Abstract
Objective To highlight key anatomical and technical considerations for facial artery identification,
and harvest and transposition of the facial artery buccinator (FAB) flap to facilitate
its future use in anterior skull base reconstruction. Only a few studies have evaluated
the reverse-flow FAB flap for skull base defects.
Design Eight FAB flaps were raised in four cadaveric heads and divided into thirds; the
facial artery's course at the superior and inferior borders of the flap was measured
noting in which incisional third of the flap it laid. The flap's reach to the anterior
cranial fossa, sella turcica, clival recess, and contralateral cribriform plate were
studied. A clinical case and operative video are also presented.
Results The facial artery had a near vertical course and stayed with the middle (⅝) or posterior
third (⅜) of the flap in the inferior and superior incisions. Seven of eight flaps
covered the sellar/planar regions. Only four of eight flaps covered the contralateral
cribriform region. Lastly, none reached the middle third of the clivus.
Conclusions The FAB flap requires an understanding of the facial artery's course, generally seen
in the middle third of the flap, and is an appropriate alternative for sellar/planar
and ipsilateral cribriform defects.
Keywords
skull base reconstruction - facial artery buccinator flap - cerebrospinal fluid leak
- facial artery
