Sternocleidomastoid Muscle Myocutaneous Flap for Corrosive Pharyngoesophageal Strictures

Abstract

This is the first report on the use of sternocleidomastoid muscle myocutaneous inlay flap for corrosive cricopharyngeal strictures. The flap is simple to construct, is effective and can be performed in a short time, and yields good cosmetic results.

Endoscopic coblation assisted laryngo pharyngeal corrosive stricture adhesiolysis-the first of its kind

“…4 Most reported cases of pharyngeal strictures were treated with dilatations, LASER ablation, electrosurgical knife, extensive surgeries such as flap, bypass and replacements according to the extension of stricture. [5][6][7][8][9][10] To our knowledge this is the first case of corrosive laryngopharyngeal stricture treated with endoscopic coblation assisted adhesiolysis. The low frequency radiofrequency energy in coblation has more precise cutting with coagulation, decreased tissue penetration with controlled coagulation depth, minimal collateral tissue damage with surface temperatures 40º-70ºC, less postoperative pain in contrast to electrocautery and LASER.…”

Therapeutic Options for Management of Pharyngoesophageal Corrosive Strictures

“…The indications were the same as for group V .The details of the procedure have been published earlier. 6 The procedure for the SMMC flap inlay is similar to the PMMC inlay flap except that it is based on the sternocleidomastoid muscle. Two patients had only a PES with no obstruction distally and were relieved after an SMMC flap without the need for further intervention.…”

Corrosive Injury of the Upper Gastrointestinal Tract: A Review

“…Once the lumen of the pharyngoesophageal stricture is stabilized, an esophagocoloplasty can be done through a left-sided neck approach. If the pharyngoesophageal stricture is the only segment of the esophagus to be narrowed, stabilization of the stricture by dilatation through an esophagostomy can be followed by asking the patient to progressively swallow liquids, semisolids and solids [68,72,73]. Patients with only synechiae between the arytenoids and the posterior pharyngeal wall benefit from repeated excision of the granulation tissue, cauterization, and adhesiolysis under anesthesia [1,12,68,72].…”

“…In those with additional distal non-dilatable strictures, the myocutaneous flap inlay which is done by an approach through the right side of the neck can be followed by a second stage esophagocoloplasty through the left side of the neck [73]. Patients who have extensive laryngeal scarring requiring a permanent tracheostomy are easier to manage.…”

“…Since the risk of aspiration is eliminated they can be treated by a colonic bypass with the proximal anastomosis being made to the lateral wall of the pharynx [74]. Those in whom none of the above is feasible due to an unfavourable anatomy of the stricture and the aerodigestive tract; a permanent feeding jejunostomy or gastrostomy is the only option [71][72][73][74].…”