Platysma Flap Research Articles

Phonatory Flap Wave in Platysma Skin Flap: Functional Evaluation and Influencing Factors Analysis.

In this study, we analyze the phonatory function of the phonatory flap vibrational wave (PFVW) and examine potential factors influencing its formation, with a focus on the tissue structure of the platysma skin flap. This investigation aims to enhance the postsurgical voice quality of patients with laryngeal defects that have been repaired using platysma skin flaps. A retrospective analysis was conducted on patients diagnosed with unilateral glottic laryngeal cancer, classified as T2-3N0-2M0, or those who were pathologically confirmed to have laryngeal squamous cell carcinoma, encompassing various degrees of differentiation. Following vertical partial laryngectomy, the resulting defect was repaired using platysma skin flaps. Post-surgery, the fundamental frequency (F0, Hz), jitter (%), and shimmer (%) of the patients' voices were recorded utilizing the multidimensional voice program (MDVP) system. Additionally, voice quality was evaluated subjectively using the GRBAS scale. Stroboscopic laryngoscopy was performed to observe the phonatory movements of the reconstructed larynx and the vibration of the internal flap. Based on the presence of PFVW 3 months after surgery, 54 patients were divided into two groups: the PFVW group (20 cases) and the non-PFVW group (34 cases). After 6 months, the PFVW group exhibited significantly better jitter, shimmer, and MPT parameters than the non-PFVW group (p < 0.05). Additionally, the PFVW group had lower overall hoarseness, roughness, breathiness, strain, and total GRBAS scores than the non-PFVW group (p < 0.05). Univariate and multivariate logistic regression analyses suggested that the subcutaneous fat thickness of the platysma flap was a predictive factor for the occurrence of PFVW following vertical partial laryngectomy and platysma flap repair (odds ratio [OR] = 7.835, p = 0.003). The thickness of subcutaneous fat tissue below the platysma muscle is an important factor affecting the occurrence of PFVW after vertical partial laryngectomy and platysma muscle reconstruction.

The platysma myocutaneous flap as a reconstructive option in head and neck surgery: harvesting procedure.

Reconstructive surgery relies on microvascular flaps as the gold standard, however, for patients at high risk of extended procedures, a local flap may be preferable. In such cases, the platysma flap represents an effective option for the oral cavity, oropharynx, and small to medium-sized facial defects. Nevertheless, its use remains controversial, particularly regarding oncological radicality and safe neck dissection. This paper presents a step-by-step description and video of a clinical case from the Hospital of Bolzano, demonstrating a modified platysma flap technique. The proposed variant, with its arterial supply from the facial artery, offers a more oncologically radical approach for local reconstruction.

Efficacy of Platysma Flap in the Management of Oral Submucous Fibrosis—A Case Report

Oral submucous fibrosis (OSMF) is a potentially malignant condition of the oral cavity. Various surgical treatment modalities have been advocated in the management of OSMF with variable results. We are reporting a case of OSMF Group IVa where the post-fibrotomy defect was reconstructed using a platysma myocutaneous flap (PMF) in a young male patient. Postoperatively, patient was evaluated during a regular follow-up period for one year. The Preoperative interincisal opening of 2 mm gradually improved to 35 mm at the end of one year postoperatively with no postoperative complications. The facial aesthetic is not compromised as the incision is some way from the face and the scars are hidden underneath the collar. PMF can be considered a good reconstructive option for OSMF with aesthetically acceptable results, however, the technique is more demanding and must be mastered properly.

Neurovascular anatomy of the platysma muscle for blepharoptosis repair: a cadaveric study.

This study aimed to define a new surgical method using a neurotized platysma free flap to provide dynamic reanimation, enhanced functional recovery, and low morbidity for blepharoptosis repair. Ten hemifaces and neck halves of five formalin-fixed cadavers were included in the study. The origin of the neurovascular structures of the pedicle was identified at the submandibular triangle. A 5 × 3cm platysma flap was dissected. For the recipient side, the main donor vascular structures were observed at the frontal part of the temporal region. The diameters of the donor structures were measured with a digital Vernier caliper. The statistical analysis of the study was performed with Jamovi statistical software version 2.3.36. P < 0.05 was accepted as a statistically significant value. At the donor region, the pedicle included branches of the cervical branch of the facial nerve and the facial artery in all specimens. However, the venous graft pedicle origin could be either the facial vein or the lingual vein. At the recipient region, the mean diameters of the most anterior nerves, arteries, and veins were 1, 2.03, and 2.37mm respectively. In a side comparison of pedicle variables, only pedicle artery diameter and lateral palpebral commissure-anterior superior point of auricula distance had statistically significant differences between hemifaces. A 5 × 3cm size platysma flap located in the submandibular trigone would be a good choice for functional blepharoptosis surgery. The thin structure and the appropriate neurovascular pedicle structure should enable performing a successful flap transfer.

Fixation of Superolateral Platysma Flap to the Mastoid Fascia: A Novel Isolated Neck Lift Technique.

This study aimed to evaluate the utility of a novel neck lift technique based on fixation of superolateral platysma flap to the mastoid fascia in terms of postoperative aesthetic outcome and patient satisfaction within an 18-month follow-up period. A total of 145 female patients who underwent isolated neck lift operation with the superolateral platysma flap technique were included. Global Aesthetic Improvement Scale (GAIS) scores (by the investigator) and the patient reported outcomes were recorded in terms of improvement in the cervicofacial angle, jowls, platysmal bands and malpositioned cervical fats, at 6 and 18 months, postoperatively. The complications were recorded at early postoperative period and at 1, 6 and 18 months, postoperatively. The median duration of follow-up was 18 months (range, 6-48months). GAIS scores at 18th months, revealed exceptional improvement in the cervicofacial angle (82.8%), the jowls (93.1%), platysmal bands (93.1%) and malpositioned cervical fat (97.2%). Majority of patients were very satisfied with the treatment in terms of the aesthetic improvement. Complications involved the minor ecchymosis (17.2%) and minor skin circulatory problem (11.7%) in the early postoperative period, suture exposure (12.4%) in the postoperative 1st month, and cervical band reformation in the 6th (0.7%) and 18th (1.4%) months. In conclusion, lateral displacement and fixation of superolateral platysma flap to the mastoid fascia seems to be a useful neck lift technique for correction of platysma- and skin-derived aging sings with minor and manageable complications, immediate return to everyday activities and a high patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Complete Platysma Muscle Suspension in Deep-Plane Face-Lift Surgery.

Deep-plane face-lift surgery is not new, having originally been described over 30 years ago; however, the technique has seen a recent surge in popularity. Although proponents emphasize its ability to deliver very natural results, critics often cite the possibility of additional risk of the procedure because of its technically challenging dissection in proximity to branches of the facial nerve and other critical structures. These risks are perhaps greatest when operating in what have historically been described as the "danger zones," particularly when releasing the zygomatic retaining ligaments, when performing the medial deep plane dissection in the midface, and when extending the platysma flap over the angle of the mandible into the neck. The senior author (D.B.R.) has performed deep-plane face-lift surgery for over 20 years, training many novice surgeons to perform this procedure safely and incrementally. In this article, the authors illustrate surgical techniques to optimize safety when performing deep-plane dissections. A novel vertical midline platysmaplasty combined with extended release of the low cervical platysma provides rejuvenation of the neck that extends to the clavicles.

Evaluation of the non-endoscopic and endoscopic-assisted platysma flap - A randomized control trial.

As oral submucous fibrosis (OSMF) is a chronic progressive disorder, the treatment is based on the severity of the disease. Surgical treatment is the only choice for grade III and grade IV OSMF cases because the patient can neither clean his/her mouth nor properly chew. The resulting soft tissue defect requires resurfacing with various well-vascularized tissues such as extraoral flaps, intraoral flaps, microvascular flaps, and allografts that have been used. Reconstruction of the resultant defects proved to be challenging. Till date, none of the flaps has been proven to be effective and is universally accepted for the treatment of OSMF because of various drawbacks of the available techniques. This study was conducted to know whether an endoscopic-assisted platysma flap is associated with better outcomes in terms of ease of operation and postoperative function than the conventional approach. This study included 40 patients of grade III and grade IV OSMF reporting to the outpatient department of oral and maxillofacial surgery in a tertiary center of North India. These patients were divided randomly into two groups. Group I and Group II had 20 patients each, undergoing endoscopic-assisted platysma flap and non-endoscopic-assisted platysma flap for reconstruction after resection of OSMF bands, respectively. Data were analyzed for the mouth opening, operating time, flap viability, congestion of neck and oral cavity, signs of inflammation, neurologic assessment, and measurement of the drain. The results showed significant increase in mouth opening from the preoperative value to the values immediately after surgery and at 24 h, 1 week, 15 days, 1 month, 3 months, and 6 months after surgery in both the study groups. Reduced bleeding incidence was found in group I compared to group II, with better postoperative outcomes noted during follow-up. But the mean intraoperative time of the subjects in group I was 130.80 ± 5.5.908 min and in group II was 105.74 ± 2. 491 min. Increased time taken in group I may be due to the long learning curve. The present study concluded that the Endoscope-assisted technique has a key role during supra and subplatysmal dissection to allow for better accessibility, handling, and visibility of the flap and its orientation in relation to the underlying structures to avoid postoperative complications and to overcome the drawback of platysma myocutaneous flap in reconstruction of OSMF defects.

Comparative Evaluation of Nasolabial Flap, Buccal Fat Pad and Platysma Myocutaneous Flap for Reconstruction of Oral Sub Mucous Fibrosis Defects.

Moderately advanced (stage III) and advanced (stage IV a & b) OSMF requires surgical intervention for management A number of options are available for reconstruction of post OSMF oral cavity defects. In our study we retrospectively compared buccal fat pad, nasolabial flap and platysma flap for reconstruction of the buccal mucosal defects. Patient records were obtained from the medical records section of the Institute and divided into three groups; group A (buccal fat pad), group B (nasolabial group) and group C (platysma flap). Maximal mouth opening and intercommisural distance were the primary outcomes. Kruskal Wallis test was used to test the mean difference between three groups. Mann-Whitney test was used for intergroup comparisons. Wilcoxon signed rank test was used to evaluate the mean difference in outcomes at each follow up interval. A p value of < 0.05 was considered as statistically significant at 95% confidence interval. After 1year follow up patients in platysma group had significantly better mouth opening (39.84 ± 1.65mm) compared to both buccal fat pad (36.69 ± 3.41mm) and nasolabial groups (37.94 ± 0.43mm). Inter commisural distance was significantly better in patients reconstructed with platysma flap (59.21 ± 0.99mm) compared to both buccal fat pad (54.11 ± 1mm) and nasolabial flap (56.84 ± 1.48mm). Platysma flap lead to significantly better maximal mouth opening compared to both nasolabial and buccal fat pad. Both buccal fat pad and nasolabial lead to comparable mouth opening. Inter commissural distance is maximum with platysma flap followed by nasolabial flap and buccal fat pad.

Efficacy of platysma flap in oral submucous fibrosis: Preliminary study

: Efficacy of platysma flap in terms of esthetics, function (mouth opening) &amp; postoperative compliance of the patient.: Eight cases are included, seven men and one women, 40 - 50 years old, after resection of fibrous bands. All of them were reconstructed with a platysmaflap.No local complications occurred with this technique. Overall aesthetic and functional results were acceptable in all the patients. Of 8 patients, six had no postoperative complications. The remaining two developed venous congestion, with limited skin loss. All flaps remained viable. The platysma flap is a good method to reconstruct buccal mucosa after resection of bands in oral submucous fibrosis. It is a versatile, portable, and thin flap, is easy to perform with a primary closure of the donor site.

Protection of the marginal mandibular branches of the facial nerves by different surgical procedures in comprehensive cervical lymphadenectomy for locally advanced oral and oropharyngeal cancer: a multicenter experience

ObjectiveAccording to the different characteristics of patients and cervical lymph node metastasis of oral and oropharyngeal cancer, the marginal mandibular branches of facial nerves were treated by different surgical procedures, and the safety and protective effects of different surgical procedures were investigated.MethodsOne hundred ninety-seven patients with oral and oropharyngeal cancer satisfying the inclusion criteria were selected. According to the different characteristics of patients and cervical metastatic lymph nodes, three different surgical procedures were used to treat the marginal mandibular branches of the facial nerve: finding and exposing the marginal mandibular branches of the facial nerves at the mandibular angles of the platysma flaps, finding and exposing the marginal mandibular branches of facial nerves at the intersections of the distal ends of facial arteries and veins with the mandible, and not exposing the marginal mandibular branches of the facial nerves. The anatomical position, injury, and complications of the marginal mandibular branches of the facial nerves were observed.ResultsThe marginal mandibular branches of the facial nerves were found and exposed at the mandibular angles of the platysma flaps in 102 patients; the marginal mandibular branches of facial nerves were found and exposed at the intersections of the distal ends of the facial arteries and veins with the mandibles in 64 patients; the marginal mandibular branches of facial nerves were not exposed in 31 patients; among them, four patients had permanent injury of the marginal mandibular branches of the facial nerves, and temporary injury occurred in seven patients. There were statistically significant differences in the protection of the mandibular marginal branch of the facial nerve among the three different surgical methods (P = 0.0184). The best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap, and the injury rate was only 2.94%.ConclusionThe three different surgical procedures were all safe and effective in treating the marginal mandibular branches of the facial nerves, the best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap.

A New Technique for Chondrolaryngoplasty in Patients Assigned Female at Birth.

Chondrolaryngoplasty is a classical facial feminization surgery for transgender women. In recent years, however, an increasing number of patients assigned female at birth are seeking chondrolaryngoplasty for esthetic purposes. Traditional chondrolaryngoplasty can no longer cope with problems of the growing group whose leading cause of laryngeal prominence differs from the transgender population. A modified technique is designed as a supplement to the classical procedure. After the cartilage reduction process, paired platysma flaps are raised and advanced successively, resulting in an overlapped area over the thyroid notch, to further camouflage the thyroid prominence. To evaluate the efficiency of the new technique, a retrospective survey of 34 patients (5 men and 29 women) who underwent the surgery from 2016 to 2021 was performed, via a 5-point Likert scale including 7 questions. Physician assessment was also accomplished to provide an extra estimation. Complications were followed up and analyzed to evaluate the safety of modified surgery as well. Although only half of the patients graded prominence changes more than "moderately changed," as many as 75.0% of them still expressed "completely satisfied" or "satisfied very much" with the outcome. Similarly, physician assessment indicated a satisfactory result in appearance improvement. No severe and irreversible complications occurred after surgery, but lasting scar-related issues were reported by 4 patients and should be paid more attention to. Generally speaking, the new technique is both safe, efficient, and satisfying for most patients, especially ones assigned females at birth with esthetic demand.

Subperiosteal Midface Lift with Sub–Superficial Musculoaponeurotic System Rhytidectomy

The subperiosteal midface lift is a powerful tool that allows the surgeon to reposition the SOOF and malar fat pad in a vertical direction. Additionally, it significantly softens deep nasolabial folds. Its effect, however, is minimal with regards to addressing the jowl, jawline, gonial angle and cervicomental angle. Combining the subperiosteal midface lift with an extended sub-SMAS rhytidectomy addresses the pre-jowl sulcus by releasing the mandibular ligament. The jawline and gonial angle become more defined with the transposition and suspension of the SMAS flap. The SMAS transposition flap along with the suspension of the platysma flap to the mastoid fascia support the submandibular glands and deepen the cervicomental angle. These two approaches are valuable additions to the surgeons armamentarium and can yield excellent results in carefully selected patients.

Role of Indocyanine Green in Mapping Sentinel Cervical Lymph Node Involvement in Patients of Oral Squamous Cell Carcinoma - Preliminary Data from a University Hospital

Role of Indocyanine Green in Mapping Sentinel Cervical Lymph Node Involvement in Patients of Oral Squamous Cell Carcinoma - Preliminary Data from a University Hospital

The use of ARTISS fibrin sealant in thyroid surgery: case series and review of the literature.

Abstract Introduction Many techniques have been described to reduce length of stay and complication rates in thyroid surgery. ARTISS is a fibrin sealant used as an adjunct to sutures or staples, whereby it simultaneously adheres and seals subcutaneous tissues. In the context of thyroid surgery, it can augment the closure of dead space beneath the strap muscles and the platysma flaps. Methods A single surgeon adopted this novel technique from February 2017. A retrospective audit of 72 thyroid cases using ARTISS was conducted. Data were collected on patient demographics, ASA grade, procedure, histology, drain insertion and output, length of stay and complications. Results 71 (99%) patients had a drain inserted. Of the 57 hemithyroidectomies, 13 (23%) patients had their drain removed and were discharged on the same day, 41 (65%) the next day and 3 (6%) remained at 2 days post-operatively. Of the 41 hemithyroidectomies who stayed one night, 21 (51%) patients had been operated on in the afternoon and were discharged the following morning. Of the 15 total thyroidectomies, 9 (60%) patients had their drain removed the following day and 6 (40%) at 2 days post-operatively. There was one post-operative superficial haematoma which did not require re-operation, another which required aspiration only, and one case of suspected wound infection treated with oral antibiotics. Conclusion The use of ARTISS fibrin sealant in this case series has been shown to be a safe and successful technique. Most patients are discharged within 24 hours of surgery and no cases required a return to theatre.

Efficacy of Platysmamyocutaneous Flap in Oral Defects.

Clinicians are baffling for reconstruction of small- to medium-sized defects of the oral cavity since time immemorial, each and every flap has its own limitations, ideal flap should be pliable, easily transferrable that can result in a better restoration of form and function of oral mucosa, we have platysma for the same purpose. We aim to provide surgical technique of the superiorly-based platysma myocutaneous flap with a single neck incision in this study, as well as the flap design, results, and complications associated with age, gender, the recipient site, and the size of the defect. Study included 20 patients with oral potentially malignant disorders operated under local anaesthesia with wide local excision and reconstruction with platysma myocutaneous flap at a single tertiary care centre. The association between the variables was calculated using Chi-square tests and paired t tests. P < .05 was considered significant. Five cases of dehiscence were found at varied sites and flap viability was significantly influenced by location of skin paddle. In between anterior jugular vein and posterior external jugular vein it was 100% viable while on and posterior to the vein, had skin paddle loss. Significant improvement in mouth opening was also seen in Oral Sub-mucous Fibrosis patients. The platysma flap is a technique sensitive, and its results are promising for the reconstruction of oral defects.

A case of electric injury with exposed neck vessels and scapula treated with flaps

In modern times, the use of electricity has increased many times and so has the incidence of high-voltage electrical injuries. The incidence of high-voltage electrical injuries is much higher in developing countries when compared to developed countries, lack of proper transmission systems being the cause. Electric burn injuries lead to debilitating morbidity to the affected patients and are often deadly. In such cases with exposed vessels in the neck, major flaps such as the deltopectoral flap or forehead flap or free flaps increase the hospital stay or two-staged procedures and hence increase the morbidity of such patients. Here, we present a case of a young male patient who sustained an electric injury to his foot, neck, and shoulder, which was managed with the platysma flap and parascapular flap with no donor site morbidity.

The sub-fascial pattern of the myocutaneous platysma flap – The anatomical basis and preliminary cases for oral reconstruction.

The sub-fascial pattern of the myocutaneous platysma flap – The anatomical basis and preliminary cases for oral reconstruction.

Comparative Evaluation of Reconstructive Methods in Oral Submucous Fibrosis.

Oral submucous fibrosis is a chronic, progressive, scarring, precancerous condition of oral mucosa which on progression causes severe trismus. To compare and evaluate the efficiency of buccal fat pad, platysmal mucocutaneous flap, nasolabial flap, collagen membrane graft, split thickness skin graft and temporoparietal fascia in reconstruction of surgical defect created by excision of fibrous bands in oral submucous fibrosis. After 6months of follow-up, the interincisal mouth opening was 40.0mm in case of buccal pad fat, 24.5mm in temporoparietal fascia flap group, 33.8 in collagen membrane graft group, 34.5mm in platysma flap group, 34.7mm in nasolabial flap group, 29.3mm in split thickness skin graft. ANOVA statistical analysis for postoperative interincisal distance at various time intervals and between pre-, intra- and postoperative interincisal distances were carried out which showed the results were significant at p value < 0.05 in all groups. No postoperative complications were noted in buccal fat pad group, split thickness skin graft group and collagen membrane group. However, platysmal group had flap necrosis and temporoparietal flap group patients had to undergo a second debulking procedure after one month. From our study, we concluded buccal fat pad yields superior results with respect to postoperative mouth opening and related complications.

Total Neck Rejuvenation, Harnessing the Platysma in the Lower Neck and Décolletage.

Efforts to rejuvenate the lower neck and décolletage have not been adequately addressed by neck lift techniques which predominantly focus on improving the cervicomental angle and correcting fullness in the submental and submandibular region. Disappointment with a lack of initial result in the lower neck and early relapse of laxity led the author (DJH) to adopt the Fogli/Labbé vertical neck lift with a fixation of the platysma muscles to Loré's fascia Fogli (Aesthet Plast Surg 32:531-541, 2008), Labbé et al. (Plast Reconstr Surg 117:2001-2007, 2006). Over the past 8years, since the original "modified" Fogli description was published by Hodgkinson (Aesthet Plast Surg 36:28-40, 2012), the technique has evolved with a specific aim to improve the initial results of the neck lift in the lower half of the neck and have the result maintained in follow-up. The clinical photographs of female patients who underwent face and neck rejuvenation utilising a modified Fogli vertical platysma advancement technique were evaluated as to the improvement of the rejuvenation in the lower neck and décolletage and compared with the photographs obtained by the original pexy technique. The review was restricted to patients operated on in the prior extant three-year period and compared with the results of patients having surgery in that preceding five years prior to the review period. The results of the recent technical modifications of the vertical lift by the platysma flap advancement were superior to the previous pexy technique and attributable to the advent of the surgical auricular-platysmal flap advancement. This flap, which in continuity with the distal platysma was affixed with permanent sutures to Loré's fascia after definitive release of the cervical retaining ligaments of the platysma. The modifications of the vertical platysma fixation to Loré's fascia after mobilisation of the distal platysma by detachment of the cervical retaining ligaments utilising an advancement of the platysma led to improvement in the rejuvenation of the lower neck and décolletage when compared to the pexy technique of the original Fogli/Labbé description. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Platysma muscle additionally innervated by a variant anterior branch of the great auricular nerve

Damage to the great auricular nerve, with consequent clinical deficits, is a common surgical complication in facial aesthetic and in head and neck procedures such as parotidectomy, neck dissection, rhytidectomy and platysma flap operations. Hence, a thorough knowledge of nerve anatomy, particularly its potential variations, is critical in reducing the associated operative morbidity. Accordingly, we report an unusual variation of the anterior branch of the great auricular nerve noted in an 81-year-old female cadaver. The nerve was observed to course into the submandibular region anterior and superficial to the internal jugular vein, communicating with the cervical branch of the facial nerve, while independently innervating the platysma muscle. Although several anatomical variations of the branches of the cervical plexus have been documented, our report describes unique innervation of the platysma muscle by the great auricular nerve, which provides a new insight on the motor component of the nerve.