Reconstruction of Post–Radical Parotidectomy Defects

Abstract

Radical parotidectomy presents a unique combination of reconstructive challenges. The high visibility of the region and the specialized structures involved create an interdependence between aesthetics and function. This article describes the authors' surgical concepts and experience in post-radical parotidectomy reconstruction. The various components of reconstruction following radical parotidectomy, including contour restoration, skin coverage, mandible reconstruction, and facial reanimation, are reviewed. The authors discuss their methods of choice and specific technical refinements. Twenty-one post-radical parotidectomy reconstruction patients (male:female, 17:4; median age, 75 years) treated from July of 2006 through May of 2010 were identified. Information on patient demographics, etiology, reconstruction technique, surgical complications, postoperative adjuvant radiotherapy, and survival was obtained. The most common indication for radical parotidectomy was metastatic cutaneous squamous cell carcinoma, followed by carcinoma ex pleomorphic adenoma and direct extension from primary cutaneous malignancy. The authors' standard approach in reconstruction was a combination of anterolateral thigh free flap and cervicofacial rotation advancement flap, repair of the facial nerve with the nerve to the vastus lateralis segmental interpositional graft, gold weight loading of the upper eyelid, lateral canthopexy, temporalis and digastric muscle transfers, and a delayed brow lift. Surgical complications include undercorrection of facial reanimation, gold weight extrusion, wound breakdown, and infections. Seventeen patients (81 percent) received adjuvant radiotherapy (range, 50 to 66 Gy to the primary site, 40 to 60 Gy to the neck). Radical parotidectomy is a morbid procedure that is sometimes necessary for oncologic control. With sound principles and attention to detail in reconstruction, however, quality of life can be greatly improved. Therapeutic, V.