Inferiorly based buccinator myomucosal island flap in oral and pharyngeal reconstruction. Four techniques to increase its application

•We introduced a literature review on the inferiorly based buccinator myomucosal flap.•With four cases, all possible applications for this flap in oral and oropharyngeal reconstruction are explained.•Indications, limitations and considerations for this flap are explained.•Surgical technique, the ways for reducing donor site morbidity and who to increase pedicle length is demonstrated.

IntroductionReconstruction of oral and pharyngeal defects after pathologic resections with the same tissue is an optimal and ideal target. Islanded variety of inferiorly pedicled facial artery musculomucosal flap, in which facial artery and vein are skeletonized (referred to as inferiorly based BUMIF), is suitable for reconstruction of medium-sized mucosal defects.Presentation of casesIn this article, with four cases, modifications of this flap are demonstrated in reconstruction of large intraoral and oropharyngeal defects and coverage of alveolar ridge in the mandible.DiscussionIn some situations, there is a need for more mucosal paddle, longer vascular pedicle and more adaptation to the recipient bed.ConclusionRelocating Stensen’s duct increases the mucosal paddle with cranial extension of superior limit while differential incision of the mucosa and buccinator muscle in mandibular vestibule extend the lower limit of this flap. Bone suture is a good complementary technique when this flap is used for coverage of mandibular alveolar ridge. Inferiorly based BUMIF with added length is indicated for oropharyngeal and contralateral mouth floor reconstructions.

Graphical abstractAxial view of the cheek at the level of upper lip showing the layers included in the flap. Small part of orbicularis muscle, partial fibers of buccinator muscle, facial artery and vein are compositions of this flap. Buccopharyngeal fascia separates the buccal fat pad () from the buccinator muscle.Figure optionsDownload full-size imageDownload high-quality image (10 K)Download as PowerPoint slideFigure optionsDownload full-size imageDownload high-quality image (114 K)Download as PowerPoint slide