Platysmal Flaps for Cheek and Intraoral Reconstruction
J. N. BARRON
M. N. SAAD
L. O. VASCONEZ
The figures were originally included in Chapter 103, but because they are actually illustrations of platysma musculocutaneous flaps, a separate chapter was created for them, and text has been added. Special care must be taken to include the blood supply to the platysma in the pedicle.
A turnover platysma muscle flap based superiorly and including an island of skin in its distal third is admirably suited for resurfacing the intraoral mucosa following excision of buccal mucosal tumors and cicatricial release of caustic burn scars as well as for resurfacing the oral surface of the lower lip and creating a deeper sulcus. It has the added attraction of providing sensitive skin to the buccal mucosa as well as to the lower lip (1).
Clinical experience has demonstrated that defects in the buccal mucosa should be resurfaced with flap tissue, avoiding the use of skin grafts, which usually contract and produce trismus. The platysma is admirable for this purpose because it provides a flap that is quite thin and has skin devoid of hair. As a turnover flap pivoting along the mandible, it is introduced intraorally through a small tunnel. Although the flap has been used for extraoral coverage, to accomplish this, an additional twist must be added that may compromise the blood supply.
The platysma is a well-defined, thin muscular sheet in males, but it can be hypoplastic, especially in females. It consists of paired muscles that are obliquely oriented and flat and that phylogenetically represent the remnants of the panniculus carnosus (2).
The platysma extends from above the mandible to below the clavicle, and its cephalad and caudad edges insert into the skin. The blood supply to the muscle comes most often from the submental branch of the facial artery superiorly, and a smaller vessel is noted that is a branch of the superficial cervical artery inferiorly. The skin overlying the platysma derives its sensory supply from the cutaneous branches of the cervical plexus. Its medial and lateral borders are easily identified from the strap muscles and the trapezius muscle, respectively.