Experiences with the sternocleidomastoid muscle and myocutaneous flaps

AbstractThe use of the sternocleidomastoid muscle and musculocutaneous flaps in the reconstruction of defects arising after surgery for cancer of the head and neck has been a subject of some discussion.Experience with these flaps over a ten year period from 1980 until 1989 is presented. Attention is drawn to the various types of flaps in vogue, their indications to date, benefits and drawbacks. A new reliable compound musculocutaneous flap developed by the author for use in defects of the skull base after total temporal bone excision is presented.

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Long-Term Effects on Volume Change in Musculocutaneous Flaps after Head and Neck Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1672134 ◽

2018 ◽

Vol 35 (04) ◽

pp. 235-243 ◽

Cited By ~ 3

Author(s):

Akiko Sakakibara ◽

Junya Kusumoto ◽

Shunsuke Sakakibara ◽

Takumi Hasegawa ◽

Masaya Akashi ◽

...

Keyword(s):

Radiation Therapy ◽

Head And Neck ◽

Muscle Volume ◽

Musculocutaneous Flap ◽

Flap Reconstruction ◽

Musculocutaneous Flaps ◽

Significant Difference ◽

Long Term Follow Up

Objective Musculocutaneous flap reconstruction surgery is one of the standard procedures following head and neck cancer resection. However, no previous studies have classified flaps in terms of muscle and fat or examined them after long-term follow-up. The purpose of this study was to estimate the fat and muscle volume changes in musculocutaneous flaps during long-term follow-up. Methods We conducted a retrospective analysis of 35 patients after musculocutaneous flap reconstruction. The total, fat, and muscle volumes of the musculocutaneous flaps were measured using 3-dimensional images. Changes in flap volumes over time (1 month, 1 year [POY1], and 5 years [POY5] postoperatively) were assessed. Flap persistence was calculated using flap volumes at 1 month after reconstruction for reference. Results Flap persistence at POY5 was 42.0% in total, 64.1% in fat, and 25.4% in muscle. Muscle persistence was significantly decreased (p < 0.0001). In a multiple regression analysis, decreased body mass index (BMI) of ≥ 5% influenced fat persistence less than muscle persistence at POY1; however, there was no significant difference at POY5. Postoperative radiation therapy was associated with a significant decrease in total flap persistence at POY1 (p = 0.046) and POY5 (p = 0.0097). Muscle persistence significantly decreased at POY5 (p = 0.0108). Age significantly influenced muscle volume at POY1 (p = 0.0072). Conclusion Reconstruction flaps are well-preserved with high fat-to-muscle ratios. Recommendations for weight maintenance are necessary for patients less than 2 years after surgery due to the influence of BMI on fat persistence. Radiation therapy is necessary for some patients based on their disease state. Intensity-modulated radiation therapy can be offered to reduce scattering irradiation to normal tissues.

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Skull Base Invasion Patterns of Malignant Head and Neck Tumors: A Neurosurgical Perspective

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-3402034 ◽

2020 ◽

Author(s):

Kenichiro Iwami ◽

Masazumi Fujii ◽

Naoki Nishio ◽

Takashi Maruo ◽

Yasushi Fujimoto ◽

...

Keyword(s):

Nasal Cavity ◽

Head And Neck ◽

Skull Base ◽

Temporal Bone ◽

Tumor Invasion ◽

Ethmoid Sinus ◽

Head And Neck Tumors ◽

Neck Tumors ◽

Lateral Skull Base ◽

Invasion Patterns

Abstract Objective Craniofacial resection (CFR) and temporal bone resection (TBR) on malignant head and neck tumors (MHNTs) invading skull base require accurate and precise determination of the tumor invasion. We investigated tumor skull base invasion patterns and surgical results in CFR and TBR cases. Methods We performed either CFR or TBR for 75 selected patients with the possibility of en bloc resection over the period between 2011 and 2018. The medical charts of the selected patients were reviewed. Results Primary tumor onset site (TOS) groups were: (1) nasal cavity/ethmoid sinus, 20 cases; (2) orbit, 10 cases; (3) maxillary sinus, 28 cases; and (4) external ear/temporomandibular joint, 17 cases. Grades for tumor invasion depth (TID) included: (I) extracranial invasion and skull base bone invasion; (II) extradural invasion; or (III) intradural invasion. Patients in groups 1 and 2 had a significantly higher frequency of grade II and III invasions than patients in groups 3 and 4. The main invasion site was nasal cavity superior wall and ethmoid sinus superior wall for group 1 tumors, orbit superior wall, and lateral skull base sphenoid bone for group 2 and 3 tumors, and lateral skull base temporal bone for group 4 tumors. Positive resection margins represented a significant negative prognostic factor. TID and TOS did not affect skull base margin status. Conclusion Skull base invasion of MHNTs exhibits certain fixed patterns in sites susceptible to invasion based on the TOS. The frequencies of extradural and intradural invasions differed, indicating the importance for accurate preoperative tumor evaluation.

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Combined Exoscopic and Endoscopic Technique for Craniofacial Resection

Current Oncology ◽

10.3390/curroncol28050336 ◽

2021 ◽

Vol 28 (5) ◽

pp. 3945-3958

Author(s):

Kenichiro Iwami ◽

Tadashi Watanabe ◽

Koji Osuka ◽

Tetsuya Ogawa ◽

Shigeru Miyachi ◽

...

Keyword(s):

Head And Neck ◽

Skull Base ◽

Temporal Bone ◽

Surgical Procedures ◽

Blind Spot ◽

Endoscopic Technique ◽

Craniofacial Resection ◽

Microscopic Surgery ◽

Neck Tumors ◽

Compact Size

We determined the feasibility of the combined exoscopic-endoscopic technique (CEE) as an alternative to the microscope in craniofacial resection (CFR). This retrospective study was conducted at a single institution and included eight consecutive patients with head and neck tumors who underwent CFR between September 2019 and July 2021. During the transcranial approach, microsurgery was performed using an exoscope in the same manner as in traditional microscopic surgery, and an endoscope was used at the blind spot of the exoscope. The exoscope provided images of sufficient quality to perform microsurgery, while the sphenoid sinus lumen was the blind spot of the exoscope during anterior (n = 3) and anterolateral CFR (n = 2), and the medial aspect of the temporal bone was the blind spot of the exoscope during temporal bone resection (n = 2). These blind spots were visualized by the endoscope to facilitate accurate transection of the skull base. The advantages of the exoscope and endoscope include compact size, ergonomics, surgical field accessibility, and equal visual experience for neurosurgeons and head and neck surgeons, which enabled simultaneous transcranial and transfacial surgical procedures. All the surgeries were successful without any relevant complications. CEE is effective in transcranial skull base surgery, especially CFR involving simultaneous surgical procedures.

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