Radical Parotidectomy: Reconstruction and Facial Reanimation

Abstract

Objective: 1) Report a viable reconstructive alternative after parotid gland mucoepidermoid carcinoma resection, rendering a large facial defect and facial nerve paralysis. 2) Demonstrate the combination of temporalis muscle pedicled flap and microvascular fasciocutaneous radial forearm flap, fulfilling 3 purposes: bulk restitution, facial paralysis reanimation, and adequate skin replacement for acceptable aesthetics. Method: Facial defect was left after radical parotidectomy with facial nerve sacrifice, as well as masseter muscle, mandibular periosteum, and skin removal. Reconstruction of the large defect was achieved recurring to temporalis muscle transposition combined with fasciocutaneous radial forearm flap. Facial artery and vein were used for microvascular sutures. Results: The necessity of the head and neck surgeon to make aggressive interventions has enabled the usage of flaps for reconstruction of significant facial defects. Satisfactory results require careful 3-dimensional thought, adequate texture matching as well as functional restoration. The results showed that temporalis muscle transposition was a successful method for bulk restitution and reanimation of permanent facial paralysis in the resting position, including both eyelid and mouth, by tension provided to orbicularis ori and orbicularis oculi muscles. Fasciocutaneous radial forearm flap provided the best possible tissue color and contour restoration of skin due to its thin, pliable tissue. Conclusion: Radial forearm flap and temporalis muscle transposition combined offered a viable reconstructive option after radical parotidectomy resulting in acceptable aesthetic and functional outcomes. Radial forearm flap was a good choice for skin restoration. Temporalis muscle transposition proved to be adequate both for bulk restitution as for reanimation of facial paralysis.