【Abstract】 Objective To investigate the therapeutic method and effectiveness of multi ple sternocleidomastoid headamputation for adult congenital muscular torticoll is. Methods Between March 2009 and February 2011, 19 patients withcongenital muscular torticoll is were treated with multi ple sternocleidomastoid head amputation. There were 13 males and 6 females, aged 16-32 years (mean, 23.5 years). The X-ray films showed that 12 cases were accompanied with some extent cervical lateral bending and wedge change. Ten patients were with i psilateral facial bradygenesis. Four patients had recieved single sternocleidomastoid head amputation. All of the 19 patients were treated with multi ple sternocleidomastoid head amputation, then plaster support and neck collar were used after operation for 3-6 months. Results The wounds of all the 19 patients healed primarily, without infection or hematoma. Sixteen patients were followed up 5 months to 2 years (mean, 8 months). The head and neck malformations were amel iorated significantly. The effectiveness was assessed 2 weeks later, in 7 patients without cervical vertebral malformation results were excellent; in 12 patients with cervical vertebral malformation, the results were excellent in 1 case, good in 7 cases, and fair in 4 cases. The length between mastoid process and sternoclavicular joints was elongated (1.88 ± 0.30) cm significantly after operation in patients without cervical vertebral malformation (t=6.24, P=0.00), showing no significant difference when compared with normal value (t=1.87, P=0.11); the length was elongated (3.38 ± 0.30) cm significantly (t=11.37, P=0.00) after operation in patients with cervical vertebral malformation, but it was significant shorter than normal value (t=12.19, P=0.00). Conclusion Multi ple sternocleidomastoid head amputation is a safe and effective method for adult congenital muscular torticoll is, which can improve the neck rotation function.
【Abstract】 Objective To investigate the effectiveness of pedicled sternocleidomastoid muscle flap in repairing defect after parotidectomy by comparing with direct suture. Methods The clinical data were retrospectively analyzed, which were from 73 patients with parotid tumor undergoing parotidectomy between January 2002 and April 2010. After parotidectomy, defects were repaired with pedicled sternocleidomastoid muscle flap in 38 cases (flap group) and with direct suture in 35 cases (control group). There was no significant difference in gender, age, disease duration, tumor location and size between 2 groups (P gt; 0.05). Meanwhile the complications, such as local introcession deformity, Frey’s syndrome and parotid gland fistula were observed. Results In flap group, the flaps were all alive and incisions healed by first intention; in control group, all incisions healed by first intention. All patients were followed up 6-98 months and no tumor recurred. There was significant difference in local introcession deformity between 2 groups (χ2=53.202, P=0.000). The parotid gland fistula was found in 1 case (2.6%) of the flap group and in 8 cases (22.8%) of the control group, Frey’s syndrome was found 1 case (2.6%) of the flap group and in 20 cases (57.1%) of the control group, showing significant differences between 2 groups (P lt; 0.05). Conclusion The use of pedicled sternocleidomastoid muscle flap for defect repair after parotidectomy can avoid the complications of local introcession deformity, Frey’s syndrome, and parotid gland fistula.
Objective To investigate cl inical effect and prognosis of the modified sternocleidomastoid (MSCM) myocutaneous flap for reconstruction of tissue defects in patients with oral carcinomas undergoing tumorectomy. Methods From April 2001 to January 2007, 43 patients with large or medium-sized tissue defects because of oral carcinomas radical operation were treated with MSCM myocutaneous flap. There were 31 males and 12 females with an average age of 58.5 years(25-76 years). The disease course was 25 days to 14 months (4.5 months on average). There were 27 cases of well-differentiated squamous cell carcinoma (SC), 14 cases of poorly-differentiated SC, 1 case of rhabdomyosarcoma, and 1 case of adenoid cystic carcinoma. Affected locations were tongue in 25 cases, mouth floor in 11 cases, lower gingiva in 4 cases, and buccal mucous membranes in 3 cases. According to 2002 International Union Control Cancer criterion for cl inical stage, there were 3 cases of stage I, 13 cases of stage II, 7 cases of stage III, and 20 cases of stage IV. Both the ranges of soft tissue defects and the flap were from 4 cm × 3 cm to 8 cm × 6 cm. The vital ity of the flaps and the heal ing of wounds were observed postoperatively. The function restoration of deglutition and dehisce were observed during the follow-up period. Results Necrosis of quarter MSCM myocutaneous flap occurred in 3 cases 1 week after operation, wounds healed by secondary intention after dressing; other flaps were survival. Infection with fluidify occurred at the donor site of 2 cases, wounds healed by incision and drainage; other incision at the donor sites healed primarily. No arterial or venous crisis occurred in all 43 flaps after 48 hours of operation. Thirty-nine patients were followed up for 6 months to 6 years. The 3 patients with buccal carcinoma could open their mouths normally. The function of deglutition and pronunciation were recovered in 24 patients with tongue carcinoma. Only 3 patients needed to have soft diet after operation. In 26 patients who were followed up above 2 years, oral metaplasia of the the skin flaps epithel ium was observed. Four patients and 2 patients recurred and died after 6 months and 1 year of operation, respectively.Two patients received the second operation after 6 months because of the metastatic lymph node, and survived up to now. The 2-year survival rate was 85%. Conclusion MSCM myocutaneous flap is simple to perform and effective in reconstruction of tissue defects for patients with oral carcinomas. It has active effect to recover the function of oral and axillofacial region and elevate l iving qual ity of patients.
Objective To evaluate the preliminary effect of using the sternal head of the sternocleidomastoid myocutaneous flap to reconstuct a defect in the maxillofacial region. Mathods From May 2004 to September 2006, 5 male patients aged 2334 underwent the reconstruction for the defect in the maxillofacial region by using the sternal head of the sternocleidomastoid myocutaneous flap. Their defects were caused by an infection of the face, an injection of medicine in the mother’s uterus or a scar or depressed abnormality left by an electric injury. The defects ranged in size from 5 cm×3 cm to 9 cm×6 cm. Results All the 5 sternocleidomastoid myocutaneous flaps survived, with a little necrosis of the epidermis because of the venous return disturbance, but 2-3 weeks after operation the necrosis healed spontaneously with just a little scar formation around the flap. One patient had weakness in the left shoulder after operation, which almost recovered 6 months after operation. The postoperative follow-up for 1-6 months revealed that 1 patient had a little fat and clumsy appearance in the flap pedicle, 1 patient had an obvious scar at the operation site, but the 2 patients still felt satisfaction. The other 3patients were satisfied with their good appearance at the operation sites. Conclusion The sternal head of the sternocleidomastoid myocutaneous flap can be designed with more flexibility compared with the entire sternocleidomastoid myocutaneous flap. It can provide an enough tissue mass for restoring the defect. The sternal head of the sternocleidomastoid myocutaneous flap is an ideal tissue flap for restoring defects in the maxillofacial region.
Objective To study the methods and results of a combination of forehead skin flap and sternocleidomastoid island myocutaneous flap in the reconstruction of large through-andthrough defect of check. Methods One case of check cancer received ampliative resection and functional neck dissection. The defect area of the skin side was 9 cm×7 cm, of the mucosa side 4.5 cm×3.0 cm.The defect of the mucosa side was repaired with sternocleidomastoid island myocutaneous flap which blood supply was from thyroidea superior artery, occipitalis artery and carotis extera vein; of the skin side with forehead skin flap which blood supply was from temporalis superficialis artery and vein. The size of the sternocleidomastoid island myocutaneous flap was 5 cm×3 cm, of the forehead skin flap10 cm×6 cm. Results Two flaps and the split survived after operation. One-stage healing was achieved. The patient was discharged from hospital 2 weeks afteroperation.The color and the quality were good.The tumor did not recur during follow-up of one year. The patient could take care of herself, and she lived normally in talk and diet. Conclusion A combination of forehead skinflap and sternocleidomastoid island myocutaneous flap is a useful method to repair large through-and-through defect of cheek after cancer dissection. It is easy-to-operate and economical.
OBJECTIVE To explore a new surgical approach to repair facial paralysis in late stage, using regional transposition of pedicled sternocleidomastoid muscle for the dynamic reanimation of the paralyzed face. METHODS Seven cases with facial paralysis in late stage from December 1999 were treated and followed up for 10 months before clinical evaluation. In all of the cases, the sternal and clavicular branches of the sternocleidomastoid muscle were both elevated from their bony attachments, with the mastoid insertion left in situ as the pedicle for blood supply and accessory nerve maintained in it. The muscle strips were transposed and sutured to the orbicularis oris around the mouth corner on the paralyzed side. RESULTS Static asymmetry of nose and oral commissure on the paralyzed side were corrected immediately after operation, and the movement of the oral commissure recovered one week after operation. Symmetric smiling was observed in one month and all of the oral movements recovered in 10 months postoperatively. CONCLUSION The new approach to repair facial paralysis in late stage by regional transposition of pedicled sternocleidomastoid muscle is effective in restoration of both static and dynamic symmetry of nose and mouth, and in recovery of the facial expression and the oral commissure.
This article introduced a new method to repairthe mandibular micrognathia of mandible. Thehalf-split clavicle bone with bilateralsternocleidomastoid muscular pediclcs was used.Based on the results of our clinical data, it hadthe advantages of bone graft with vascularpodicle, no functional ill- effect in the donorsite, shortens the operative time, and might beaccomplished reliability in a one stage.
our patients with brachial plexus root arulsion, who had undergone various nerve operationswith no functional recovery of the limb, were treated with transfer of sternocledomastoid muscle toreconstruct the function of elbow fleaion. The sternocleidomastoid muscle was datached from itsincertions and was lengthened by fascia lata graft from the thigh , and then , was transferred under theclavicle to the radiai shaft just distal to the radial tuberosity. After the recostruction, The potient...
Objective To assess the effectiveness of sternocleidomastoid muscle (SCM) flap in preventing gustatory sweating syndrome following parotidectomy. Methods Databases including The Cochrane Library, MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data were searched from inception to March 2012 to retrieve randomized controlled trials (RCTs) about SCM flap in preventing gustatory sweating syndrome following parotidectomy. The data of studies meeting the inclusion criteria were extracted by two reviewers independently, the methodological quality was assessed and cross-checked, and meta-analysis was performed using the RevMan 5.1 software. Results A total of 10 RCTs involving 825 patients were included. The results of meta-analyses showed that compared with the blank control group, SCM flap could obviously decrease the subjective incidence of gustatory sweating syndrome by 78% (OR=0.22, 95%CI 0.08 to 0.59, P=0.003) and the objective incidence by 83% (OR=0.17, 95%CI 0.05 to 0.60, P=0.006). The sensitivity analysis indicated the above results were robust. The evidence based on GRADE system was of “low quality”. There was no obvious publication bias according to the tunnel chart. Conclusions Current evidence shows that SCM flap can obviously decrease both subjective and objective incidence of gustatory sweating syndrome following parotidectomy. Considering the limitation of the included studies, this conclusion still needs to be tested by more large-scale and high-quality RCTs taking SCM function as one of the outcome.