Modificiation of infrahyoid neuromyocutaneous flap with radical neck dissection

Understanding technique of flap surgery allow uncompromising tumor resection and operation of tumors previously considered inoperable. Infrahyoid neuro-myocutaneous flap (IHNMCF) is pedicled flap harvested from the anterior part of the neck. IHNMCF is a good solution for the moderated sized defects of the head and neck below the zygomatic arch. The objective of this article was to describe modified infrahyoid neuromyocutaneous flap used for reconstruction of tongue and mouth floor defects, immediate after removing neoplasm.

A 63 year old patient were hospitalized with pathohistologically confirmed-squamocellular carcinoma. The tumor were in the region of the ventral part of the mouth. Magnetic resonance imaging (MRI) and ultrasound investigation of the head and neck showed detectable nodes in the right side of the neck and suspicious nodes in the left side of the neck. Through the transmandibular approach it was performed a wide local excision of the tumor. IHNMCF was harvested from the right side. It was performed meticulous microvascular procedure venous end-to-end anastomosis of the right superior thyroid vein to the left superior thyroid vein. Patient is during procedure subjected to the supraomohyoid neck dissection on the left side and radical neck dissection on the right side.

Disadvantage of this modified infrahyoid flap is the extremely limited arc of rotation. This seriously limits its applications to specific situations, where defects are located very close to the flap. Othervise, advantage of this modified flap is that radical neck dissection is not contraindication anymore. In this case flap was successful, without flap necrosis or complications in the donor side. Speech and swallow were without significant decrease. After radiation therapy flap remained sufficiently soft, trophic and mobile.