© Georg Thieme Verlag KG Stuttgart · New York
Der M.-sternocleidomastoideus-Lappen: Eine Möglichkeit zum Verschluss des Stimmshunts nach LaryngektomieThe sternocleidomastoid muscle flap: An option to close a voice shunt after laryngectomy
23. Februar 2006 (online)
The closure of the voice shunt after surgical voice rehabilitation in totally laryngectomized patients is often a difficult task. The surgical procedure described by Manni does not always lead to success. We report about our experiences with the interposition of a sternocleidomastoid muscle flap to protect the suture. After separation of trachea and esophagus and the subsequent closure of the voice shunt, a sternocleidomastoid muscle flap is interposed between trachea and esophagus. The flap is caudally based at the sternum and measures half of the length and width of the muscle.
10 patients underwent surgery in this manner. In 9 out of 10 patients we were able to achieve a definite closure of the voice shunt right away. For the other patient, the remaining fistula healed within one more week without further surgery. In 2 cases, we noticed a partial necrosis of the posterior wall of the trachea, which healed without further complications. We did not see any of the possible complications, such as the stenosis of trachea respectively tracheostoma or esophagus or a paresis of the accessory nerve.
In due consideration of the blood supply, the sternocleidomastoid muscle flap is a reliable possibility of tissue transfer.
- 1 Conley J . Gullane PJ . The sternocleidomastoid muscle flap. Head Neck Surg. 1980; 2 308-311
- 2 Kierner AC . Zelenka I . Gstoettner W . The sternocleidomastoid flap - its indications and limitations. Laryngoscope. 2001; 111 2201-2204
- 3 Kierner AC . Aigner N . Zelenka I . Riedl G . Burian M . The blood supply of the sternocleidomastoid muscle and its clinical implications. Arch Surg. 1999; 134 144-147
- 4 Manni JJ . Indikationen zur definitiven Entfernung der Groningen-Stimmprothese und Schicksal der tracheoösophagealen Fistel. Otorhinolaryngol Nova. 1991; 1 146-150
- 5 Mann W . Grenzen und Anwendungsbereiche myokutaner Inselllappen in der rekonstruktiven Kopf-Hals-Chirurgie. Laryng Rhinol Otol. 1983; 62 29-32
- 6 Ross UH . Klenzner T . The myocutaneus sternocleidomastoid flap for reconstruction of the mouth cavitiy und pharynx. Laryngorhinootolgie. 1998; 77 168-171