Oncologic Safety of Facial-Vessel– Based Buccinator Myomucosal Flaps for Tongue and Oral Floor Reconstruction: A Retrospective Multicenter Case–Control Study

Abstract

Background: Buccinator myomucosal flaps (BMFs) have been proposed as a reconstructive solution for defects of the tongue and oral floor; however, their harvest requires preservation of the facial artery and vein. This study aimed to evaluate the oncologic safety of this approach compared with free fasciocutaneous flaps (FFF).

Methods: A retrospective multicenter case-control study including cT1-T3 cN0 tongue/oral floor squamous cell carcinoma was performed. Cases received BMFs while controls received FFFs. The primary endpoint was progression-free survival (PFS) tested for non-inferiority. Secondary endpoints were overall survival (OS), disease-specific survival (DSS), and cumulative incidence of local, regional, and distant recurrence using competing-risk methods.

Results: A total of 615 patients (BMF n = 390; FFF n = 225) with comparable baselines were included. Five-year PFS was 69.8% (BMF) versus 66.2% (FFF); adjusted HR (FFF vs. BMF) 0.87 (95% CI: 0.43-1.78), meeting non-inferiority. Five-year OS was 77.9% versus 73.5%. Cumulative incidence of recurrence was similar: local 7.5% versus 8.3%, regional 6.3% versus 6.1%, and distant 2.1% versus 1.7%.

Conclusions: Preservation of the facial artery and vein during selective neck dissection did not compromise oncologic outcomes. Facial-vessel-based BMFs are a valid option for small-to-medium tongue/oral floor defects in appropriately selected cN0 patients when meticulous level I clearance is performed and a pull-through resection is not required.