Surgical approaches to the temporomandibular joint. In 22 patients, the superior vascular pedicle, the submental branch of the facial artery, was used, and in two other patients, the inferior pedicle, the superficial branch of the transverse cervical artery, was used. From january to may 2012, 17 patients were treated with this flap, and all flaps survived. Leftsubcutaneous surface of flap will form inside of lumen.
In this article, we describe 12 consecutive patients who underwent platysma flap reconstruction of various oral cavity and oropharyngeal defects. In that order, it is critical for the surgeon to choose the best surgical approach in treating the. Role of platysma muscle flap in depressed scars of neck. The composite flap was pulled by the surgeon using a kocher or allis clamp, taking the anterior border of the incised platysma attached on the flap. Its fibers cross the clavicle, and proceed obliquely upward and medially along the side of the neck fibres at the front of the muscle from the left and right sides intermingle together below and behind the symphysis menti. Original article defining the facial extent of the. A platysma myocutaneous flap for intraoral reconstruction is outlined and the surgical technique described. Platysma myocutaneous flap for intraoral and surface. Platysma myocutaneous flap for reconstruction of skin defects.
This flap should be considered for reconstruction of small and mediumsized defects of the oral cavity. The complete tumor resection was controlled by frozensection biopsy in. Role of platysma muscle flap in depressed scars of neck original. Flap survival is threatened if it is elevated without the adipofascial tissue under the muscle as with a. Platysma myocutaneous flap pmf is a generally used technique for defect reconstruction after an oral cancer resection. The effect of midline corset platysmaplasty on degree of. Jun 01, 2001 the platysma myocutaneous flap for intraoral reconstruction was introduced in 1978.
The upper part of platysma is supplied by submental artery and the lower part is supplied by transverse cervical artery, 14. The flap was raised along with the platysma muscle and artery, with the first lobe rotated to the lip and the second lobe inset into the first lobe site, permitting neck closure without skin redundancy. The muscle was taken with the forceps at the spot where the cervicomandibular angle was to be placed figure 3, a and b. Nov 20, 2017 the platysmal bands are marked with patients awake and standing up and can be treated easily by two methods, the closed platysmotomy, as i describe elsewhere, using strong multibraided threads with needles fig. There has been an emphasis on the anatomical vascular supply and method of preparation of the platysma myocutaneous flap and its use in the oral cavity. The platysma myocutaneous visor flap for intraoral. The objective of this paper is to show that platysma flaps have good results and should be an alternative in reconstructive surgery for oral tumors when microsurgery is not possible. The platysma flap is a myocutaneous flap that is based on. This study investigated whether a prevascularized segmental tracheal substitute using platysma can enhance tracheal mucosal regeneration. Platysma muscle flap was advanced into the defect after excision of depressed scar. A lateral platysma flap is created to enhance the jaw line and the smas is treated by transverse high plication baker gordon symposium on cosmetic surgery. Based on the vasculature characteristics, the platysma can be horizontally divided into two muscle flaps.
Platysma myocutaneous flap for intraoral defects jama. The platysma myocutaneous flap for intraoral reconstruction was introduced in 1978. It is a versatile, portable, and thin flap, is easy to perform, and can be obtained during neck dissection, with a primary closure of the donor site. Disorders of temporomandibular joint are intolerable for the patients in severe cases. Composite platysmaplasty and closed percutaneous platysma. The platysma flap should be considered fasciocutaneous rather than musculocutaneous. The surgical technique used was original and was based on the principle of auricular cartilage revascularization using the platysma muscle.
The platysma flap may be used to close defects on the lower face, buccal mucosa, and floor of mouth. The platysma myocutaneous flap offers an excellent alternative for reconstructing appropriate oral cavity defects resulting from tumor ablation. The platysma is a broad sheet arising from the fascia covering the upper parts of the pectoralis major and deltoid. Patients patients described in the literature with head and neck surgery who underwent platysma flap reconstruction. Various planes of dissection as well as the deep subperiosteal plane has also been used for surgical correction of the aging face 12. The flap is elevated well beyond the anterior end of the parotid. Yet, it was only introduced to the english literature in 1978 by futrell et al, 1 and since then, it has become established as an attractive reconstructive alternative with several potential advantages. The procedure was done under local anesthetic in two patients. However, there are several reasons why this flap should remain in our armamentarium of reconstructive options. The posteriorly based platysma flap in oral and facial reconstruction. Submental versus platysma flap for the reconstruction of. The advantages of this flap are the proximity to the surgical area, and the fact that the skin island pedicled by platysma muscle is easily. Prevascularized tracheal scaffolds using the platysma flap.
The aim of the study is to present our experience using vertical pmf that sacrificed the facial artery and vein for intraoral reconstruction. Jul 01, 2008 the platysma myocutaneous flap pmf is a common reconstructive option for defects in the head and neck region. The platysma flap is simple, versatile and should be valued as a reconstructive option, with interesting visual qualities 1, 1921. Nineteen of 22 patients in whom this flap was used healed without major complication. Platysma myocutaneous flap revisited jama otolaryngology. The flap should not be used if the sternocleidomastoid muscle will be removed as a part of the planned neck surgery. Furthermore, surgical treatment of temporomandibular joint problems is a challenge for surgeons in some cases. The platysma musculocutaneous flap has been used in 24 patients for reconstruction in the head and neck area. The possible advantages and limitations of the technique are discussed. Subcutaneous surface includes loose adipose tissue.
Therefore, the platysma flap should usually be elevated with the deep adipofascial tissue under the platysma. The platysma myocutaneous flap is an infrequently used flap in head and neck reconstruction. This flap carries on its distal tip a portion of isolated cervical skin to be used for intraoral replacement of the resected tiss fourteen patients were treated for intraoral epidermoid carcinoma with a single stage reconstructive technic employing a myocutaneous flap based upon the platysma muscle. The platysma myocutaneous flap pmf is a common reconstructive option for defects in the head and neck region. In 22 patients, the superior vascular pedicle, the submental branch of the facial artery, was used, and in two other. The additional operating room time is negligible, the surgical complications minimal, and the overall quality of life very good. The platysma myocutaneous flap dates back to 1887 when an austrian surgeon, robert gersuny, described repair of a cheek defect. Platysma muscle flap was advanced into the defect after excision of. Platysma myocutaneous flap for intraoral reconstruction.
It is a good therapeutic tool for craniofacial reconstruction, especially for small and mediumsized defects of the oral cavity and lower mid face 15, 20, ideal for patients with difficulty to withstand. Dec 01, 2005 the platysma myocutaneous flap dates back to 1887 when an austrian surgeon, robert gersuny, described repair of a cheek defect. Five cases are presented, three men and two women, 51 and 71. Neurotized free platysma flap for functional eyelid. Sandhir, et al platysma flap in depressed neck scars tracheostomy scar. The locations where neurovascular structures entered the platysma muscles were expressed as the percentage distance sd from the sternocleidomastoid muscle mastoid insertion to manubrium origin. The authors used a stickshaped platysma flap technique to close these narrow and deep intractable fistulas. The aim of the study is to present our experience using vertical pmf that. Use of the inferiorly based platysma flap for hypopharyngeal. The upper muscle flap was reversed upward to be fixed to the margin of mandible. Reconstruction of the oral cavity using the platysma. The vertical platysma plication extends from just above the thyroid cartilage to approaching the bony chin.
Possonnet, complications of the myocutaneous platysma flap in intraoral reconstruction, head neck 20 1998, pp. The platysma flap can be superiorly, posteriorly, or inferiorlybased. Methods information regarding the tumor, surgical procedure, flap design, and outcome emphasizing complications and function was extracted. However, the platysma flap remains an alternative for reconstruction of the oral cavity because it is versatile, portable, and thin. Results seventyone patients 37% developed a complication, ranging from 20% at the buccal mucosa to 55% at the tonsil and at the alveolar ridge.
Dissection continues over the superficial surface of this muscle to avoid its denervation fig. The arc of rotation is suitable for reconstruction of the anterior and lateral floor of mouth, buccal mucosa, retromolar trigone, and skin of the lower cheek and parotid region. Platysma myocutaneous flap including the external jugular vein with special reference to neck dissection. The platysma skin flap is an ideal tissue for the reconstruction of articulation structure in open surgery of t2 and t3 unilateral glottic laryngeal carcinoma. In selected patients, the platysma myocutaneous flap is a highly useful onestage procedure to close defects of the oral cavity. The platysma myocutaneous flap has enjoyed limited popularity despite its versatility, dependability, and ease of harvesting. With the forceps pulled firmly, the first anchoring suture was made. It has certain advantages over other local or distant pedicled flaps and has been proved to be a reliable alternative for singlestage repair of these defects.
The platysma flap was described in 1970 by paul tessier, but was immediately eclipsed by other techniques such as the myocutaneous pectoralis flap or the microsurgical temporary flap 57. Flap survival is threatened if it is elevated without the adipofascial tissue under the muscle as with a usual musculocutaneous flap. The temporomandibular joint tmj acts as a sliding hinge between mandible and temporal bone. Platysma myocutaneous flap for oral cavity reconstruction. A total of 65 patients presented with tumors of head and neck and underwent curative tumor resection with different neck dissections at the department of oromaxillofacialhead and neck surgery, school of stomatology of china medical. The platysma flap has often been used for reconstructions of the head and neck, but the arterial anatomy of the platysma itself has not been clarified. Associations between putative risk factors for flap failure and outcome were assessed using the. The authors conclude that the platysma myocutaneous flap provides thin, pliable, reliable tissue for use in the oral cavity.
The lopplateral overlapping plication of the platysma. Vertical platysma myocutaneous flap that sacrifices the. Use of a platysma myocutaneous flap for the reimplantation of a. The platysma myocutaneous flap has seen limited application in the reconstruction of head and neck defects over the past decade. The anterolateral neck skin in five sides of four fresh cadavers that had been injected systemically with a lead oxidegelatin mixture was elevated and divided into three layers. The platysmal bands have been cut, sutured, and zplastied 11. This flap should be used more frequently in the reconstruction of oral cavity defects. The platysma myocutaneous flap for oral cavity reconstruction. Its anterior portion, the thickest part of the muscle, depresses the lower jaw. This flap carries on its distal tip a portion of isolated cervical skin to be used for intraoral replacement of the resected tiss.
This flap had limited usefulness for hypopharyngeal reconstruction for two reasons. In selected cases, the flap will extend to the oropharynx. Superior platysma musculocutaneos flap the dominant blood supply is from the submental branch of the facial artery and the venous drainage of the v. The large smas platysma flap is rotated in a cephaloposterior direction, trimmed, and sutured along the original incision lines. Its applications have expanded from the reconstruction of intraoral defects to include laryngopharyngeal, lip, and cheek defects. Neck dissection was performed in two of these three cases with ischemic complications. Our experience concerns the use of the platysma myocutaneous flap in 12 patients after intraoral and extraoral malignant tumor resection. Platysma myocutaneous flap for reconstruction of skin.
Angiographic study of the platysma the platysma flap has often been used for reconstructions of the head and neck, but the arterial anatomy. The superior thyroid, facial, and lingual vessels were the major pedicles in eight of 14 57. There are anatomical and physiological reasons for this. Management of the lateral portion of the platysma muscle has evolved from plication to suspension and flap transposition 8910. The external jugular vein provided the primary venous drainage, followed by the submental vein. After cervical flap elevation and appropriate defatting, the medial border of each platysma muscle is identified and joined in the midline with the use of a series of interrupted sutures. Pdf platysma myocutaneous flap its current role in. Jun 15, 2020 acceptable voice quality was achieved for 46 patients who underwent vertical partial laryngectomy. Main outcome measures results of logistic regression analyses. To compare the platysma flap with submental flap in terms of tumor and flap characteristics, operative properties and the functional outcomes. May 30, 2002 the use of a modified myocutaneous platysma flap is presented for a patient with a large ameloblastmoma of the mandible. Fourteen patients were treated for intraoral epidermoid carcinoma with a single stage reconstructive technic employing a myocutaneous flap based upon the platysma muscle. This video demonstrates surgical correction of vertical bands on the anterior neck with muscle approximation and wedge resection of platysma below the level of suturing.
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