The effects of head rotation and tilt on oral pressure and muscle activity / 대한해부학회지

Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip / Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip

Abstract Introduction: The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up. Objective: To evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency. Methods: Patients with repaired cleft palate (± lip) who were submitted to surgical correction of velopharyngeal insufficiency using the bilateral buccinator myomucosal flap were assessed. Hypernasality (scores 0 [absent], 1 [mild], 2 [moderate], or 3 [severe]) was analyzed by three evaluators by measuring the audiovisual records collected in early and late preoperative and postoperative periods (3 and 12 months, respectively). The values were considered significant for a 95% Confidence Interval (p < 0.05). Results: Thirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Analyses of the late postoperative period showed that hypernasality (0.5 ± 0.7) was significantly (p < 0.05) lower than the hypernasality of the preoperative and recent postoperative periods (2.8 ± 0.4 and 1.7 ± 0.9, respectively). Conclusion: The buccinator myomucosal flap is effective in reducing/eliminating hypernasality in patients with cleft palate (± lip) and velopharyngeal insufficiency.

Resumo: Introdução: A interpretação dos resultados de fala obtidos com o retalho miomucoso do músculo bucinador no tratamento da insuficiência velofaríngea em pacientes fissurados tem sido limitada pela restrição do número de pacientes e do tempo de seguimento pós-operatório. Objetivo: Avaliar o efeito do retalho miomucoso do músculo bucinador sobre a hipernasalidade da fala no tratamento de pacientes fissurados com insuficiência velofaríngea. Método: Foram avaliados pacientes com fissura palatina (± lábio) reparada, com retalho miomucoso do músculo bucinador bilateral para a correção cirúrgica da insuficiência velofaríngea. A hipernasalidade (escores 0 [ausente], 1 [leve], 2 [moderada] ou 3 [severa]) foi analisada por três avaliadores por meio da mensuração dos registros audiovisuais coletados nos períodos pré-operatório e pós-operatórios recente e tardio (3 e 12 meses, respectivamente). Os valores foram considerados significativos para um intervalo de confiança de 95% (p < 0,05). Resultado: Foram incluídos 37 pacientes fissurados com hipernasalidade moderada (16,2%) ou severa (83,8%) no período pré-operatório. As análises do período pós-operatório tardio revelaram que a hipernasalidade (0,5 ± 0,7) foi significativamente (p < 0,05) menor do que a hipernasalidade dos períodos pré-operatório e pós-operatório recente (2,8 ± 0,4 e 1,7 ± 0,9; respectivamente). Conclusão: O retalho miomucoso do músculo bucinador é eficaz na redução/eliminação da hipernasalidade nos pacientes fissurados com insuficiência velofaríngea.

An in vivo study to correlate the relationship of the extraoral and intraoral anatomical landmarks with the occlusal plane in dentulous subjects.

Background: The occlusal plane position is considered to be the primary link between esthetic and function. Aim: To evaluate the relationship between extraoral and intraoral soft tissue landmarks with the occlusal plane in dentulous subjects on both sides and to check for any variations. Study and Design: An in vivo study and 100 subjects with all healthy permanent teeth in normal arch and alignment were selected from Modern Dental College and Research Centre, Indore. Materials and Methods: Three custom made instruments (occlusal plane analyzer, buccinator groove relator, and level analyzer) were indigenously designed to check parallelism of the interpupillary line, ala‑tragus line, buccinator groove with the occlusal plane. Relation of retromolar pad with the occlusal plane was checked with the metallic scale. Statistical Analysis: Chi‑square test. Results: In 20.0% subjects, the occlusal plane was parallel to the interpupillary line. The posterior reference point for ala‑tragus line was middle point on right side in 56% and left side in 58% subjects. Intraorally, right side 59% and left side 62% subjects had the occlusal plane at the same level as that of buccinator groove. Right side 48% and left side 45% subjects showed occlusal plane at the middle one‑third of retromolar pad. Conclusion: The occlusal plane is not generally parallel to interpupillary line. The occlusal plane is parallel to the ala‑tragus line with middle point of tragus as posterior reference point on right and left sides. Both sides, the buccinator groove and the middle one‑third retromolar pad are coinciding with occlusal plane level.

Intramuscular cavernous hemangioma: A rare entity in the buccinator muscle.

Intramuscular hemangiomas are rare benign neoplasms accounting for <1% of all hemangiomas and <20% are found in head and neck area. The muscle most frequently involved is the masseter muscle and very few cases have been reported for the occurrence of these hemangiomas in the buccinator muscle. Here, we are presenting a case report of intramuscular hemangioma occurring in the buccinator muscle in a 22‑year‑old girl.

Tunnelized-facial Artery Myomucosal Island Flap (t-FAMMIF) for Palatomaxillary Reconstruction: A Report of Two Cases

Use of Double Buccinator Myomucosal Flap for Treating Secondary Velopharyngeal Insufficiency: a Case Report

External location of the buccinator muscle to facilitate electromyographic analysis

Electromyography is frequently used to measure the activity of masticatory muscles. It requires the precise setting of the electrodes, which demands the accurate location of the muscle to be evaluated. The purpose of this study was to investigate the accuracy of an external method to locate the buccinator muscle. Fifteen human cadavers were evaluated and planes were determined on the face using anatomic landmarks. An angle (a) was obtained at the intersection of these planes on the central point of buccinator muscle and measured with a protractor. The value of the angle allows locating the central point of buccinator muscle based on anatomic landmarks on the face. Statistical analysis of the collected data indicated an angle of 90º with 95 percent reliability, thus proving the efficacy of the proposed method.

A eletromiografia é frequentemente utilizada para mensurar a atividade dos músculos mastigatórios. Esta análise exige a colocação precisa dos eletrodos, o que requer a localização exata do músculo a ser avaliado. O objetivo do presente estudo foi investigar a acurácia de um método externo para localização do músculo bucinador. Quinze cadáveres humanos foram avaliados e planos foram determinados na face utilizando-se pontos de referência anatômicos. Um ângulo (a) foi obtido na interseção desses planos no ponto central do músculo bucinador e foi medido com um transferidor. O valor do ângulo permite localizar o ponto central do músculo bucinador baseado nos pontos de referência anatômicos da face. A análise estatística dos dados obtidos indicou um ângulo de 90º com 95 por cento de confiabilidade, confirmando dessa forma a eficácia do método proposto.

Buccinator Myomucosal Flap for Wide Cleft Palate

PURPOSE: The goal of palatoplasty is focused on two points. One is to close the palatal defect completely, and the other to create a velopharyngeal system for normal speech. While established methods such as pushback palatoplasty or double opposing Z palatoplasty are used in wide cleft palate repair, sequelae such as maxillary hypoplasia or oronasal fistula may result. Therefore, when palatoplasty with buccinator myomucosal flap is used in the case of wide cleft palates, maxillary hypoplasia and oronasal fistula is reduced and optimal results are obtained. METHODS: From October 2005 to December 2006, four children with wide complete cleft palate underwent unilateral buccinator myomucosal flap and intravelar veloplaty. Mean age at cleft repair was 15 months, and mean cleft size was 2.15cm. The patients underwent intravelar veloplasty and palatoplasty was done using unilateral buccinator myomucosal flap. RESULTS: The patients, after mean 10 months of follow- up observation, showed no signs of oronasal fistula resulting from flap tension. The shape and color similar to normal oral mucosa was obtained, and velopharyngeal function was acquired. CONCLUSION: When intravelar veloplasty and palatoplasty with unilateral buccinator myomucosal flap is done on wide cleft palates, postoperative speech function is optimal, velopharyngeal incompetence is effectively corrected, and sequelae resulting from pushback palatoplasty and double opposing Z-plasty, such as maxillary hypoplasia and oronasal fistula, is reduced.

Intraoral Reconstruction with Buccinator Myomucosal Flap

Since the buccinator myomucosal flap was first described, it has been modified, with the study of anatomical model. Therefore, buccinator myomucosal flap can be elevated in various direction according to defect with its sufficient arc of rotation. With the buccinator myomucosal flap, intraoral reconstruction was performed in 3 patients. Two adult patients were suffered from complete cleft palete. Partial tongue reconstruction was performed in another patient following partial glossectomy due to tongue cancer. Satisfied results were obtained in all three patients. In these cases, the author designed flaps in island patterns. It would be more helpful to close donor site primarily and obtaining free rotation arc. The pedicle was located in retromolar trigone, flap detachment was not needed. Considering the disadvantages of other reconstruction methods, such as contracture, hair growth and poor oral hygiene caused by skin graft or conventional free flap, the buccinator myomucosal flap would be another good option for intraoral reconstruction with "like tissue".

Usefulness of Buccinator Myomucosal Flap for Intraoral Reconstruction / 대한이비인후과학회지

BACKGROUND: The myomucosal flap from the buccinator muscle is known to be useful for the reconstruction of intraoral defects. We used the buccinator myomucosal flap for the treatment of mild to moderate defects after intraoral tumor resection. This paper represents the versatility of the buccinator myomucosal flap for intraoral reconstruction and to introduce our clinical experience. METHODS: The flap was applied clinically in 5 patients to reconstruct intraoral defects from January, 1999 to December, 1999, with an average follow-up of 6 months. We evaluated these patients retrospectively. RESULTS: The buccinator myomucosal flap was used in the reconstruction of 5 defects of soft palate, retromolar trigone, and posterior pharyngeal wall. All flaps survived completely. There was no flap necrosis and fistula. The results were functionally and esthetically satisfactory. CONCLUSION: The buccinator myomucosal flap was used for mild to moderate intraoral defect reconstruction. It has many advantages and versatilities. It is reliable and safe. It does not require microsurgical technique, and rapid healing can be achieved due to its mucosal nature. The buccinator myomucosal flap, the only myomucosal flap that can be used for intraoral reconstruction, can be widely used.

Versatile Use of Buccinator Myomucosal Flap for Oral Cavity and Orbital Reconstruction

This paper represents the versatility of buccinator myomucosal flap for intraoral and orbital reconstruction of mild to moderate defect and we introduce recontructive methods are introduced along with our clinical experience. Buccal artery from internal maxillary artery is the main arterial pedicle, and buccal branch from facial artery also can supply blood for the buccinator muscle. The abundant blood flow from interconnected pedicles supports the reliable circulation of the buccal mucosa. So we could reconstruct the eye socket using reversed island buccinator myomucosal flap based on the angular vessel. The motor innervation of the buccinator muscle comes from the facial nerve. The buccinator muscle is considered to be a part of the sphincteric muscular system involving the functions of sucking, whistling, propelling food during mastication and voiding the buccal cavity. From 1990 to 1999, the flap was utilized in 8 patients to reconstruct the small to moderate intraoral defect and 1 patient for orbital mucosal defect. All flaps survived completely. There has been no flap necrosis and fistula. The results have been functionally and esthetically satisfactory. It is very reliable and safe flap with a minimal morbidity of donor site. It doesn't require microsurgical technique. Rapid healing may be achieved with its mucosal nature. We conclude that buccinator myomucosal flap can be widely used with a lot of advantages for intraoral and orbital defect because of its many advantages.