Immediate Reconstruction of Mandibular Defects With a Composite Sternocleidomastoid Musculoclavicular Graft

Abstract

\s=b\ The problem of mandibular reconstruction has been approached using many surgical techniques. This article studies one such approach\p=m-\reconstruc-tion using full-thickness clavicle pedicled on the sternocleidomastoid muscle. Five patients with stage II and stage III carcinoma of the anterior part of the floor of the mouth were treated with mandibular resection and neck dissection. The resulting defects were immediately reconstructed with the clavicle-sternocleidomastoid muscle technique. The patients were observed from one to three years and were examined postoperatively with technetium Tc 99m medronate scans, which demonstrated the grafts to be viable. The technique proved reliable in a limited clinical trial.

Sternocleidomastoid Muscle-Clavicle Myoosseous Flap for Single-Stage Reconstruction of Postoperative Tracheal Defects in Patients with Invasive Thyroid Tumor

“…So, in cases with a large defect, the MO flap may be better than the MP flap for stabilization and epithelization of tracheal lumen. Seroma formation was reported to occur in SCM-C MO flaps used for mandibular reconstruction [4], In the present study, serous discharge from the drain age tube continued for 2 weeks in the 2nd case, although it subsided spontaneously. Fracture of the clavicle was also reported after mandibular reconstruction with SCM-C MO flaps [3].…”

“…As the SCM is supplied by branches of the thyrocervical trunk inferiorly, by branches of the supe rior thyroid artery in the middle and by branches of the posterior auricular artery superiorly, the muscle is capable of surviving as long as any one of the three vessels is intact [4], There have been several reports of laryngotracheoplasty for benign stenotic lesions using a composite hyoidsternohyoid interposition graft [7] and a sternohyoid myocutaneous rotatory door flap [8], However, the integ rity of the blood supply to the sternohyoid muscle through SCM-C MO Flap for Tracheal Defect the inferior thyroid artery or superior thyroid artery (pref erably both) must be considered when using these flaps.…”

“…However, re ports of cases with an invasive thyroid tumor are very few. Since Conley [ 1 ] presented the use of a compound myoos seous (MO) flap in the reconstruction of a mandibular defect, several studies using a sternocleidomastoid-clavic ular (SCM-C) MO flap have been reported [2][3][4] In this report, we present 3 cases with thyroid carcino ma whose postoperative defects in the tracheal wall were successfully reconstructed in a single-stage operation us ing an SCM-C MO flap.…”

The Sternocleidomastoid Flap—Its Indications and Limitations

“…The sternocleidomastoid (SCM) flap has been described in an enormous variety of applications within the last 91 years. It has been used to reanimate the face, 1 prevent Frey's syndrome, 2,3 reconstruct the cheek and floor of the mouth, 4–6 restore the lower jaw and masticatory function, 7,8 reconstruct the oro‐ and hypopharyngeal wall 9–12 and the laryngotracheal complex in adults and children, 13–17 close pharyngocutaneous and cervical esophageal fistulae, 18–21 protect the carotid and anonymous arteries, and even to aid shoulder elevation. 22 The muscle has been used either superiorly or inferiorly based, as a whole or split, as a muscular, myocutaneous, myoperiosteal, or myosseus (osteomuscular) compound flap.…”

The Sternocleidomastoid Flap for Oral Cavity Reconstruction: Extended Indications and Technical Modifications

“…open drainage tubes in the remaining cases intraoperatively and an air-tight vacuum system was not recommended for possibly inadvertent damage to perforators underneath the SCM muscle.In our case series, we used 3 types of flap: the myocutaneous flap, the perforator myocutaneous flap, and the osteomyocutaneous flap with a half-thickness clavicular graft.The SCM-clavicle myocutaneous flap35 was first used in 1981, and direct harvesting of a full thickness of the clavicle might cause shoulder instability, pain, limited shoulder abduction, and brachial plexus damage36 . Two recent studies 21, 37 stated that instead of using the full thickness of the clavicle, the upper portion of the clavicle was harvested.…”