S113 – Facial Suspension & Free Flaps in Composite Parotid Defects

Abstract

Objectives 1) Study efficacy of 2 methods of immediate static facial suspension after total composite parotidectomy, facial nerve sacrifice & free flap reconstruction. 2) Compare these regarding outcomes & patient satisfaction. Methods Retrospective review 2005–08 of all patients at academic tertiary referral center with advanced H&N malignancy necessitating extirpation, including parotidectomy, CN-VII sacrifice, and microvascular reconstruction. Ipsilateral face addressed simultaneously with either acellular human dermal allograft (AHDA) ‘sling’ or suture suspension (SS). Follow-up 2–18 months. Outcomes assessed: suspension status (commissure symmetry 1–4 complete ptosis), overall aesthetics (excellent 1–4 unsatisfactory), oral competence (no drooling 1–3 constant drooling) and patient/family satisfaction scores (very satisfied 1–4 very dissatisfied). Results 9 patients underwent extirpation, CNVII sacrifice, fasciocutaneous microvascular reconstruction (forearm, ALT or parascapula) and facial suspension. 8 received postoperative radiation; 1 expired. 2 underwent AHDA facial ‘slings.’ 7 underwent SS using polybutilate-coated braided polyester (Ethibond Excel). Both techniques used 3 distal suspension sites (nasolabial crease, upper/lower commissure) and proximal zygomatic stablization. Suspension grades were 1–3 for AHDA, 1–2 for SS; aesthetic 2–3 for AHDA, 1–3 for SS; competence 2 for AHDA, 1–2 for SS; satisfaction 1–2 for AHDA, 1–2 for SS. Conclusions Facial nerve rehabilitation in post-extirpative oncologic setting remains challenging for optimizing function/aesthetics. In our series of patients undergoing extensive resection with facial nerve sacrifice and free flap reconstruction, suture suspension provided slightly better oral symmetry and overall aesthetics compared to AHDA ‘sling’ suspension. Patient satisfaction was high in both groups. Long-term follow-up and greater sample size are needed to determine if any observed advantage is real and sustained.