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PECTORALIS MAJOR MYOCUTANEOUS FLAP

INDIAN DENTAL ACADEMY
Leader in continuing dental education
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INTRODUCTION
• Development of myocutaneous flap- mid 70’s.
• Floor of the mouth, lateral tongue- sternocleidomastoid,
temporalis, nasolabial flaps.
• Larger defects- free flaps, regional flaps.

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TEMPORALIS MUSCLE FLAP

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TEMPORALIS MUSCLE
NASOLABIAL FLAP

NASOLABIAL
FLAP

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PECTORALIS
MAJOR

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ANATOMY
BLOOD SUPPLY
 Thoracoacromial artery, Lateral thoracic, Superior thoracic artery,
and Intercostal perforators from internal mammary artery

NERVE SUPPLY
 Lateral and medial pectoral nerves
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THORACOACROMIAL
ARTERY
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• ORIGN:- 1) Clavicular head
2)Sternocostal head
• INSERTION:- Lateral lip of intertubercular groove of
humerus
• ACTION:-Adducts and medially rotates humerus; draws
scapula anteriorly and inferiorly
Acting alone: clavicular head flexes humerus and
sternocostal head extends it.
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Clavicular head

Sternoclavicular head
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SURFACE MARKING

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INDICATIONS FOR PECTORALIS MAJOR
• OROPHARYNX
• MANDIBULAR RECONSTRUCTION
• ORBITAL EXENTERATION
• TEMPORAL BONE RESECTION
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CASES
1

2

3

4

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5

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CASE DETAILS
• CASE 1:- tumor-Lt gingivo buccal complex
nodal involvement-node positive
preop radiation-yes
 CASE 2:- tumor -right gingivo buccal complex
nodal involvement-node positive
preop radiation-no
 CASE 3:- tumor- left gingivo buccal complex
nodal involvement-node positive
preop radiation-no
• CASE 4:- tumor size- Lt gingivo buccal complex
nodal involvement- node positive
preop radiation-no
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DISSECTION MARKING

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AFTER RESECTION

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DISSECTED SPECIMENS

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DEFECT

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INCISION MARKING

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DISSECTION

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PECTORALIS MAJOR MUSCLE

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PEDICLE MARKING

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FLAP ELEVATED

Thoracoacromial vessels www.indiandentalacademy.com
INSET OF FLAP

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TUNNELING SUPRACLAVICULARLY

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SUTURING THE FLAP TO THE DEFECT

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FLAPS IN POSITION

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DONOR SITE

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DONOR SITE CLOSED PRIMARILY

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HEALING

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CASE 5

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ADVANTAGES
•
•
•
•
•
•
•

Single stage repair
Single dominant blood supply
Provides inner and outer lining
Protects carotid artery
Sufficient skin and soft tissue bulk
Good arc of rotation
Donor site closed primarily
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DISADVANTAGES
•
•
•
•
•

Might be too bulky for oral cavity
Arc of rotation limited for upper facial defects
Shoulder function impaired
Distal skin blood supply not reliable
Distortion of symmetry in donor site

SUPRACLAVICULAR BULGE

DISTORTED BREAST

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THANK U
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Leader in continuing dental education

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