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Galeal flap based on superficial temporal vessels for oral cavity and pharynx reconstruction--an anatomical study.

Pinto F, Magalhães R, Durazzo M, Brandão L, Rodrigues Jr AJ - Clinics (Sao Paulo) (2008)

Bottom Line: Hypopharyngeal reconstruction was tested by transposing the flap to the neck under the facial nerve.In the reconstruction simulations, the flap was shown to be suitable for the coverage of hypothetical defects in most oral cavity and pharyngeal sites, mainly the retromolar trigone, tonsil area, and buccal mucosa.A galeal flap based on the superficial temporal vessels presents favorable anatomical characteristics for oral cavity and pharyngeal reconstruction.

View Article: PubMed Central - PubMed

Affiliation: Head and Neck Surgery Service, Hospital de Ensino, Faculdade de Medicina do ABC, São Bernardo do Campo, Brazil. pintofr@uol.com.br

ABSTRACT

Purpose: Despite the advances in microvascular free tissue transfer for intraoral reconstruction, this surgery is not recommended for all patients. In specific cases, the pedicled temporoparietal galeal flap may be an option for reconstructive procedures in the head and neck regions. The objective of this paper is to present the anatomical aspects of a galeal flap based on the superficial temporal vessels and to test its potential for reconstructing diverse sites of the oral cavity and pharynx.

Methods: We performed 40 dissections on 34 fresh adult cadavers. The flap vascular anatomy was studied by injecting latex into the superficial temporal vessels. A standardized square-shape flap measuring 10 x 10 cm(2), pedicled on the superficial temporal vessels, was raised. Oral cavity and oropharynx reconstruction simulations were performed after flap transposition into the mouth by passing it under the zygomatic arch. Hypopharyngeal reconstruction was tested by transposing the flap to the neck under the facial nerve.

Results: After latex injection, a rich vascular network over the temporoparietal galea was observed directly from the superficial temporal artery, and a well-vascularized flap based on this vessel was raised. In the reconstruction simulations, the flap was shown to be suitable for the coverage of hypothetical defects in most oral cavity and pharyngeal sites, mainly the retromolar trigone, tonsil area, and buccal mucosa.

Conclusions: A galeal flap based on the superficial temporal vessels presents favorable anatomical characteristics for oral cavity and pharyngeal reconstruction.

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Related in: MedlinePlus

Galeal flap inside the oral cavity after its transposition through a tunnel under the zygomatic arch.
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f3-cln63_1p0097: Galeal flap inside the oral cavity after its transposition through a tunnel under the zygomatic arch.

Mentions: We analyzed the following factors: the ease of injecting latex into the vessels; the external diameter of the superficial temporal artery and vein in front of the external auditory canal; the number of artery branches over the galea; the relative location of the superficial temporal vessels and the facial nerve; the distance from the trunk of the superficial temporal artery in front of the ear to its terminal branches over the galea (described here as the maximum distance of the flap pedicle); and the maximum area available for flap constitution based on a quadrangular area of the galea macroscopically vascularized by the superficial temporal vessels. We also tried to observe arterial anastomosis crossing the midline in the bilateral dissections (six cases). A standardized square-shape galeal flap measuring 10 x 10 cm2, based on the superficial temporal vessels, was raised from the temporoparietal region. The inferior limit of the flap was at the temporal region, 2 cm above the auditory canal. The dissection of the pedicle flap stopped at the level of the canal (Fig 2). The flap was transposed into the mouth through a tunnel under the zygomatic arch (Fig 3). It was then tested to determine whether it could reach to the following sites: the retromolar trigone, buccal mucosa, floor of the mouth, oral tongue, hard palate, soft palate, tonsil area and posterior wall of oropharynx. The flap was also tested to determine whether it would cover the mucosa of each site entirely or partially. In the last 20 dissections, we tested the possibility of transferring the flap to the neck by passing it under the facial nerve (Fig 4). Lesions to the nerve and its branches were recorded as well as the flap reaching the anatomical position of the thyroid and cricoid cartilages.


Galeal flap based on superficial temporal vessels for oral cavity and pharynx reconstruction--an anatomical study.

Pinto F, Magalhães R, Durazzo M, Brandão L, Rodrigues Jr AJ - Clinics (Sao Paulo) (2008)

Galeal flap inside the oral cavity after its transposition through a tunnel under the zygomatic arch.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2664184&req=5

f3-cln63_1p0097: Galeal flap inside the oral cavity after its transposition through a tunnel under the zygomatic arch.
Mentions: We analyzed the following factors: the ease of injecting latex into the vessels; the external diameter of the superficial temporal artery and vein in front of the external auditory canal; the number of artery branches over the galea; the relative location of the superficial temporal vessels and the facial nerve; the distance from the trunk of the superficial temporal artery in front of the ear to its terminal branches over the galea (described here as the maximum distance of the flap pedicle); and the maximum area available for flap constitution based on a quadrangular area of the galea macroscopically vascularized by the superficial temporal vessels. We also tried to observe arterial anastomosis crossing the midline in the bilateral dissections (six cases). A standardized square-shape galeal flap measuring 10 x 10 cm2, based on the superficial temporal vessels, was raised from the temporoparietal region. The inferior limit of the flap was at the temporal region, 2 cm above the auditory canal. The dissection of the pedicle flap stopped at the level of the canal (Fig 2). The flap was transposed into the mouth through a tunnel under the zygomatic arch (Fig 3). It was then tested to determine whether it could reach to the following sites: the retromolar trigone, buccal mucosa, floor of the mouth, oral tongue, hard palate, soft palate, tonsil area and posterior wall of oropharynx. The flap was also tested to determine whether it would cover the mucosa of each site entirely or partially. In the last 20 dissections, we tested the possibility of transferring the flap to the neck by passing it under the facial nerve (Fig 4). Lesions to the nerve and its branches were recorded as well as the flap reaching the anatomical position of the thyroid and cricoid cartilages.

Bottom Line: Hypopharyngeal reconstruction was tested by transposing the flap to the neck under the facial nerve.In the reconstruction simulations, the flap was shown to be suitable for the coverage of hypothetical defects in most oral cavity and pharyngeal sites, mainly the retromolar trigone, tonsil area, and buccal mucosa.A galeal flap based on the superficial temporal vessels presents favorable anatomical characteristics for oral cavity and pharyngeal reconstruction.

View Article: PubMed Central - PubMed

Affiliation: Head and Neck Surgery Service, Hospital de Ensino, Faculdade de Medicina do ABC, São Bernardo do Campo, Brazil. pintofr@uol.com.br

ABSTRACT

Purpose: Despite the advances in microvascular free tissue transfer for intraoral reconstruction, this surgery is not recommended for all patients. In specific cases, the pedicled temporoparietal galeal flap may be an option for reconstructive procedures in the head and neck regions. The objective of this paper is to present the anatomical aspects of a galeal flap based on the superficial temporal vessels and to test its potential for reconstructing diverse sites of the oral cavity and pharynx.

Methods: We performed 40 dissections on 34 fresh adult cadavers. The flap vascular anatomy was studied by injecting latex into the superficial temporal vessels. A standardized square-shape flap measuring 10 x 10 cm(2), pedicled on the superficial temporal vessels, was raised. Oral cavity and oropharynx reconstruction simulations were performed after flap transposition into the mouth by passing it under the zygomatic arch. Hypopharyngeal reconstruction was tested by transposing the flap to the neck under the facial nerve.

Results: After latex injection, a rich vascular network over the temporoparietal galea was observed directly from the superficial temporal artery, and a well-vascularized flap based on this vessel was raised. In the reconstruction simulations, the flap was shown to be suitable for the coverage of hypothetical defects in most oral cavity and pharyngeal sites, mainly the retromolar trigone, tonsil area, and buccal mucosa.

Conclusions: A galeal flap based on the superficial temporal vessels presents favorable anatomical characteristics for oral cavity and pharyngeal reconstruction.

Show MeSH
Related in: MedlinePlus