Anatomical status of the human musculus uvulae and its functional implications.

In our ongoing series of anatomical studies to determine the three-dimensional architecture of the human velar muscles, we have previously reported on the palatopharyngeus. The present study deals with the musculus uvulae (MU), in which the positional relationships of its origin to the posterior nasal spine and the palatine aponeurosis, as well as the interrelation between its anatomical status and functions, have yet to be clarified. Macroscopic and microscopic examinations were performed on 25 and 2 cadavers, respectively. In the former, bilateral MUs and their adjacent structures were exposed mainly from the nasal aspect. In the latter, the soft palates embedded in paraffin were cut into frontal and sagittal sections and alternately processed with HE and Azan stains. The left and right MUs adjacent to each other were found to run longitudinally along the midline beneath the nasal aspect of velum. It was overlaid by glandular tissue that increased in amount as it coursed distally. After originating from the oral surface of palatine aponeurosis, it ran backward to cross above the sling formed by the levator veli palatini muscles of both sides and reached the tip of uvula with its muscle fibers intermingled with glandular tissue. Past studies have proposed three functions of MU to enhance the efficiency of velopharyngeal closure: space occupier, stiffness modifier, and velar extensor. All of the above-described anatomical characteristics of MU could be explained as being adapted for these functions. This implies that MU is actively responsible for maintaining the velopharyngeal closure efficiency.

Inferolateral extension of the groin flap based on the artery accompanying the lateral femoral cutaneous nerve.

The authors reconstructed hand defects using a new type of the extended groin flap in two patients. The extended portion includes the lateral femoral cutaneous nerve (LFCN) and the artery accompanying the LFCN (LFCA). Circulation to the extended portion was maintained by the communicating branches between the LFCA and the superficial circumflex iliac artery (SCIA). The flap was used as a pedicle flap in one patient and as a free flap in the other patient. The extended portion was elevated as an island flap based on LFCA in the latter. These flaps, including the extended portion, were transferred successfully. We have already reported use of the inferior extension of the groin flap based on the descending branch of the SCIA, in 2002. However, the extension technique described here is a different type of extension, due to the use of a different nutrient vessel. We believe that this new technique increases the usefulness of the groin flap.

Orbicularis oris myomucosal island flap transfer to the nose.

We developed the orbicularis oris myomucosal island flap (OOMMIF) to reconstruct the nasal lining in one stage. The OOMMIF blood supply derives from the intramuscular vascular network which communicates with the submucosal vascular plexus via the vascular network formed by the deep ascending branches of the superior labial artery. An oral mucosal flap of approximately 2 x 3cm can be harvested from the upper lip pedicled solely on the orbicularis oris muscle. We transferred this flap to a nasal lining defect located in the ala in four patients, the nasal floor in two patients, and the columella in two patients. The flap donor site was closed primarily. All flaps took completely with satisfactory results. Minor complications included slight asymmetry of the vermilion height due to donor site contracture in one patient and flap drooping in two patients corrected by secondary debulking. Upper lip functional loss was not observed, although upper lip hypoaesthesia occurred in one patient, which disappeared within 6 months. An OOMMIF can be easily elevated with minimal donor site morbidity. Thus, the OOMMIF is a good candidate for one-stage reconstruction of small nasal lining defects.

A new flap design for reconstruction of full-thickness defects of the lower lip: the extended upper lip island (EULI) flap.

The extended upper lip island (EULI) flap has two advantages. It provides a wide mucosal surface, like that of the facial artery musculomucosal flap and does not leave a pedicle across the mouth. Aesthetic results with the EULI flap are almost as good as those with the cross-lip flap. An 89-year-old woman presented with squamous cell carcinoma of the lower oral vestibule. Full-thickness lower lip resection and marginal mandibulectomy, including resection of the surrounding gingiva and mucosa, were performed. The defect was reconstructed with an EULI flap that included the facial artery and vein. There were no severe postoperative complications, but two mild complications did occur: mild congestion of the distal end of the skin paddle and mucosa for two days after surgery and partial paralysis of the orbicularis oris and levator anguli oris muscles. The EULI flap is useful for extended lower lip reconstruction.