Modified transmanubrial osteomuscular sparing approach in head and neck tumor extending to the upper lateral mediastinum

Abstract

The transmanubrial osteomuscular sparing approach （TMA） for apical chest tumors reported by Grunenwald et al. preserves shoulder articulation and provides excellent access to the subclavicular region. We performed modified TMA with resection of sternocleidomastoid muscle （SCM） and major pectoralis muscle in five patients in order to remove head and neck tumor extending to the upper lateral mediastinum. In all cases, exposure of the subclavian vessels was excellent. In four cases, the brachiocephalic vein or subclavian vein was resected. Complete resection of the tumor was performed in four cases. In all cases, favorable shoulder articulation was obtained and the postoperative course was uneventful. We conclude that modified TMA for head and neck tumor extending to the upper mediastinum provides a good surgical view and excellent cosmetic and functional results.