## 4 Discussion  
### Summary of Evidence  
From the myomucosal side of the cheek, several flaps are available to reconstruct different small to medium sized defects of the oral cavity such as the floor of the mouth, tongue, hard and soft palate. [PERSON] was the first one identifying the myomucosal cheek as a donor site for intraoral reconstruction [4]. The author described the axial buccinator musculomucosal flap, pediched on the buccal artery, with a posterior mucosal pivot at the maxillary tuberosity and a horizontal axis on the oral commissure. In 1991, [PERSON] et al.,  
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in contrast with [PERSON]'s beliefs, reported that the buccal artery was not the main blood supply of the buccinator, but the facial artery seemed to be preeminent instead [28]. On this basis, [PERSON] proposed the anteriorly based buccinator myomucosal island flap based on the facial artery and vein [29; 30]. In 1992, [PERSON] et al. proposed the facial artery musculomucosal flap, an axial myomucosal flap centered on the course of the facial artery with an orthograde flow (inferiorly based) or a reverse flow (superiorly based). In 1999, [PERSON] et al. described two buccinator myomucosal island flaps, with two different vascular patterns: the buccinator myomucosal neurovascular flap posteriorly based supplied by the buccal artery and the buccinator myomucosal reversed-flow arterial island flap superiorly based supplied by the lateral nasal artery, a terminal branch of the facial artery, with a reverse flow supply [6]. The main difference between FAMM and i-FAMM flaps is represented by the need, for the former, of a temporary post-operative bite block and the need for secondary pedicle section surgery, at least in dedulous patients. i-FAMM, on the contrary, has the advantage of avoiding the aforementioned secondary surgery, although the harvesting is technically challenging compared to FAMM. The present systematic review was performed in order to evaluate flap viability between FAMM and i-FAMM considering flap loss and flap marginal necrosis. During the article evaluation process, the reviewers encountered a problem regarding flap nomenclature. This issue was already raised by a review performed by [PERSON] et al. who tried to suggest a rational and simplified nomenclature for the buccinator myomucosal flaps. [PERSON] et al. identified the flap names based on the vascular pedicle: for example, the reverse FAMM flap described by [PERSON], with the axial pattern based on the facial artery and a reverse flow, was identified as the nasal artery myomucosal (NAMM) flap because the reverse flow was based on the nasal artery. In the review performed by [PERSON] et al. the most confused nomenclature was the one related to the BAMM flap. First described by [PERSON] et al., it is an axial flap based and centered on the buccal artery, an internal maxillary artery branch, extending from the maxillary tuberosity to the oral commissure. It can be used to close small mucosal defects of the posterior hard palate, soft palate and maxillary alveolus. The nomenclature of this flap is confused and imprecise. Vague terms such as Bozola's flap or buccal flap or the improper FAMM flap have been often used. The term buccal artery myomucosal flap is precise and unequivocal. Moreover, the acronym BAMM is similar to FAMM, and it could be successfully accepted and avoid confusion resulting from the use of incorrect or confused terms. For the aforementioned reasons, in order to perform an objective evaluation, the reviewers carefully examined the description of the harvesting technique of all selected papers. The flaps where the pedicle was not identified and where the flap was almost with random vascularization rather than axial were excluded. All BAMM flaps with the identification of the buccal pedicle were considered as FAMM.