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Lu H, Xu W, Zhu W, Wu Y, Yang W, Liu S. Functional reconstruction of tissue defects after total parotidectomy using a modified submandibular gland flap. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2025; 126:102022. [PMID: 39241830 DOI: 10.1016/j.jormas.2024.102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/18/2024] [Accepted: 08/22/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE Reconstruction of soft tissue defects after total parotidectomy requires a feasible and effective pedicled flap with sufficient volume. In this study, we introduce a modified submandibular gland flap (SMGF) for functional reconstruction of soft tissue defects resulting from total parotidectomy. MATERIALS AND METHODS This study included 12 patients diagnosed with parotid gland carcinoma undergoing total parotidectomy and ipsilateral selective neck dissection. The modified SMGF was harvested and transferred to the parotid bed. This procedure was coupled with anastomosis between the parotid gland duct and Wharton's duct. The feasibility of the surgery, postoperative complications, facial profile restoration, and salivary secretion were assessed. RESULTS All SMGFs pedicled only over the proximal facial artery survived without major complications. Facial profiles were well-restored, and salivary secretion was partially reserved. During the postoperative follow-up, no tumor recurrence was observed in any of the cases, and the volume of the SMGFs did not show obvious atrophy. CONCLUSIONS The modified SMGF is a viable solution for volume restoration and functional reconstruction after total parotidectomy. CLINICAL RELEVANCE This modified technique is simple and feasible for the functional reconstruction of soft tissue defects after total parotidectomy compared to other flaps and is worthy of clinical promotion.
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Affiliation(s)
- Hao Lu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China
| | - Wanlin Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China
| | - Wenya Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China
| | - Yifan Wu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China
| | - Wenjun Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China
| | - Shengwen Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China.
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Enin K, Bellas A, Puram SV, Jackson RS, Doering M, Pipkorn P. Clinical applications of vascularized fascia lata in head and neck reconstruction: A systematic review. Am J Otolaryngol 2024; 45:104432. [PMID: 39151381 DOI: 10.1016/j.amjoto.2024.104432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 07/21/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Given limitations in the current literature, the precise indications, techniques, and outcomes relevant to vascularized fascia lata free flap reconstruction remain uncertain. The objective of this study was to perform a systematic review of published literature to evaluate indications, methods, and complications for vascularized fascia lata free flap reconstruction. METHODS A systematic review of the literature was performed using a set of search criteria to identify patients who underwent free flap reconstruction of the head and neck region using vascularized fascia lata. Articles were reviewed based on relevance, with the primary outcome being surgical complications and surgical indications. RESULTS A comprehensive search revealed 783 articles and 5 articles were ultimately found to be appropriate to this review- 55 patients undergoing free flap reconstruction were identified. Overall complication rates were 10.9 % for major complications and 18.1 % for minor complications. Follow-up spanned 1 to 95 months with a median of 48 months. CONCLUSIONS Microvascular reconstruction of the head and neck with vascularized fascia lata is achievable with high adaptability and reliability reported in the literature.
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Affiliation(s)
- Kwasi Enin
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Andrew Bellas
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michelle Doering
- Washington University in St. Louis - Bernard Becker Medical Library, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Pannuto L, Soh JY, Duah-Asante K, Shaharan S, Ward J, Bisase BS, Norris P, Koshima I, Nduka C, Kannan RY. A Novel Approach to Facial Reanimation and Restoration Following Radical Parotidectomies. J Clin Med 2024; 13:2269. [PMID: 38673542 PMCID: PMC11051263 DOI: 10.3390/jcm13082269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Parotidectomies are indicated for a variety of reasons. Regardless of the indication for surgery, facial reanimation may be required because of facial nerve sacrifice or iatrogenic damage. In these cases, facial restoration performed concurrently with ablative surgery is considered the gold standard, and delayed reanimation is usually not attempted. Methods: A retrospective review of all patients who underwent parotidectomies from 2009 to 2022 in a single institution was performed. Indications, surgical techniques, and outcomes of an algorithmic template were applied to these cases using the Sunnybrook, Terzis scores, and Smile Index. A comparison was made between immediate vs. late repairs. Results: Of a total of 90 patients who underwent parotidectomy, 17 (15.3%) had a radical parotidectomy, and 73 (84.7%) had a total or superficial parotidectomy. Among those who underwent complete removal of the gland and nerve sacrifice, eight patients (47.1%) had facial restoration. There were four patients each in the immediate (n = 4) and late repair (n = 4) groups. Surgical techniques ranged from cable grafts to vascularized cross facial nerve grafts (sural communicating nerve flap as per the Koshima procedure) and vascularized nerve flaps (chimeric vastus lateralis and anterolateral thigh flaps, and superficial circumflex perforator flap with lateral femoral cutaneous nerve). Conclusions: The algorithm between one technique and another should take into consideration age, comorbidities, soft tissue defects, presence of facial nerve branches for reinnervation, and donor site morbidity. While immediate facial nerve repair is ideal, there is still benefit in performing a delayed repair in this algorithm.
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Affiliation(s)
- Lucia Pannuto
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Jun Yi Soh
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Kwaku Duah-Asante
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Shazrinizam Shaharan
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Joseph Ward
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Brian S. Bisase
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (B.S.B.); (P.N.)
| | - Paul Norris
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (B.S.B.); (P.N.)
| | - Isao Koshima
- Department of Plastic Surgery, Hiroshima University Hospital, Hiroshima 734-0037, Japan;
| | - Charles Nduka
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
| | - Ruben Yap Kannan
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; (J.Y.S.); (K.D.-A.); (S.S.); (J.W.); (C.N.); (R.Y.K.)
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Dou CB, Ma SR, Zhang SL, Su H, Yu ZL, Jia J. Algorithm for the reconstruction of the parotid region: a single institution experience. BMC Oral Health 2024; 24:106. [PMID: 38238723 PMCID: PMC10795291 DOI: 10.1186/s12903-024-03872-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/07/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE This study aims to discuss the characteristics and treatment methods of malignant tumors in the parotid region, as well as the therapeutic effects of immediate free flap reconstruction of soft tissue for postoperative defects. MATERIALS AND METHODS A retrospective review was conducted on 11 cases of soft tissue flap reconstruction for postoperative defects following the resection of malignant tumors in the parotid region. Statistical analysis was performed based on clinical data. RESULTS Among the 11 cases of malignant tumors in the parotid region, there were 2 cases of secretory carcinoma (SC) of the salivary gland, 2 cases of squamous cell carcinoma (SCC), 2 cases of carcinosarcoma, 1 case of mucoepidermoid carcinoma (MEC), 1 case of epithelial-myoepithelial carcinoma (EMC), 1 case of salivary duct carcinoma (SDC), 1 case of basal cell carcinoma (BCC), and 1 case of osteosarcoma. Among these cases, 4 were initial diagnoses and 7 were recurrent tumors. The defect repairs involved: 8 cases with anterolateral thigh free flap (ALTF), 2 cases with pectoralis major muscle flaps, and 1 case with forearm flap. The size of the flaps ranged from approximately 1 cm × 3 cm to 7 cm × 15 cm. The recipient vessels included: 4 cases with the facial artery, 4 cases with the superior thyroid artery, and 1 case with the external carotid artery. The ratio of recipient vein anastomosis was: 57% for branches of the internal jugular vein, 29% for the facial vein, and 14% for the external jugular vein. Among the 8 cases that underwent neck lymph node dissection, one case showed lymph node metastasis on pathological examination. In the initial diagnosis cases, 2 cases received postoperative radiotherapy, and 1 case received 125I seed implantation therapeutic treatment after experiencing two recurrences. Postoperative follow-up revealed that 2 cases underwent reoperation due to local tumor recurrence, and there were 2 cases lost to follow-up. The survival outcomes after treatment included: one case of distant metastasis and one case of death from non-cancerous diseases. CONCLUSION Immediate soft tissue flap reconstruction is an important and valuable option to address postoperative defects in patients afflicted with malignant tumors in the parotid region.
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Affiliation(s)
- Chun-Bo Dou
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
- Dongfeng Stomatological Hospital, Hubei University of Medicine, Shiyan, China
| | - Si-Rui Ma
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Shi-Long Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
- Dongfeng Stomatological Hospital, Hubei University of Medicine, Shiyan, China
| | - Heng Su
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Zi-Li Yu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
| | - Jun Jia
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Nagi K, Sekar R, Ganesan S, Alexander A, Saxena SK. Recurrent Giant Mucoepidermoid Carcinoma of the Parotid: A Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:6170-6173. [PMID: 36742934 PMCID: PMC9895182 DOI: 10.1007/s12070-021-02848-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/01/2021] [Indexed: 02/07/2023] Open
Abstract
Mucoepidermoid carcinoma is the most common salivary gland malignancy and about one third occurs in the parotid gland. The peak incidence is commonly seen between the third and fifth decades of life. It routinely presents as a fixed, painless mass below the ear. However, its presentation as a giant mass is exceedingly rare. Here, we report a case of a recurrent giant exophytic mucoepidermoid carcinoma in a young male. He underwent Revision Total Parotidectomy with Modified Radical neck dissection with Sural nerve grafting and an Anterolateral thigh flap reconstruction followed by Adjuvant radiotherapy. The rarity of the clinical presentation and the management challenges faced in a young male are being discussed in this case report.
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Affiliation(s)
- Kezevino Nagi
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006 India
| | - Raghul Sekar
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006 India
| | - Sivaraman Ganesan
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006 India
| | - Arun Alexander
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006 India
| | - Sunil Kumar Saxena
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006 India
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Cabañas Weisz LM, Guarin DL, Townley WA. A Comparative Study of Autologous and Acellular Dermal Matrix Static Cheek Slings in Corrective Surgery for Facial Palsy. Ann Plast Surg 2021; 87:669-675. [PMID: 34117139 DOI: 10.1097/sap.0000000000002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facial palsy causes devastating disability due to loss of facial function as well as social and psychological impairment. Cheek slings are a secondary technique that provide static support to the midface. This study aimed to describe our technique and compare a traditional sling material (tensor fascia lata) with a porcine-derived acellular dermal matrix alternative (Strattice). METHODS A 5-year case-control retrospective review of consecutive static cheek slings in a tertiary cancer and facial palsy center was performed. Demographic data, risk factors, and complications were collected and compared. Improvement in static smile position was assessed by Emotrics (Massachusetts Eye and Ear Infirmary, Boston, MA) at 3 months. Long-term sling failure was assessed by need for reoperation. RESULTS The study group comprised 41 patients on which 33 autogenous fascia lata slings and 12 Strattice slings were performed. Medium-term improvement in static smile position was similar between the 2 groups (judged by the Emotrics software), as was complication rate (P = 0.496). Need for revision due to stretching was higher in the Strattice group but did not achieve significance (P = 0.087). Mean follow-up was 38.02 ± 19.17 months. Twelve of 41 patients were deceased at study conclusion. CONCLUSIONS Fascia lata and Strattice slings provide satisfactory results in restoring symmetry at rest and functional oral competence. Our results suggest that Strattice is a safe sling material with an acceptable risk profile and comparable medium-term maintenance of tensile strength to fascia lata, and should be considered where life expectancy, donor site morbidity, and procedure length are important considerations.
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Affiliation(s)
- Laura M Cabañas Weisz
- From the Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; and Department of Plastic Surgery and Burns Unit, Cruces University Hospital, Baracaldo, Spain
| | - Diego L Guarin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - William A Townley
- Department of Plastic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Kadota H, Yoshida T. Infrahyoid myofascial flap transfer for the prevention of concave deformity and gustatory sweating after parotidectomy. Auris Nasus Larynx 2021; 49:484-494. [PMID: 34772563 DOI: 10.1016/j.anl.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/09/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Concave deformities and gustatory sweating are the most common complications that cause substantial patient dissatisfaction after parotidectomy. Various surgical methods to prevent these complications have been described. However, effective techniques have not been established, especially in patients with medium- to large-sized parotidectomy defects. We evaluated the utility of infrahyoid myofascial flap reconstruction of parotidectomy defects for the prevention of these complications. METHODS We conducted a retrospective case series study in patients with a benign or malignant parotid tumor measuring over 4 cm who underwent immediate pedicle infrahyoid myofascial flap reconstruction after total or subtotal parotidectomy or total resection of either the superficial or deep parotid gland at our hospital. Subjective analyses of facial symmetry, postoperative concave deformities of the anterior neck, gustatory sweating, voice disorders, odynophagia, neck scarring in the parotid and anterior neck areas, sensory disorders, pain, and neck stiffness were performed using patient interview data. Objective evaluations of facial symmetry were made by the first or second author. Both analyses were performed after a follow-up of more than six months. Additionally, patient demographic data, clinicopathological factors, parotidectomy and skin incision types, flap survival, and postoperative complications were evaluated. RESULTS We included eight patients (male, n=5; mean age, 69.3 years [range, 37-93 years]). Procedures included total or subtotal parotidectomy (n=4), superficial lobe parotidectomy (n=2), and deep lobe parotidectomy with partial superficial lobe parotidectomy (n=2). Infrahyoid myofascial flaps reached the cranial tip of the parotid defect without tension, and their volume sufficiently filled the parotidectomy defect in all patients. There were no local signs of insufficient blood flow within the transferred flaps. OBJECTIVE AND SUBJECTIVE: assessments were made after a mean duration of 1.2 years (range, 0.6-1.8). Postoperatively, no patient subjectively reported facial asymmetry. Objectively, facial symmetry was "good" in four patients and "fair" in four patients. No distinctly visible concave deformity in the parotid or anterior neck area occurred in any patient. Gustatory sweating occurred in one patient; this individual had the largest parotidectomy defect. Only one patient experienced donor site morbidity (mild anterior neck stiffness) related to infrahyoid myofascial flap elevation. CONCLUSION Although complete prevention of gustatory sweating was unsuccessful, infrahyoid myofascial flap reconstruction of medium- to large-sized parotidectomy defects led to postoperative facial symmetry with minimal donor site morbidity.
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Affiliation(s)
- Hideki Kadota
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Sasebo Kyosai Hospital, Japan.
| | - Takamasa Yoshida
- Department of Otorhinolaryngology and Head and Neck Surgery, Sasebo Kyosai Hospital, Japan
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Lee JJ, Wood CB, Puram SV, Zenga J, Bollig CA, Pipkorn P. Free vascularized parascapular fat flap for parotidectomy reconstruction. Am J Otolaryngol 2021; 42:103028. [PMID: 33848769 DOI: 10.1016/j.amjoto.2021.103028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The contour defect resulting after parotidectomy can be cosmetically unappealing. Multiple reconstructive efforts have been reported to mitigate this problem. We describe a novel technique of vascularized parascapular fat reconstruction based on the circumflex scapular vessels and evaluate its outcomes. METHODS Consecutive patients who underwent parotidectomy with or without additional resections and vascularized parascapular fat flap reconstruction in 2020 were included. Demographic, morphologic, intraoperative, and postoperative data were assessed. RESULTS Eight patients (3 female) were included. Median cut-to-close time was 247 (range 209-298) minutes, including tumor ablation. None of the patients had any wound complications, and all except one was discharged on postoperative day 1. Flap monitoring was not performed. None reported any significant donor site morbidity except scar formation. At last follow up, all patients reported satisfactory facial contour. CONCLUSION Vascularized parascapular fat flap reconstruction of parotidectomy contour defects has satisfactory cosmetic outcomes with minimal morbidity and short hospitalization courses.
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Cameron N, Balsiger R, Prueter J, Kadakia S. Transfacial transmandibular approach to the masticator space: Excision of odontogenic myxoma arising from the mandibular condyle. Am J Otolaryngol 2021; 42:102944. [PMID: 33592553 DOI: 10.1016/j.amjoto.2021.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
Odontogenic myxomas are an uncommon benign odontogenic tumor that can present with a wide variety of symptomatology depending on location and potentially be locally destructive. The present case describes a 66-year-old female who presented with left lower facial paresthesia, left aural fullness and hearing loss. She was found to have an odontogenic myxoma that involved the condylar head and extended into the masticator space. In this report we detail our surgical approach utilizing a preauricular transfacial transmandibular approach to the masticator space. In addition, we will discuss various approaches to the masticator space and infratemporal fossa along with considerations on how to manage facial nerve paralysis, facial contour deformities, and post-operative rehabilitation for permanent unilateral condylar head disarticulation.
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Affiliation(s)
- Nicholas Cameron
- Department of Otolaryngology-Head and Neck Surgery, Kettering Health Network, Dayton, OH, United States of America.
| | - Robert Balsiger
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, United States of America.
| | - James Prueter
- Department of Otolaryngology-Head and Neck Surgery, Southwest Ohio ENT, Dayton, OH, United States of America
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Boonshoft School of Medicine at Wright State University, Premier Health Comprehensive Head and Neck Oncology and Reconstruction Program, 30 E Apple St, Suite 2200, Dayton, OH 45409, United States of America.
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Charters E, Coulson S. Oral competence following facial nerve paralysis: Functional and quality of life measures. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:113-123. [PMID: 32116032 DOI: 10.1080/17549507.2020.1728380] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Oral competence refers to the maintenance of lip closure with sufficient strength to prevent anterior spillage of saliva, food and fluid, and to clearly articulate labial sounds. Despite facial nerve paralysis having an impact on eating, drinking and communicating, little research has been done in this area. METHOD Studies examining oral competence associated with a diagnosis of facial nerve paralysis were considered using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement checklists and evaluated for their risk of bias using the RevMan Risk of Bias Tool. RESULT 44 articles were examined. There was an over-representation of case-series and cohort studies. All studies carried a high risk of bias due to lack of (a) validated outcome measures, (b) comparison group and (c) blinding or randomised assessors and participants. Studies primarily examined facial nerve intervention for the purpose of restoring smiling or facial aesthetics rather than oral competence. CONCLUSION Whilst oral competence is often compromised after a facial nerve paralysis, it is inconsistently measured, managed and described. Further studies are required to examine the (a) incidence, (b) severity and (c) impact on quality of life relating to oral incompetence using validated measures at consistent time intervals.
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Affiliation(s)
- Emma Charters
- University of Sydney, Lidcombe, Australia
- Chris O'Brien Lifehouse, Sydney, Australia
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Reply: Chimeric Vastus Lateralis and Anterolateral Thigh Flap for Restoring Facial Defects and Dynamic Function following Radical Parotidectomy. Plast Reconstr Surg 2020; 146:366e-367e. [PMID: 32842125 DOI: 10.1097/prs.0000000000007088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A Sequential Thoracoacromial Artery Perforator Flap for Reconstructing the Donor Site of Sternocleidomastoid Myocutaneous Flaps. Ann Plast Surg 2020; 84:657-664. [DOI: 10.1097/sap.0000000000002042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Liang KY, Breen MS, Tracy JC, Vaezi AE. Submandibular gland flap for reconstruction after parotidectomy. Laryngoscope 2020; 130:E155-E162. [DOI: 10.1002/lary.28037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/15/2019] [Accepted: 04/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Kevin Y. Liang
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
| | - Matthew S. Breen
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
| | - Jeremiah C. Tracy
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
| | - Alec E. Vaezi
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
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Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases. J Otolaryngol Head Neck Surg 2019; 48:64. [PMID: 31744535 PMCID: PMC6862743 DOI: 10.1186/s40463-019-0387-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy. METHODS A retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events. RESULTS There were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation. CONCLUSIONS There are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting.
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Autologous Free Fat Graft for Repair of Concave Deformity After Total Parotidectomy. J Craniofac Surg 2019; 30:834-837. [DOI: 10.1097/scs.0000000000005178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Graboyes EM, Hornig JD. Evolution of the anterolateral thigh free flap. Curr Opin Otolaryngol Head Neck Surg 2018; 25:416-421. [PMID: 28786847 DOI: 10.1097/moo.0000000000000394] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW To review the recent literature on the evolution and advanced uses of the anterolateral thigh (ALT) free flap in reconstruction of oncologic defects of the head and neck. RECENT FINDINGS The ALT free flap is a versatile flap that can be harvested in a chimeric fashion with independent, vascularized skin, muscle, fascia, nerve and bone. Various techniques for chimeric flap harvest and flap inset have been described for reconstruction of pharyngocutaneous, oromandibular and radical parotidectomy defects. These reports expand the indications for the ALT free flap while demonstrating good functional and aesthetic outcomes. SUMMARY The ALT free flap remains popular for reconstruction of head and neck oncologic defects because of its versatility. Continued evolution in chimeric flap harvest techniques for pharyngocutaneous, osseous and radical parotidectomy defects highlights novel advanced reconstructive uses for the ALT free flap.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Reconstruction of parotidectomy and lateral skull base defects. Curr Opin Otolaryngol Head Neck Surg 2017; 25:431-438. [DOI: 10.1097/moo.0000000000000391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Clancy K, Huwyler C, Li S, Otiti J, Zender CA. The use of the submental island flap in reconstructing palatal and facial defects in a surgical camp in East Africa. Am J Otolaryngol 2017; 38:96-99. [PMID: 27793460 DOI: 10.1016/j.amjoto.2016.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/25/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The goals of successful reconstructive surgery are to restore function and cosmesis; however, limitation of resources can become an important consideration in low-middle income countries. METHODS We describe our experience using the submental island flap in two cases during a short-term surgical camp in East Africa. RESULTS The submental island flap was utilized as an excellent alternative to a free flap to reconstruct a subtotal maxillectomy and a parotidectomy defect in two patients. CONCLUSIONS We demonstrate the successful use of this flap and describe some necessary modifications to achieve optimal results in a resource limited setting.
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Lombardi D, McGurk M, Vander Poorten V, Guzzo M, Accorona R, Rampinelli V, Nicolai P. Surgical treatment of salivary malignant tumors. Oral Oncol 2016; 65:102-113. [PMID: 28017651 DOI: 10.1016/j.oraloncology.2016.12.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/16/2016] [Accepted: 12/09/2016] [Indexed: 12/14/2022]
Abstract
Salivary gland malignant tumors (SGMT) are of key interest for head and neck surgeons since surgery with adjuvant radiotherapy is considered the treatment of choice in most of the cases. Some factors, namely rarity, high histologic heterogeneity, and possible occurrence in all the head and neck subsites, contribute to make this topic very controversial; some unclear aspects pertain surgical treatment. When dealing with major salivary gland malignant tumors (MaSGMT), the most debated issues remain the extent of surgery and management of facial nerve. In minor salivary gland malignant tumors (MiSGMT), conversely, surgical planning is influenced by the specific pattern of growth of the different neoplasms as well as the site of origin of the lesion. Finally, two additional issues, the treatment of the neck (therapeutic or elective) and reconstructive strategy after ablative surgery, are of pivotal importance in management of both MaSGMT and MiSGMT. In this review, we discuss the most relevant and controversial issues concerning surgery of SGMT.
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Affiliation(s)
- Davide Lombardi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy.
| | - Marc McGurk
- Guys and St. Thomas NHS Trust, London, United Kingdom
| | - Vincent Vander Poorten
- Otorhinolaryngology - Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; European Salivary Gland Society, Geneva, Switzerland
| | - Marco Guzzo
- Department of Head and Neck Surgery, Istituto Nazionale dei Tumori, Milan, Italy
| | - Remo Accorona
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy
| | - Vittorio Rampinelli
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy
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Cristóbal L, Linder S, Lopez B, Mani M, Rodríguez-Lorenzo A. Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects: Surgical technique and clinical outcomes. Microsurgery 2016; 37:479-486. [PMID: 27501201 DOI: 10.1002/micr.30086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Radical tumor ablation in the periauricular area often results in extensive soft tissue defects, including facial nerve sacrifice, bone and/or dura defects. Reconstruction of these defects should aim at restoring facial reanimation, wound closure, and facial and neck contours. We present our experience using free anterolateral thigh flap (ALT) in combination with masseter nerve to facial nerve transfer in managing complex defects in the periauricular area. METHODS Between 2011 and 2015 six patients underwent a combined procedure of ALT flap reconstruction and masseter nerve transfer, to reconstruct extensive, post tumor resection, periauricular defects. The ALT flap was customized according to the defect. For smile restoration, the masseter nerve was transferred to the buccal branch of the facial nerve. If the facial nerve stump was preserved, interposition of nerve grafts to the zygomatic and frontal branches was performed to provide separate eye closure. The outcomes were analyzed by assessing wound closure, contour deformity, symmetry of the face, and facial nerve function. RESULTS There were no partial or total flap losses. Stable wound closure and adequate volume replacement in the neck was achieved in all cases, as well as good facial tonus and symmetry. The mean follow-up time of clinical outcomes was 16.8 months. Smile restoration was graded as good or excellent in four cases, moderate in one and fair in one. CONCLUSION Extensive periauricular defects following oncologic resection could be adequately reconstructed in a combined procedure of free ALT flap and masseter nerve transfer to the facial nerve for smile restoration.
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Affiliation(s)
- Lara Cristóbal
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Sora Linder
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Beatriz Lopez
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Maria Mani
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Andres Rodríguez-Lorenzo
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
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Irvine LE, Larian B, Azizzadeh B. Locoregional Parotid Reconstruction. Otolaryngol Clin North Am 2016; 49:435-46. [DOI: 10.1016/j.otc.2015.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Naunheim M, Seth R, Knott PD. Sternocleidomastoid contour restoration: an added benefit of the anterolateral thigh free flap during facial reconstruction. Am J Otolaryngol 2016; 37:139-43. [PMID: 26954870 DOI: 10.1016/j.amjoto.2015.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 09/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To demonstrate the potential of the anterolateral thigh free flap for neck contour restoration. STUDY DESIGN Retrospective chart review at a tertiary care medical center of patients who underwent radical parotidectomy with sternocleidomastoid sacrifice, with or without temporal bone resection, and reconstruction of both facial and cervical contour with the anterolateral thigh free flap between November 2011 and March 2015. Seven patients were included and demographics, flap viability, pathology and tumor staging, surgical intervention, adjunctive reanimation procedures, ischemia time, and pre-operative and post-operative photos were recorded and analyzed. RESULTS There were no flap failures and the mean ischemia time was 82 minutes. There were 2 recipient site complications. Post-operative neck symmetry was improved for all 7 patients. CONCLUSIONS The adipofascial anterolateral thigh flap is useful for improving the aesthetic contour of the neck among patients undergoing sternocleidomastoid muscle resection/disinsertion following total parotidectomy with/without temporal bone resection. Contour restoration may be performed with minimal added morbidity and with relatively little additional operative time. This technique may be adapted for other complex facial and neck defects caused by ablative surgery. LEVEL OF EVIDENCE 4.
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Wang S, Li L, Chen J, Li X, Yin J, Liu K, Li C, Wang Z, Li C, Zhu G. Effects of free fat grafting on the prevention of Frey's syndrome and facial depression after parotidectomy: A prospective randomized trial. Laryngoscope 2015; 126:815-9. [PMID: 26451695 DOI: 10.1002/lary.25714] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/12/2015] [Accepted: 09/10/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Shaoxin Wang
- Department of Head and Neck Surgery; Sichuan Cancer Hospital and Institute; Sichuan People's Republic of China
| | | | - Jin Chen
- Department of Head and Neck Surgery; Sichuan Cancer Hospital and Institute; Sichuan People's Republic of China
| | - Xiaoxia Li
- Department of Head and Neck Surgery; Sichuan Cancer Hospital and Institute; Sichuan People's Republic of China
- Department of Stomatology; Sichuan Cancer Hospital and Institute; Sichuan People's Republic of China
| | - Jun Yin
- Department of Radiation Oncology; Sichuan Cancer Hospital and Institute; Sichuan People's Republic of China
| | - Kun Liu
- Department of Head and Neck Surgery; Sichuan Cancer Hospital and Institute; Sichuan People's Republic of China
| | - Chunhua Li
- Department of Head and Neck Surgery; Sichuan Cancer Hospital and Institute; Sichuan People's Republic of China
| | - Zhaohui Wang
- Department of Head and Neck Surgery; Sichuan Cancer Hospital and Institute; Sichuan People's Republic of China
| | | | - Guiquan Zhu
- Department of Head and Neck Surgery; Sichuan Cancer Hospital and Institute; Sichuan People's Republic of China
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Xu ZF, Duan WY, Tan XX, Sun CF. Reconstruction of Complex Total Parotidectomy Defect With a Chimeric Anterolateral Thigh Perforator Flap and Vascularized Motor Branch of Femoral Nerve Grafting. J Oral Maxillofac Surg 2015; 73:2448.e1-7. [PMID: 26342951 DOI: 10.1016/j.joms.2015.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/12/2015] [Accepted: 08/12/2015] [Indexed: 11/29/2022]
Abstract
Reconstruction of complex total parotidectomy defects after ablation is always a challenge for surgeons. The surgical technique in reconstructing total parotidectomy defects using an anterolateral thigh (ALT) flap has not been described in detail. This report describes the treatment of a difficult case with a complex total parotidectomy defect. An ALT flap composed of a vascularized motor branch of the femoral nerve and a narrow portion of the vastus lateralis muscle was harvested. An 8-cm-long vascularized nerve was transplanted into the gap, which can be considered a cable transplant graft, and a myocutaneous paddle was used to cover and fill in the soft tissue defect. There were no complications after surgery, and the patient was satisfied with the reconstructed facial contours. This case shows that using a chimeric ALT flap for reconstruction is possible in a complex total parotidectomy defect.
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Affiliation(s)
- Zhong-fei Xu
- Associate Professor, Departments of Oromaxillofacial-Head and Neck Surgery and Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, China
| | - Wei-yi Duan
- Attending Physician, Departments of Oromaxillofacial-Head and Neck Surgery and Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, China
| | - Xue-xin Tan
- Professor, Departments of Oromaxillofacial-Head and Neck Surgery and Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, China
| | - Chang-fu Sun
- Professor; Vice-Dean, School of Stomatology, Departments of Oromaxillofacial-Head and Neck Surgery and Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, China.
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Free fat grafting in superficial parotid surgery to prevent Frey's syndrome and improve aesthetic outcome. The Journal of Laryngology & Otology 2013; 128 Suppl 1:S44-9. [DOI: 10.1017/s0022215113001394] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Frey's syndrome and cosmesis are important considerations in parotid surgery. Placement of an interpositional barrier can prevent these complications; however, surgical technique and efficacy remain controversial.Methods:A prospective case series was collected comprising all patients undergoing primary superficial parotidectomy for benign pathology with abdominal free fat grafting between June 2007 and December 2010, performed by a single surgeon. A survey was also distributed to otorhinolaryngology consultants across Australia to assess current practice.Results:Twenty-eight patients were included. No patient had clinical symptoms of Frey's syndrome. Seventy-five per cent of patients were completely satisfied with their aesthetic outcome, 18 per cent scored 4/5 and the remaining 7 per cent (2 patients) scored 3/5. The survey revealed that 79 per cent of respondents did not use interpositional grafts.Conclusion:Abdominal free fat is ideal for grafting as it is an effective, safe, simple, accessible, fast and inexpensive method of providing an interpositional graft.
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Dynamic reconstruction of the paralyzed face, part II: Extensor digitorum brevis, serratus anterior, and anterolateral thigh. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.otot.2012.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ettl T, Schwarz-Furlan S, Gosau M, Reichert TE. Salivary gland carcinomas. Oral Maxillofac Surg 2012; 16:267-283. [PMID: 22842859 DOI: 10.1007/s10006-012-0350-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 07/18/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Salivary gland carcinomas are rare tumours of heterogeneous morphology that require distinctive surgical and adjuvant therapy. METHODS Relevant studies were electronically searched in PubMed and reviewed for innovative and important information. RESULTS Recent insights in genetic alterations like chromosomal aberrations, expression of receptor tyrosine kinases, malfunction of tumour suppressor genes or DNA promoter methylations increased the knowledge about aetiology and pathogenesis. New histological subtypes are recognised, and a three-tiered grading system seems reasonable. Ultrasound remains the basic diagnostic imaging procedure. New developments comprise the diffusion-weighed magnetic resonance imaging, while fluorodeoxyglucose positron emission tomography/computed tomography shows good diagnostic accuracy in detecting distant metastases and local recurrence. Fine-needle aspiration cytology helps in differentiating a neoplasia from a non-neoplastic lesion while being unreliable in recognising malignancy. In contrast, additional core needle biopsy and/or intraoperative frozen section diagnosis increase the accuracy in diagnosing a malignant lesion. Conservative parotid surgery with nerve monitoring remains state-of-the-art. Free flaps or musculoaponeurotic flaps are proposed for prevention of Frey's syndrome. As parotid cancer often shows skip metastases, complete ipsilateral neck dissection (level I-V) is indicated particularly in high-grade lesions. Adjuvant radio(chemo)therapy increases local tumour control, whereas overall survival is not necessarily improved. Current results of systemic chemotherapy or targeted therapy in advanced tumour stages are disappointing. CONCLUSION Despite several developments, salivary gland carcinomas remain a heterogeneous group of tumours challenging both pathologists and clinicians.
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Affiliation(s)
- Tobias Ettl
- Department of Oral and Maxillofacial Surgery, Regensburg University, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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