Role of sternomastoid muscle interposition in concomitant transoral oncologic resection and neck dissection

To report the experience with sternomastoid (SM) myofascial flap for reconstruction/buttressing of lateral pharyngeal wall and floor of mouth defects following transoral onco-surgery.

Prospectively collected data from February 2012-January 2018. SM flap harvested as a superiorly based flap supplied by the occipital artery and consisting of only the anterior SM head.

A total of 42 patients were included (TORS, n = 40; TOUSS, n = 2). Three of 42 patients developed transient pharyngo-cervical communications with subsequent spontaneous healing. Flap loss was not noted in any patient. Forty-one of 42 patients resumed normal swallowing and one patient was PEG dependent. Fifteen of 42 patients had pretreatment metastatic neck nodes. No patient however developed nodal recurrence over a median follow-up of 30 months.

The modified SM flap as reported here is a simple locally available reconstructive option when undertaking transoral surgery. Oncological concerns may however limit its use in situations with large nodal metastasis or extracapsular spread.