of 615 patients (BMF n = 390; FFF n = 225) with comparable baselines were included. Five-year PFS was 69.8% (BMF) versus 66.2% (FFF); adjusted HR (FFF vs. BMF) 0.87 (95% CI: 0.43–1.78), meeting non-inferiority. Five-year OS was 77.9% versus 73.5%. Cumulative incidence of recurrence was similar: local 7.5% versus 8.3%, regional 6.3% versus 6.1%, and distant 2.1% versus 1.7%. Conclusions: Preservation of the facial artery and vein during selective neck dissection did not compromise oncologic outcomes. Facial-vessel–based BMFs are a valid option for small-to-medium tongue/oral floor defects in appropriately selected cN0 patients when meticulous level I clearance is performed and a pull-through resection is not required.
Oncologic Safety of Facial-Vessel–Based Buccinator Myomucosal Flaps for Tongue and Oral Floor Reconstruction: A Retrospective Multicenter Case–Control Study / Vaira, L. A.; Massarelli, O.; Polesel, J.; Ferri, A.; Chiesa-Estomba, C. M.; Cuellar, I. N.; Consorti, G.; Cirignaco, G.; Cucurullo, M.; Salzano, G.; Padmanabhan, S.; George, A.; Petrocelli, M.; Ali, J.; Gonzalez-Garcia, J. A.; Manfuso, A.; Ayad, T.; Cuellar, C. N.; Giudici, F.; Lechien, J. R.; Joseph, S. T.; Copelli, C.; Biglioli, F.; Ferrari, S.; De Riu, G.. - In: HEAD & NECK. - ISSN 1043-3074. - 48:3(2025), pp. 827-836. [10.1002/hed.70082]
Oncologic Safety of Facial-Vessel–Based Buccinator Myomucosal Flaps for Tongue and Oral Floor Reconstruction: A Retrospective Multicenter Case–Control Study
Vaira L. A.;Biglioli F.;De Riu G.
2025-01-01
Abstract
Background: Buccinator myomucosal flaps (BMFs) have been proposed as a reconstructive solution for defects of the tongue and oral floor; however, their harvest requires preservation of the facial artery and vein. This study aimed to evaluate the oncologic safety of this approach compared with free fasciocutaneous flaps (FFF). Methods: A retrospective multicenter case–control study including cT1–T3 cN0 tongue/oral floor squamous cell carcinoma was performed. Cases received BMFs while controls received FFFs. The primary endpoint was progression-free survival (PFS) tested for non-inferiority. Secondary endpoints were overall survival (OS), disease-specific survival (DSS), and cumulative incidence of local, regional, and distant recurrence using competing-risk methods. Results: A total of 615 patients (BMF n = 390; FFF n = 225) with comparable baselines were included. Five-year PFS was 69.8% (BMF) versus 66.2% (FFF); adjusted HR (FFF vs. BMF) 0.87 (95% CI: 0.43–1.78), meeting non-inferiority. Five-year OS was 77.9% versus 73.5%. Cumulative incidence of recurrence was similar: local 7.5% versus 8.3%, regional 6.3% versus 6.1%, and distant 2.1% versus 1.7%. Conclusions: Preservation of the facial artery and vein during selective neck dissection did not compromise oncologic outcomes. Facial-vessel–based BMFs are a valid option for small-to-medium tongue/oral floor defects in appropriately selected cN0 patients when meticulous level I clearance is performed and a pull-through resection is not required.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
