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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
STERNOCLEIDO-MASTOID
MYOCUTANEOUS FLAP
FOR INTRAORAL
RECONSTRUCTION AFTER
RESECTION OF ORAL
SQUAMOUS CELL
CARCINOMA
www.in...




American journal of maxillofacial
surgery 61:1179-1183,2003
Noubuyuki
tanaka, Akirayamaguchi, Kazuhiro
ogi, and Geni...
Purpose of the study




Sternocleidomastoid myocutaneous flap
remains an important tool in head and
neck reconstruction...
The sternocleidomastoid(SCM)muscle flap
for reconstruction was first reported by
Jianu in 1908,who suggested its use for
f...








But it is reported that the SCM flap did not gain
popularity for several reasons
A) possible breach of oncolog...
PATIENTS AND METHODS




The retrospective data on 40 consecutive SCM
myocutaneous flaps after resection of OSCC
between...
www.indiandentalacademy.com
FOM-SCC

www.indiandentalacademy.com
MEASURING THE DEFECT
(if epithelium required)

www.indiandentalacademy.com










The myocutaneous flap was elevated off of the investing
cervical fascia.
After the resection of tumor if tu...
www.indiandentalacademy.com
FLAP SECURED IN PLACE AFTER
SND

www.indiandentalacademy.com
RESULTS




There were 31 men and 9 women in the
study (age range, 31 to 70 yrs; average
age 58.3 yrs)
T Staging
Tongue
...




In 1 case bilateral SCM myocutaneous
flap was used
Flap was combined with metal plates-3

hydroxyapatite-2
clavicle-...
SND
No.cases

11

P(N+ve)

4

FND
16
14

Bil.ND

10

5

8

5yrs survival rate-51.9%
In case of p(N-ve)-75.5%
Died of
recur...
DISCUSSION








Not as common as pectoralis major flap though
it is very straightforward.
Previous radiotherapy– af...
-- SND applied for—No cases of high
malignancy potential of the primary lesion.
--FND applied for – cases with positive LN...







ARIYAN, HAREN,
If LN are fixed to SCM or have broken through
cervical fascia---SCM should be removed in
continu...
LITTLE WOOD :-- BLOOD SUPPLY

SCM-post auricular & occipital.A .
Thence splitting of the muscle should be
avoided.
 SCM ...





ALVI & STEGNJAJIC used myofascial flap
CHARLES et all –augmentation of the blood
supply with preservation of the p...


Indication of SCM flap depends on the
features of the neck metastasis, the
diagnosis of which has improved
significantl...
CONCLUSION


The SCM myocutanious flap appears to be
simple to use and useful for reconstruction
of the defect after rese...
Thank
you
www.indiandentalacademy.com
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Sternocleidomastoid myocutanious flap for intraoral reconstruction after resection /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Sternocleidomastoid myocutanious flap for intraoral reconstruction after resection /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. STERNOCLEIDO-MASTOID MYOCUTANEOUS FLAP FOR INTRAORAL RECONSTRUCTION AFTER RESECTION OF ORAL SQUAMOUS CELL CARCINOMA www.indiandentalacademy.com
  3. 3.   American journal of maxillofacial surgery 61:1179-1183,2003 Noubuyuki tanaka, Akirayamaguchi, Kazuhiro ogi, and Geniku kohama. www.indiandentalacademy.com
  4. 4. Purpose of the study   Sternocleidomastoid myocutaneous flap remains an important tool in head and neck reconstruction. This article retrospectively reviews 40 consecutive SCM myocutaneous flaps used for the reconstruction after resection of oral squamous cell carcinoma with respect to reliability and complications. www.indiandentalacademy.com
  5. 5. The sternocleidomastoid(SCM)muscle flap for reconstruction was first reported by Jianu in 1908,who suggested its use for facial reanimation in patients with facial paralysis. : www.indiandentalacademy.com
  6. 6.     But it is reported that the SCM flap did not gain popularity for several reasons A) possible breach of oncologic principles due to its proximity to the juglar lymph node chain, B)questionable reliability of adequate blood supply, C)possible detrimental effects of radiotherapy on flap viability. www.indiandentalacademy.com
  7. 7. PATIENTS AND METHODS   The retrospective data on 40 consecutive SCM myocutaneous flaps after resection of OSCC between 1987-1997 were reviewed including age, gender, site of the defect, and clinical course. .The skin paddle was delineated along the inferior aspect of the SCM muscle and extended no more than 2cm below the clavicle with the width of equal to or less than that of the muscle. www.indiandentalacademy.com
  8. 8. www.indiandentalacademy.com
  9. 9. FOM-SCC www.indiandentalacademy.com
  10. 10. MEASURING THE DEFECT (if epithelium required) www.indiandentalacademy.com
  11. 11.      The myocutaneous flap was elevated off of the investing cervical fascia. After the resection of tumor if tunneling was necessary (intra oral defects), the flap was placed into the defect without constriction. The skin portion within the tunnel was marked and subsequently de-epithelialized. The tip of the muscle pedicle was anchored with sutured all around the mucosa without tension. The donor site was closed by local advancement of neck skin. www.indiandentalacademy.com
  12. 12. www.indiandentalacademy.com
  13. 13. FLAP SECURED IN PLACE AFTER SND www.indiandentalacademy.com
  14. 14. RESULTS   There were 31 men and 9 women in the study (age range, 31 to 70 yrs; average age 58.3 yrs) T Staging Tongue 7 Floor of the mouth Man.gingiva Buccal mucosa oropharynx 12 14 3 4 T1 1 T2 10 T3 8 T4 Total 20 39 www.indiandentalacademy.com
  15. 15.   In 1 case bilateral SCM myocutaneous flap was used Flap was combined with metal plates-3 hydroxyapatite-2 clavicle-1 www.indiandentalacademy.com
  16. 16. SND No.cases 11 P(N+ve) 4 FND 16 14 Bil.ND 10 5 8 5yrs survival rate-51.9% In case of p(N-ve)-75.5% Died of recurrence Partial epith loss 2 2 4 1 4 1 www.indiandentalacademy.com
  17. 17. DISCUSSION     Not as common as pectoralis major flap though it is very straightforward. Previous radiotherapy– affects the survival of SCM flap. The use of SCM myocutanious flap is thought to compromise oncologic principles because of its proximity to jugular LN chain. SND/FND:- SCM & /or IJV & /or 11th CN. www.indiandentalacademy.com
  18. 18. -- SND applied for—No cases of high malignancy potential of the primary lesion. --FND applied for – cases with positive LN that is isolated movable and located in level 1&2 The incidence of neck metastasis in oscc is high, RND was performed not only for N+ pts but also for N-ve pts as prophylaxis. www.indiandentalacademy.com
  19. 19.     ARIYAN, HAREN, If LN are fixed to SCM or have broken through cervical fascia---SCM should be removed in continuity with neck structures. If LN are seen with in the structures deep to cervical fascia---muscle can be elevated off the tissue layer & entire neck dissection be completed. Thus the use of SCM m.flap is extended. www.indiandentalacademy.com
  20. 20. LITTLE WOOD :-- BLOOD SUPPLY  SCM-post auricular & occipital.A . Thence splitting of the muscle should be avoided.  SCM upper 1/3- occipital.A  Middle 1/3- Br of superior thyroid artery Br of ECA . Lower 1/3- Br supra scapular.A  www.indiandentalacademy.com
  21. 21.    ALVI & STEGNJAJIC used myofascial flap CHARLES et all –augmentation of the blood supply with preservation of the platysma had expanded the application of SCM myocutanious flap with less incidence of necrosis or superficial slough. LARSON &GEOFERT- used Bulk flap that requires later revision.So use only head of SCM. www.indiandentalacademy.com
  22. 22.  Indication of SCM flap depends on the features of the neck metastasis, the diagnosis of which has improved significantly in recent years. www.indiandentalacademy.com
  23. 23. CONCLUSION  The SCM myocutanious flap appears to be simple to use and useful for reconstruction of the defect after resection or oral CA and indications for this flap will be extended in accordance with recent increase in number of SND &FND cases. www.indiandentalacademy.com
  24. 24. Thank you www.indiandentalacademy.com

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