Reconstructing large palate defects: the double buccinator myomucosal island flap.

After oncologic resection, the palate can be reconstructed by use of fasciocutaneous free flaps, locoregional pedicled flaps, or local flaps, depending on the size and site of the defect. Although microsurgical free flaps are currently the first choice for reconstructing several head and neck defects, palate resections smaller than 8 to 10 cm can easily be restored by use of a local or locoregional flap, reducing the donor-site morbidity and lengths of surgery and hospitalization. However, the use of locoregional flaps such as a temporalis myocutaneous pedicled flap or pedicled temporoparietal fascial flap is limited by postoperative contracture, which can limit mouth opening or even lead to trismus. The buccinator myomucosal flap is an ideal option for reconstructing palate defects, although the amount of tissue available with a single flap may be inadequate for wide palate defects. For such defects, we suggest the use of a double buccinator myomucosal flap harvested from the mucosa of both cheeks.