The Sternomastoid Island Myocutaneous Flap for Oral Cancer Reconstruction

Stolzmann, Paul; Cherian, Thomas; Mi, Ahamed; Kl, Jayakumar; P, Sivaramakrishnan

doi:10.1001/archotol.1994.01880300043006

Cited by 12 publications

(4 citation statements)

References 12 publications

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“…5 Traditionally, local control is achieved by surgical resection and/or radiation therapy. 10,18,19 However there still remain some cases in which staged reconstruction is safer. Thus reconstruction of head and neck region is still a great challenge and if not performed adequately changes of anatomy or functions can have devastating consequences.…”

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“…5,9Y11 Defects created as a result of surgical intervention may involve mandible, lower and upper lip, floor of mouth, cheek, eyelids, maxilla, orbit and nose. 19,21Y24 Anterior portion of ribs can be harvested with pectoralis major muscle flap for reconstruction of mandibular defects. Moreover, feeding and speech may be impaired.…”

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“…Moreover, feeding and speech may be impaired. 19,27 Local flaps are especially useful for reconstruction of cutaneous components of complex defects, because they provide better results in terms of color match and texture match. 12Y15 Recent reconstructive procedures not only aim closure of the defect should also restore the function (speech, mastication, deglutition) and aesthetics.…”

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Unusual and Giant Tumors of Head and Neck Region

Ünlü¹,

Orbay²,

Uysal³

et al. 2006

Journal of Craniofacial Surgery

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Head and neck tumors can reach to massive dimensions if patients are uneducated and ignorant about the disease. Resection of such giant tumors creates a significant functional and aesthetic loss due to proximity of vital structures in head and neck region. Reconstruction of these complex defects is a demanding procedure and postoperative results are not always excellent in terms of function and aesthetics. We have reviewed a group of patients with giant head and neck tumors treated in our department. Postoperative results were evaluated in terms of function and aesthetic appearance. Postoperative functional results were good in most of the patients and aesthetic results were acceptable. Early diagnosis and excision of the tumors in head and neck region decrease the morbidity of the disease. Treatment should be planned on individual basis. Most of the patients with head and neck tumors are elderly patients with additional medical problems so reconstructive procedures should be selected by taking this in consideration. Complex and long-lasting operations should be reserved for young patients.

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Unusual and Giant Tumors of Head and Neck Region

Ünlü¹,

Orbay²,

Uysal³

et al. 2006

Journal of Craniofacial Surgery

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“…Depending on the size, larger fistulas require two flaps, one for the inner lining and one for the cover, either of which includes a muscle layer for the intermediate cover (1). Myocutaneous flaps are among the various flaps that have been used (1); in particular, the sternomastoid myocutaneous flap has been used for the closure of oral and pharyngeal defects after oral surgery (2)(3)(4)(5). The sternomastoid by itself, without the cutaneous component, has been used to fill in the defect after a parotidectomy (6), with clavicle used for mandibular reconstruction (7).…”

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Closure of a pharyngocutaneous fistula using a sternomastoid muscle flap

Raman¹

2005

J Plast Surg

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R Raman, UD Arumainathan. Closure of a pharyngocutaneous fistula using a sternomastoid muscle flap. Can J Plast Surg 2005;13(1):49.Presented here is a case of a pharyngocutaneous fistula which was closed primarily using a sternomastoid muscle flap, without skin coverage, thus obviating the need for a three-layered closure. Providing an intermediate cover was sufficient for the closure because the mucosal lining on the inside and the cutaneous covering on the outside grew using the muscle for support.Key Words: Closure; Pharyngocutaneous fistula; Sternomastoid flap Fermeture d'une fistule pharyngo-cutanée à l'aide d'un lambeau musculaire sterno-cléido-mastoïdienOn présente ici un cas de fistule pharyngo-cutanée qui a été principalement refermée à l'aide d'un lambeau du muscle sterno-cléido-mastoïdien, sans couche cutanée, évitant ainsi le recours à une fermeture en trois couches. Il a été suffisant d'implanter une couche intermédiaire pour la réparation parce que la paroi muqueuse interne et la couche cutanée externe se sont développées à partir du support musculaire. (1); in particular, the sternomastoid myocutaneous flap has been used for the closure of oral and pharyngeal defects after oral surgery (2-5). The sternomastoid by itself, without the cutaneous component, has been used to fill in the defect after a parotidectomy (6), with clavicle used for mandibular reconstruction (7).Here, we present a case that describes a method in which the sternomastoid, by itself, without the cutaneous cover, is used for the closure of a pharyngocutaneous fistula, thus obviating the need for a three-layered closure. CASE PRESENTATIONThe patient developed a small suprastomal fistula in the midline on the eighth postoperative day after a total laryngectomy and a radical neck dissection for a carcinoma of the larynx. This fistula increased in size, reaching 4 cm (transverse) and 3 cm (vertical) after three weeks. Under general anesthesia, the original U-shaped incision skin flap was again raised to the base of the tongue, thus separating the mucous lining of the fistula. This procedure helped to make both the edges of the mucous lining and the cutaneous lining fresh. The sternomastoid muscle on the nonradical dissection side of the neck was exposed up to the sternal and clavicular attachment sites of the muscle, located beside the tracheostoma. An approximate measurement of the muscle, equivalent to the transverse measurement of the fistula (4 cm) was taken, and the sternomastoid muscle was divided above the sternal attachment and separated from the clavicular attachment of the muscle up to the level of the superior thyroid vessels. This muscle flap was then rotated medially and sutured to the remnants of the muscle and soft tissue on the opposite side, thus closing the fistula. A few stay sutures were inserted between the mucosal lining and the rotated muscle. The skin flap was returned to its original location. A few more stay sutures were inserted between the muscle and the raw cutaneous edges of the fistula. The cutaneous d...

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