Per-Sternomastoid Neck Suspension in Rhytidectomy: A Technical Note

Abstract

Introduction: Compound skin platysma suspension to the tympanoparotid fascia according to Labbé is an efficient technique in neck lift with minimal dissection and morbidity. One disadvantage remains in the fatty neck; the lifted tissue block is pulled over one of the most prominent features of a young neck: the retromandibular fovea situated between the ascending mandibular ramus and the insertion of the sternomastoid muscle (SCM). The authors propose to pull the compound flap medially by suspending it deep through the SCM to the mastoid fascia. This also helps to support a ptotic submandibular gland. Materials and Methods: Computed tomography (CT) scans and magnetic resonance imaging (MRI) of 40 patients (20 female, 20 male) with oropharyngeal malignancy were analyzed for the thickness of the SCM and the safety distance to the internal jugular vein. Results: The total average thickness of the SCM was 10.5 mm (SD 1.4) for females and 11.7 mm (SD 1.9) for males. A security distance of 6 mm from the medial SCM surface to the jugular vein was noted in females, and 7–8 mm in males. Conclusion: Deep per-sternomastoid suspension of the platysma to the mastoid fascia, performed with an Obwegeser mandibular awl coming from the superoposterior direction, is a safe and useful modification of the Labbé platysma suspension.