Designing a bipedicled sternocleidomastoid muscle flap for parotidectomy contour deformities.The bipedicled sternocleidomastoid sternocleidomastoid /ster·no·clei·do·mas·toid/ (-kli?do-mas´toid) pertaining to the sternum, clavicle, and mastoid process. ster·no·clei·do·mas·toid adj. (SCM) muscle flap is useful for the reconstruction of contour deformities secondary to parotidectomy Parotidectomy Definition Parotidectomy is the removal of the parotid gland, a salivary gland near the ear. Purpose The main purpose of parotidectomy is to remove cancerous tumors in the parotid gland. defects. Proper design of this flap allows for the total reconstruction of parotid parotid /pa·rot·id/ (pah-rot´id) near the ear. pa·rot·id adj. 1. Situated near the ear. 2. Of or relating to a parotid gland. n. A parotid gland. tail defects. We describe the design and utility of this flap as a simple, reproducible, and aesthetically pleasing method of reconstructing posterior facial concave deformities that occur as a result of superficial parotidectomy. The posterior limb of the cervical portion of the modified Blair incision is undermined to obtain full access to the SCM muscle (figure 1, A). An incision is made along the rostral-caudal axis of the the diameter of the sphere which is perpendicular to the plane of the circle. See also: Axis muscle, splitting the SCM into vertical halves (figure 1, B). This incision is taken down to the depth level of the transverse raphe raphe /ra·phe/ (ra´fe) pl. ra´phae a seam; the line of union of the halves of various symmetrical parts. raphe of penis (figure 1, C). Above the level of the posterior belly of the digastric muscle digastric muscle n. 1. A muscle with two fleshy bellies separated by a fibrous insertion. 2. A muscle consisting of two bellies united by a central tendon connected to the body of the hyoid bone, with origin from the digastric , this incision can be made with impunity. Below the digastric muscle, the spinal accessory nerve is more of a consideration. This incision is a relaxing incision, and it can be extended as far inferiorly as necessary to achieve a tension-free advancement. Lower parotid defects rarely require an extension more than 2 or 3 cm below the inferior margin of the posterior belly of the digastric muscle. Small muscular arteries may be encountered as the raphe is approached. If so, bleeding can be controlled with bipolar cautery to prevent postoperative hematoma formation. Sacrificing these small arteries will not compromise the vascular integrity of the flap. Once the relaxing incision is made, the anterior border of the muscle is advanced medially into the parotid defect in an accordion fashion (figure 2). The SCM muscle and its investing deep cervical fascia are then sutured to the renmant fascia parotideomasseterica with interrupted 3-0 chromic chromic /chro·mic/ (kro´mik) of, pertaining to, or related to chromium. chromic phosphate P 32 or Vicryl sutures. The superior and inferior attachments of the SCM remain intact, thus maintaining a minimum of two vascular pedicles as well as maintaining the functionality of the muscle. Many techniques have been used to reconstruct parotid defects. The bipedicled SCM muscle flap's unique utility is drawn from its recruitment of locally well-vascularized muscle tissue that has not been denervated denervated Neurology Nervelessness; loss of neural connections. See Chemical denervation. , which protects against muscle atrophy. The muscle is fanned, which prevents a complete transposition defect because the muscle bulk is split between the harvest site and the defect in a 1:1 ratio. This procedure, which can be easily performed without the need for advanced surgical training, results in excellent cosmesis and functional reconstruction with little or no harvest site morbidity (figure 3). Suggested reading Osborne RF, Tan JW, Hamilton JS, Calcaterra TC. Bipedicled sternocleidomastoid muscle flap for reconstruction of tail of parotid defects. Laryngoscope 2004;114:2045-7. Jason Hamilton, MD; Sofia Avitia, MD; Ryan F. Osborne, MD, FACS FACS Fellow of the American College of Surgeons. FACS abbr. Fellow of the American College of Surgeons FACS fluorescence-activated cell sorter. From the Osborne Head and Neck Institute (Dr. Hamilton, Dr. Avitia, and Dr. Osborne), and the Head and Neck Cancer Center, Cedars-Sinai Medical Center (Dr. Osborne), Los Angeles. |
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