Parotid Surgery With Concurrent Bilateral Rhytidectomy

Abstract

Facial reconstruction after parotid surgery can present an aesthetic challenge. This case series describes an asymmetric cervicofacial rhytidectomy technique at the time of parotid surgery to achieve defect closure as well as volume augmentation of the postablative deformity. While unilateral superficial musculoaponeurotic system (SMAS) flaps after parotid tumor extirpation have been described many times, this is the first reported case series of parotid tumor resection with concurrent bilateral cervicofacial rhytidectomy. This series consists of two adult females with unilateral facial swelling who also desired facial rejuvenation surgery. They separately presented to the University of Texas Southwestern Maxillofacial Surgery team and proceeded to have unilateral parotid tumor removal with concurrent bilateral cervicofacial rhytidectomy. To give context to this case series, the authors also searched the PubMed, Scopus, and Google Scholar databases to look for previously reported similar cases. The authors were able to address the patients’ functional as well as aesthetic concerns with a single surgery in a safe manner. Ipsilateral to the tumor resection, there was a sizeable loss in volume in both cases. Therefore, a vascularized SMAS flap was imbricated to provide volume, while a selective SMAS removal and plication was used on the contralateral side to achieve symmetric volume bilaterally. A comprehensive literature search demonstrated one previous report of concurrent bilateral cervicofacial rhytidectomy with parotid tumor extirpation. Despite the prevalence of utilizing a rhytidectomy incision for parotid surgery, there is a dearth of literature describing concurrent bilateral cervicofacial rhytidectomy with parotid tumor extirpation. Functionally, it has been shown to decrease the incidence of gustatory sweating on the side of reconstruction. Aesthetically, the surgeon is not only re-establishing the volume by augmenting the ablative defect, but also creating a symmetrical postoperative appearance by performing a reductive rhytidectomy on the contralateral side. Utilizing an asymmetric bilateral cervicofacial rhytidectomy at the time of parotid surgery can be an efficient technique for aesthetically reconstructing a patient with a parotid mass. It should be considered in patients with benign parotid disease who have the desire for facial rejuvenation surgery.