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Filipov I, Chirila L, Bolognesi F, Sandulescu M, Drafta S, Cristache CM. Research trends and perspectives on immediate facial reanimation in radical parotidectomy (Review). Biomed Rep 2023; 19:81. [PMID: 37881603 PMCID: PMC10594070 DOI: 10.3892/br.2023.1663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/05/2023] [Indexed: 10/27/2023] Open
Abstract
For patients diagnosed with advanced malignant parotid tumour, radical parotidectomy with facial nerve sacrifice is part of the treatment. Multiple surgical techniques have been developed to cure facial paralysis in order to restore the function and aesthetics of the face. Despite the large number of publications over time on facial nerve reanimation, a consensus on the timing of the procedure or the donor graft selection has remained to be established. Therefore, the aim of the present study was to conduct a bibliometric analysis to identify and analyse scientific publications on the reconstruction of the facial nerve of patients who underwent radical parotidectomy with facial nerve sacrifice. The analysis on the topic was conducted using the built-in tool of the Scopus database and VOSviewer software. The first 100 most cited articles were separately reviewed to address the aim of the study. No consensus was found regarding the recommended surgical techniques for facial nerve reanimation. The most used donor cranial nerves for transfer included the following: Masseteric branch of the V nerve, contralateral VII nerve with cross-face graft, the XI nerve and the XII nerve. The best timing of surgery is also controversial depending on pre-exiting pathology and degree of nerve degeneration. However, most of the clinical experience suggests facial nerve restoration immediately after the ablative procedure to reduce complications and improve patients' quality of life.
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Affiliation(s)
- Iulian Filipov
- Doctoral School, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Maxillofacial Surgery, ‘Queen Maria’ Military Emergency Hospital, 500007 Brasov, Romania
| | - Lucian Chirila
- Department of Oral and Maxillofacial Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Federico Bolognesi
- Oral and Maxillo-Facial Surgery Unit, IRCCS Policlinico di Sant'Orsola, I-40138 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, I-40100 Bologna, Italy
| | - Mihai Sandulescu
- Department of Implant Prosthetic Therapy, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Sergiu Drafta
- Department of Fixed Dental Prosthetics and Occlusion, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Corina Marilena Cristache
- Department of Dental Techniques, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Stanford-Moore GB, Thompson EC, Gulati A, Carpenter P, Park A, Seth R, Knott PD. Outcomes of Vascularized Versus Nonvascularized Adipofascial Grafts for Parotidectomy Reconstruction. Facial Plast Surg Aesthet Med 2022; 25:232-237. [PMID: 35856681 DOI: 10.1089/fpsam.2022.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Parotidectomy defects can leave patients with considerable functional and cosmetic deformities. We aim to compare the success rates and complications associated with vascularized versus nonvascularized adipofascial grafts for reconstruction, including flap failure, return to surgery, infection, and delay to adjuvant treatment. Methods: Retrospective case series of patients undergoing either adipofascial anterolateral thigh (AFALT) free tissue transfer or free fat transfer (FFT) after parotidectomy from January 2010 to January 2020. Group comparisons and logistic regression were used to determine predictors of outcome measures. Results: Seventy-six patients underwent AFALT reconstruction, and 73 patients underwent FFT reconstruction. Patients treated with AFALT reconstruction had more aggressive tumor characteristics and underwent more complex resections, most commonly radical parotidectomy (n = 55, 72.4%). Postoperative complications at both the donor and recipient sites were more common in the FFT group (N = 20, 27.4% in FFT vs. N = 11, 14.5% in AFALT, odds ratio = 0.45, 95% confidence interval = 0.20-1.02, p = 0.052). Conclusions: Although used in more advanced disease and in a more heavily treated wound bed, the AFALT free flap was safe and associated with fewer infectious complications than that offered by FFT.
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Affiliation(s)
- Gaelen B. Stanford-Moore
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | | | - Arushi Gulati
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
- UC San Francisco School of Medicine, San Francisco, California, USA
| | - Patrick Carpenter
- Department of Otolaryngology Head and Neck Surgery, Virginia Tech University, Blacksburg, Virginia, USA
- Carilion Clinic, Roanoake, Virginia
| | - Andrea Park
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Rahul Seth
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - P. Daniel Knott
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
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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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Abstract
PURPOSE OF REVIEW The aim of this study was to review the recent literature on the utilization of the lateral arm free flap use in head and neck reconstruction. RECENT FINDINGS The lateral arm free flap provides a reliable fasciocutaneous free tissue transfer option ideally suited for reconstruction of the oral cavity, pharynx and parotid. Primary donor site closure, compartmentalized fat and excellent colour match make it an excellent option for head and neck reconstruction. Donor site morbidity is low, and the primary limitation is the short and narrow vascular pedicle. SUMMARY The lateral arm free flap should be considered in cases of oral cavity and skin reconstruction, particularly in cases wherein pedicle length is not restrictive.
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Anderies BJ, Dey JK, Gruszczynski NR, Price DL, Moore EJ, Janus JR. Dermal Fat Grafting to Reconstruct the Parotidectomy Defect Normalizes Facial Attention. Laryngoscope 2020; 131:E124-E131. [PMID: 32658339 DOI: 10.1002/lary.28890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Use validated eye-tracking technology to objectively measure 1) the attentional distraction of facial contour defects after superficial and total parotidectomy and 2) changes in attentional distraction with abdominal dermal fat graft reconstruction. METHODS Standardized frontal and oblique facial images of 16 patients who had undergone superficial or total parotidectomy with or without fat graft reconstruction; four normal controls were obtained. One hundred casual observers were recruited to view these images, and gaze data were collected using a Tobii Pro eye-tracking system. Gaze durations for predefined facial areas of interest were analyzed using mixed-effects linear regression to test study hypotheses. RESULTS For frontal images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (92 milliseconds, 95% confidence interval [CI]: 48-138 milliseconds, P < .001). Fat grafting normalized the attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .414). For oblique images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (658 milliseconds, 95% CI: 463-854 milliseconds, P < .001). Fat grafting normalized this attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .504). In both views, superficial parotidectomy demonstrated no significant attentional distractions, with or without fat grafting. CONCLUSIONS This eye-tracking study objectively demonstrates that total parotidectomy results in a facial contour deformity that is distracting to observers, whereas superficial parotidectomy does not. For total parotidectomy, this attentional distraction can be normalized with dermal fat graft reconstruction. LEVEL OF EVIDENCE 3b Laryngoscope, 131:E124-E131, 2021.
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Affiliation(s)
- Barrett J Anderies
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson R Gruszczynski
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
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Moore MG, Yueh B, Lin DT, Bradford CR, Smith RV, Khariwala SS. Controversies in the Workup and Surgical Management of Parotid Neoplasms. Otolaryngol Head Neck Surg 2020; 164:27-36. [PMID: 32571148 DOI: 10.1177/0194599820932512] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Parotid neoplasms are a rare heterogeneous group of tumors with varied clinical presentation and behavior. Here we provide an evidence-based review of the contemporary approach to evaluation and surgical management of parotid tumors. DATA SOURCE PubMed and Web of Science Databases. REVIEW METHODS Searches of the PubMed and Web of Science databases were performed on subjects related to the diagnosis and surgical management of parotid neoplasms. Particular emphasis was placed on the following areas: evaluation of parotid tumors, including imaging workup and the utility of fine-needle aspiration; extent of surgery of the primary lesion, including the extent of parotidectomy as well as oncologic management of the facial nerve; the extent of surgery of involved and at-risk cervical lymphatics; and parotid bed reconstruction. Articles published from 2014 to the present were prioritized, supplementing with information from prior studies in areas where data are lacking. CONCLUSION A summary of the literature in these areas is outlined to provide an evidence-based approach to evaluation and management of parotid neoplasms. IMPLICATIONS FOR PRACTICE While data are available to help guide many aspects of workup and management of parotid neoplasms, further research is needed to refine protocols for this heterogeneous group of diseases.
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Affiliation(s)
- Michael G Moore
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bevan Yueh
- The University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Derrick T Lin
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | | | | | - Samir S Khariwala
- The University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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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: 0.8] [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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Contemporary Concepts of Primary Dynamic Facial Nerve Reconstruction in the Oncologic Patient. J Craniofac Surg 2020; 30:2578-2581. [PMID: 31584554 DOI: 10.1097/scs.0000000000005619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transection of the facial nerve and its branches during extensive ablative procedures in the oncologic patient causes loss of control of facial mimetic muscles with severe functional and aesthetic sequelae. In such patients with advanced tumorous disease, copious comorbidities, and poor prognosis, rehabilitation of the facial nerve has long been considered of secondary priority. However, recent advances in primary facial nerve reconstruction after extensive resection demonstrated encouraging results focusing on rapid and reliable restoration of facial functions. The authors summarize 3 innovative approaches of primary dynamic facial nerve reconstruction by using vascularized nerve grafts, dual innervation concepts, and intra-facial nerve transfers.
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Goyal N, Deschler DG, Emerick KS. Reconstruction of total parotidectomy defects with a de-epithelialized submental flap. Laryngoscope Investig Otolaryngol 2019; 4:222-226. [PMID: 31024991 PMCID: PMC6476261 DOI: 10.1002/lio2.258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/26/2018] [Accepted: 02/05/2019] [Indexed: 11/12/2022] Open
Abstract
Objective Total parotidectomy yields a large surgical defect that leads to both cosmetic and functional deficits which can be addressed with reconstruction. We evaluated the role of a pedicled submental flap for this reconstruction. Methods We reviewed all submental flap reconstructions that were performed for total parotidectomy defects between 2014 and 2016. Data regarding harvest technique, postoperative complications, flap survival, and adjuvant treatment details were recorded. Subjective information regarding retained volume after reconstruction was also obtained. Results During the time period, eight patients were identified and in all cases the patients underwent total parotidectomy with facial nerve sacrifice. All patients were discharged within 2 days of hospitalization with no complications or concerns regarding the viability of the flap. All but one patient had radiation therapy. Results with 9.9‐ to 37.5‐month follow‐up (mean 22.0 months) show limited volume loss without major contour defect or ear deformity in the follow‐up period. Conclusions Submental flap reconstruction is a feasible and reliable method for total parotidectomy defect. The inclusion of the mylohyoid muscle aids flap reliability and adds bulk. Inclusion of the dermis helps contour the overlying skin. The flap does not add morbidity or increased complexity intraoperatively or postoperatively. Level of Evidence 4
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Affiliation(s)
- Neerav Goyal
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, College of Medicine The Pennsylvania State University Hershey Pennsylvania U.S.A
| | - Daniel G Deschler
- Department of Otolaryngology Massachusetts Eye and Ear, Harvard Medical School Boston Massachusetts U.S.A
| | - Kevin S Emerick
- Department of Otolaryngology Massachusetts Eye and Ear, Harvard Medical School Boston Massachusetts U.S.A
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Vila PM, Ramsey T, Yaeger LH, Desai SC, Branham GH. Reporting of Cosmesis in Head and Neck Reconstruction: A Systematic Review. Otolaryngol Head Neck Surg 2018; 160:573-579. [PMID: 30481122 DOI: 10.1177/0194599818815061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify the method and rate at which cosmesis is reported after reconstruction from head and neck surgery among adults. DATA SOURCES A medical librarian implemented search strategies in multiple databases for head and neck reconstruction, outcome assessment/patient satisfaction, and cosmesis/appearance. REVIEW METHODS Inclusion and exclusion criteria were designed to capture studies examining adults undergoing reconstruction after head and neck cancer surgery with assessment of postoperative cosmesis. The primary outcome was the method to assess cosmesis. Secondary outcomes were types of instruments used and the rate at which results were reported. Validated instruments used in these studies were compared and critically assessed. RESULTS The search identified 4405 abstracts, and 239 studies met inclusion and exclusion criteria. Of these, 43% (n = 103) used a scale or questionnaire to quantify the cosmetic outcome: 28% (n = 66), a visual analog, Likert, or other scale; 13% (n = 30), a patient questionnaire; and 3% (n = 7), both. Of the 103 studies that used an instrument, 14% (n = 14, 6% overall) used a validated instrument. The most common validated instrument was the University of Washington Quality of Life (UWQOL) questionnaire (4%, n = 9). The most highly rated instruments were the UWQOL and the Derriford Appearance Scale. CONCLUSIONS Reporting of cosmetic outcomes after head and neck cancer reconstruction is heterogeneous. Most studies did not report patient feedback, and a minority used a validated instrument to quantify outcomes. To reduce bias, improve reliability, and decrease heterogeneity, we recommend the UWQOL to study cosmetic outcomes after head and neck reconstruction.
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Affiliation(s)
- Peter M Vila
- 1 Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Tam Ramsey
- 2 School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Lauren H Yaeger
- 3 Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Shaun C Desai
- 4 Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Bethesda, Maryland, USA
| | - Gregory H Branham
- 1 Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Ghassemi A, Modabber A, Brzoska PO, Sababi M. Vascularised fatty tissue: its role in prevention of the symptoms of Frey syndrome after parotidectomy. Br J Oral Maxillofac Surg 2018; 56:877-880. [PMID: 30337163 DOI: 10.1016/j.bjoms.2018.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/08/2018] [Indexed: 11/16/2022]
Abstract
We studied 37 consecutive patients who had parotidectomies between 2008 and 2017 and who had vascular fat flaps inserted to replace the excised parotid tissue and prevent Frey syndrome. They were followed up for 1-9 years to check for the relevant symptoms. We studied 17 female and 20 male patients, mean age 52 (range 19-78) years. The flaps took a maximum of 17minutes to dissect. There was no donor site morbidity, the vascular fat flap was stable in all cases for up to nine years, and none of the patients complained of symptoms of Frey syndrome.
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Affiliation(s)
- A Ghassemi
- Oral and Maxillofacial Surgery, Teaching Hospital, Georg-August-University Göttingen, Klinikum-Lippe, Röntgenstr. 18, 32756 Detmold, Germany; Medical Faculty University RWTH-Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - A Modabber
- Oral and Maxillofacial Surgery, University Hospital RWTH-Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - P O Brzoska
- Department of Internal Medicine, St. Marien-Hospital, Hospitalstraße 44, 52353 Düren, Germany
| | - M Sababi
- Department of Hearing Disorders Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Comprehensive approach to reestablishing form and function after radical parotidectomy. Am J Otolaryngol 2018; 39:542-547. [PMID: 29907429 DOI: 10.1016/j.amjoto.2018.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/06/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The reconstructive goals following radical parotidectomy include restoration of symmetry, reanimation of the face, and reestablishment of oral competence. We present our experience utilizing the anterolateral thigh (ALT) free flap, orthodromic temporalis tendon transfer (OTTT), and facial nerve cable grafting to reestablish form and function. MATERIAL AND METHODS From 2010 to 2016, 17 patients underwent radical parotidectomy followed by immediate reconstruction. An ALT was harvested to accommodate the volume and skin defect. Additional fascia lata and motor nerve to vastus lateralis (MNVL) were obtained. Anastomosis of the ALT to recipient vessels was performed, most commonly using the facial artery and internal jugular vein. OTTT was performed by securing the medial tendon of the temporalis to orbicularis oris through a nasolabial incision. Fascia lata was tunneled through the lower lip, then secured laterally to the temporalis tendon. The MNVL was cable grafted from either the proximal facial nerve or masseteric nerve to the distal facial nerve branches. ALT fascia was suspended to the superficial muscular aponeurotic system. RESULTS Average follow up was 19 months. Only one patient failed to achieve symmetry attributed to dehiscence of OTTT. All patients achieved oral competence and dynamic smile with OTTT activation. Facial nerve recovery was seen in 8 patients. 5 reached a House Brackman Score of 3. Two donor site seromas and two wound infections occurred. CONCLUSION Simultaneous ALT, OTTT, and facial nerve cable grafting provides early reestablishment of facial symmetry, facial reanimation, and oral competence with minimal morbidity.
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Kang SY, Eskander A, Patel K, Teknos TN, Old MO. The unique and valuable soft tissue free flap in head and neck reconstruction: Lateral arm. Oral Oncol 2018; 82:100-107. [DOI: 10.1016/j.oraloncology.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/07/2018] [Accepted: 05/12/2018] [Indexed: 11/25/2022]
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Patel AV, Thuener JE, Clancy K, Ascha M, Manzoor NF, Zender CA. Submental artery island flap versus free flap reconstruction of lateral facial soft tissue and parotidectomy defects: Comparison of outcomes and patient factors. Oral Oncol 2018; 78:194-199. [DOI: 10.1016/j.oraloncology.2018.01.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/22/2017] [Accepted: 01/28/2018] [Indexed: 10/18/2022]
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Kang SY, Old MO, Teknos TN. Lateral arm free tissue transfer for parotid reconstruction: A pictorial essay. Head Neck 2017; 39:1015-1019. [DOI: 10.1002/hed.24695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 11/29/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Stephen Y. Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center; The James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Matthew O. Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center; The James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Theodoros N. Teknos
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center; The James Cancer Hospital and Solove Research Institute; Columbus Ohio
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McMullen CP, Smith RV, Ow TJ, Tassler A, Schiff BA. Minimal Margin Extracapsular Dissection. Ann Otol Rhinol Laryngol 2016; 125:912-917. [DOI: 10.1177/0003489416661344] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Extracapsular dissection (ECD) has become an accepted, less invasive alternative for the removal of select benign parotid lesions that may reduce complications. Minimal margin extracapsular dissection (MECD) with dissection on or closer to the tumor capsule may be a reasonable alternative to ECD. The objective of this study is to review the complications and safety of the MECD technique at a single institution. Subjects and Methods: Medical records for patients who underwent MECD for suspected benign parotid lesions were reviewed. Outcome measurements included intraoperative findings, complications, and recurrences. Results: Forty patients underwent a MECD for suspected benign parotid lesions. The average tumor size was 2.2 cm. Frozen section revealed low-intermediate grade mucoepidermoid carcinoma in 2 (5%) cases, requiring completion of a superficial parotidectomy at the same setting. There was 1 case of temporary facial nerve weakness and no cases of Frey syndrome. No tumor recurrences were observed within the follow-up period (average 3.5 years.) Conclusion: In the hands of an experienced surgeon, MECD may be a viable alternative to formal superficial parotidectomy. This study reports low rates of nerve weakness and Frey syndrome. Long-term follow-up is necessary to determine the ultimate risk of recurrence.
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Affiliation(s)
- Caitlin P. McMullen
- Department of Otolaryngology–Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Richard V. Smith
- Department of Otolaryngology–Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas J. Ow
- Department of Otolaryngology–Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew Tassler
- Department of Otolaryngology–Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Bradley A. Schiff
- Department of Otolaryngology–Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Free abdominal fat transfer for partial and total parotidectomy defect reconstruction. Laryngoscope 2016; 126:2694-2698. [DOI: 10.1002/lary.26025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 03/06/2016] [Accepted: 03/16/2016] [Indexed: 11/07/2022]
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Volk GF, Granitzka T, Kreysa H, Klingner CM, Guntinas-Lichius O. Initial severity of motor and non-motor disabilities in patients with facial palsy: an assessment using patient-reported outcome measures. Eur Arch Otorhinolaryngol 2016; 274:45-52. [DOI: 10.1007/s00405-016-4018-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
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Fritz MA, Rolfes BN. Microvascular Reconstruction of the Parotidectomy Defect. Otolaryngol Clin North Am 2016; 49:447-57. [DOI: 10.1016/j.otc.2015.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Balasundaram I, Nasser N. Paraumbilical fat graft for the correction of contour deformity following parotidectomy and prevention of Frey syndrome. Int J Oral Maxillofac Surg 2016; 45:380-2. [DOI: 10.1016/j.ijom.2015.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 06/02/2015] [Accepted: 07/22/2015] [Indexed: 11/28/2022]
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Yang XD, Zhao SF, Zhang Q, Wang YX, Li W, Hong XW, Hu QG. Use of modified lateral upper arm free flap for reconstruction of soft tissue defect after resection of oral cancer. Head Face Med 2016; 12:9. [PMID: 26825783 PMCID: PMC4731961 DOI: 10.1186/s13005-016-0105-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 01/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the suitability of a modified lateral upper arm free flap (LAFF) for reconstruction of soft tissue defects after resection of oral cancer. METHODS Eighteen cases of soft tissue defect repair performed between January 2011 and December 2013 using a modified LAFF after resection of oral cancer were reviewed. The design and harvest of the LAFF, the reconstruction procedure, and postoperative morbidity were reviewed and evaluated over a follow-up period of at least 12 months. RESULTS The overall flap survival was 94.4 % (17/18 patients). A broad scar at the donor site was the most common morbidity, but patients did not report dissatisfaction with the scar because they could easily cover it. All wounds at the donor site achieved primary recovery. One case of flap loss was repaired with a radial forearm free flap. One case complicated by diabetes mellitus involved infection of the flap with one-third of the flap becoming necrotic. This flap survived after removal of the necrotic tissue. In one other case, fat liquefactive necrosis (1.5 × 1.0 cm) occurred in the flap on the tip of the tongue, and this flap survived after debridement. Overall, the shape and function of the reconstructed tissues were well restored, and there was no severe morbidity at the donor site in any case. CONCLUSION The modified LAFF was safe and reliable for the reconstruction of soft tissue defects after resection of oral cancer.
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Affiliation(s)
- Xu-Dong Yang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Su-Feng Zhao
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Qian Zhang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Yu-Xin Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Wei Li
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Xiao-Wei Hong
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
| | - Qin-Gang Hu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No. 30 Zhong Yang Rd, Nanjing, 210008 People’s Republic of China
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Renkonen S, Sayed F, Keski-Säntti H, Ylä-Kotola T, Bäck L, Suominen S, Kanerva M, Mäkitie AA. Reconstruction of facial nerve after radical parotidectomy. Acta Otolaryngol 2015; 135:1065-9. [PMID: 26061795 DOI: 10.3109/00016489.2015.1050604] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Most patients benefitted from immediate facial nerve grafting after radical parotidectomy. Even weak movement is valuable and can be augmented with secondary static operations. Post-operative radiotherapy does not seem to affect the final outcome of facial function. OBJECTIVES During radical parotidectomy, the sacrifice of the facial nerve results in severe disfigurement of the face. Data on the principles and outcome of facial nerve reconstruction and reanimation after radical parotidectomy are limited and no consensus exists on the best practice. METHOD This study retrospectively reviewed all patients having undergone radical parotidectomy and immediate facial nerve reconstruction with a free, non-vascularized nerve graft at the Helsinki University Hospital, Helsinki, Finland during the years 1990-2010. There were 31 patients (18 male; mean age = 54.7 years; range = 30-82) and 23 of them had a sufficient follow-up time. RESULTS Facial nerve function recovery was seen in 18 (78%) of the 23 patients with a minimum of 2-year follow-up and adequate reporting available. Only slight facial movement was observed in five (22%), moderate or good movement in nine (39%), and excellent movement in four (17%) patients. Twenty-two (74%) patients received post-operative radiotherapy and 16 (70%) of them had some recovery of facial nerve function. Nineteen (61%) patients needed secondary static reanimation of the face.
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Affiliation(s)
- Suvi Renkonen
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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Agrogiannis N, Rozen S, Reddy G, Audolfsson T, Rodriguez-Lorenzo A. Vastus lateralis vascularized nerve graft in facial nerve reconstruction: An anatomical cadaveric study and clinical implications. Microsurgery 2014; 35:135-9. [DOI: 10.1002/micr.22311] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/05/2014] [Accepted: 08/08/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Nikolaos Agrogiannis
- Department of Plastic and Maxillofacial Surgery; Uppsala University Hospital and Department of Surgical Sciences, Uppsala University; Sweden
| | - Shai Rozen
- Department of Plastic Surgery; UT Southwestern Medical Center; Dallas Texas
| | - Gangadasu Reddy
- Department of Plastic Surgery; UT Southwestern Medical Center; Dallas Texas
| | - Thorir Audolfsson
- Department of Plastic and Maxillofacial Surgery; Uppsala University Hospital and Department of Surgical Sciences, Uppsala University; Sweden
| | - Andres Rodriguez-Lorenzo
- Department of Plastic and Maxillofacial Surgery; Uppsala University Hospital and Department of Surgical Sciences, Uppsala University; Sweden
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Autologous fat transfer: an aesthetic and functional refinement for parotidectomy. Surg Res Pract 2014; 2014:873453. [PMID: 25379564 PMCID: PMC4208499 DOI: 10.1155/2014/873453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 12/02/2013] [Accepted: 12/05/2013] [Indexed: 11/28/2022] Open
Abstract
Parotidectomy is a surgical procedure associated to functional (Frey's syndrome) as well as aesthetic (facial asymmetry) complications that can be very disturbing for the patient. Several procedures have been described to primarily avoid or secondarily reconstruct the facial defect and treat the neurological iatrogenic syndrome.
Autologous fat transfer was primarily used in 10 cases to avoid such complications. It is an easy technique widely used in cosmetic and reconstructive surgery. This technique gives very satisfying long-term results on the cosmetic as well as on the physiological point of view.
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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: 2.1] [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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Reconstruction of complex defects of the parotid region using a lateral thoracic wall donor site. J Craniomaxillofac Surg 2013; 41:265-9. [DOI: 10.1016/j.jcms.2012.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 10/16/2012] [Accepted: 10/16/2012] [Indexed: 11/15/2022] Open
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Pabiszczak M, Banaszewski J, Wierzbicka M, Jackowska J, Waśniewska E, Szyfter W. [Reconstructive surgery in huge tumors of salivary glands]. Otolaryngol Pol 2013; 67:40-4. [PMID: 23374663 DOI: 10.1016/j.otpol.2012.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/13/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evaluation the outcome after extensive surgery of salivary glands tumors with simultaneous reconstruction of soft tissue and skin defect. MATERIAL In the period 2007-2011, surgery treatments performed in 295 of major salivary glands. 31 patients underwent surgery due to malignant parotid gland tumors: 19 women (61%) and 12 men (39%). In 8 (26%) presented skin infiltration. 10 (32%) patients had facial palsy between II-IV degree (House Brackmann scale). The radiographic findings in some patients showed infiltration of the deep lobe of parotid gland, external auditory canal, infiltration of mastoid process, skull base and the subtemporal fossa. METHODS Of the 31 patients in 13 (42%) reconstruction techniques with muscle cutaneous trapezius flap were applied in 4 (31%) patients. In group of 7 (54%) patients using a muscle flap based on the sterno-cleido-gland, in 2 (15%) patients defects were covered using the free anterior lateral thigh flap. RESULTS In all patients, healing proceeded normally. In the operated patients, one patient did not receive radical surgery due to the infiltration of the skull base. Length of hospitalization ranged between 7-21 days. In no case was lost flap, also there was no local complications at the donor. CONCLUSIONS The choice of treatment for malignant parotid gland tumors which are usually radioresistant is surgical resection. In patients with extensive tumors with infiltration of neighbouring organs reconstruction with use of distant flaps are recommended. It provides a good oncological and aesthetic result.
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Affiliation(s)
- Maciej Pabiszczak
- Klinika Otolaryngologii i Onkologii Laryngologicznej UM im. K. Marcinkowskiego, ul. Przybyszewskiego 49, 60-355 Poznań, Poland.
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Revenaugh PC, Knott PD, Scharpf J, Fritz MA. Simultaneous Anterolateral Thigh Flap and Temporalis Tendon Transfer to
Optimize Facial Form and Function After Radical Parotidectomy. ACTA ACUST UNITED AC 2012. [DOI: 10.1001/archfaci.2011.1263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter C. Revenaugh
- Authors Affiliations: Head and Neck Institute, Department of Otolaryngology–Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio (Drs Revenaugh, Scharpf, and Fritz); and Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco (Dr Knott)
| | - P. Daniel Knott
- Authors Affiliations: Head and Neck Institute, Department of Otolaryngology–Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio (Drs Revenaugh, Scharpf, and Fritz); and Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco (Dr Knott)
| | - Joseph Scharpf
- Authors Affiliations: Head and Neck Institute, Department of Otolaryngology–Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio (Drs Revenaugh, Scharpf, and Fritz); and Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco (Dr Knott)
| | - Michael A. Fritz
- Authors Affiliations: Head and Neck Institute, Department of Otolaryngology–Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio (Drs Revenaugh, Scharpf, and Fritz); and Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco (Dr Knott)
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Higgins KM, Erovic BM, Ravi A, Yeung R, Lee JW, Yao C, Enepekides DJ. Volumetric changes of the anterolateral thigh free flap following adjuvant radiotherapy in total parotidectomy reconstruction. Laryngoscope 2012; 122:767-72. [DOI: 10.1002/lary.22509] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 10/13/2011] [Accepted: 11/28/2011] [Indexed: 11/09/2022]
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Arden RL, Miguel GS. Aesthetic parotid surgery: Evolution of a Technique. Laryngoscope 2011; 121:2581-5. [DOI: 10.1002/lary.22154] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/06/2011] [Accepted: 06/14/2011] [Indexed: 11/09/2022]
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Aesthetic Restoration of Parotidectomy Contour Deformity Using the Supraclavicular Artery Island Flap. Plast Reconstr Surg 2011; 127:1925-1931. [DOI: 10.1097/prs.0b013e31820cf40a] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Henstrom DK, Lindsay RW, Cheney ML, Hadlock TA. Surgical Treatment of the Periocular Complex and Improvement of Quality
of Life in Patients With Facial Paralysis. ACTA ACUST UNITED AC 2011. [DOI: 10.1001/archfaci.2011.9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Douglas K. Henstrom
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston (Drs Henstrom, Cheney, and Hadlock); and Department of Otolaryngology–Head and Neck Surgery, Bethesda Naval Medical Center, Baltimore, Maryland (Dr Lindsay)
| | - Robin W. Lindsay
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston (Drs Henstrom, Cheney, and Hadlock); and Department of Otolaryngology–Head and Neck Surgery, Bethesda Naval Medical Center, Baltimore, Maryland (Dr Lindsay)
| | - Mack L. Cheney
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston (Drs Henstrom, Cheney, and Hadlock); and Department of Otolaryngology–Head and Neck Surgery, Bethesda Naval Medical Center, Baltimore, Maryland (Dr Lindsay)
| | - Tessa A. Hadlock
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston (Drs Henstrom, Cheney, and Hadlock); and Department of Otolaryngology–Head and Neck Surgery, Bethesda Naval Medical Center, Baltimore, Maryland (Dr Lindsay)
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Cannady SB, Seth R, Fritz MA, Alam DS, Wax MK. Total parotidectomy defect reconstruction using the buried free flap. Otolaryngol Head Neck Surg 2010; 143:637-43. [DOI: 10.1016/j.otohns.2010.08.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 08/13/2010] [Accepted: 08/13/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE 1) Present an alternative method of total parotidectomy with or without neck dissection defect reconstruction that results in improved cosmesis. 2) Describe applications of free tissue transfer in parotidectomy defect reconstruction. STUDY DESIGN Case series with chart review. SETTING Two tertiary-care medical centers. SUBJECTS AND METHODS A two-institution retrospective review from 2002 to 2009 was conducted for buried free flaps utilized in reconstruction of defects from total parotidectomy with or without neck dissection. Patients with temporal bone or skin resections were excluded. Demographic information, tumor characteristics, surgical interventions, flap details, and adjunctive facial reconstructive techniques were recorded. Postoperative cosmetic results were evaluated by patient and physician satisfaction. RESULTS Eighteen patients with a mean age of 57.4 years underwent flap reconstruction. Total parotidectomy was performed in all cases, 11 cases required facial nerve sacrifice, and 14 cases included neck dissection. The anterolateral thigh flap was the most often utilized free flap. Mean flap area was 65.5 cm2. Adjunctive static facial reanimation was employed in eight patients. All flaps survived. Ten patients underwent adjuvant radiation. Free flap reconstruction resulted in cosmetic patient and surgeon satisfaction, despite adjuvant radiation therapy. CONCLUSION Free flap reconstruction of total parotidectomy (with or without neck dissection) defects is safe and effective. It does not preclude adjunctive facial reanimation and provides sufficient tissue bulk to match the contralateral facial contour despite radical resections and adjuvant radiation therapy in most cases.
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Affiliation(s)
| | - Rahul Seth
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | | | - Daniel S. Alam
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - Mark K. Wax
- and the Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland, OR
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Rhee JS, McMullin BT. Outcome measures in facial plastic surgery: patient-reported and clinical efficacy measures. ACTA ACUST UNITED AC 2008; 10:194-207. [PMID: 18490547 DOI: 10.1001/archfaci.10.3.194] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To survey the existing literature to identify, summarize, and evaluate procedure- and condition-specific outcome measures for use in facial plastic and reconstructive surgery. METHODS A review of the English-language literature was performed to identify outcomes instruments specific for targeted facial plastic surgery interventions and conditions. A search was performed using MEDLINE (1950 to September 2007), CINAHL (Cumulative Index to Nursing & Allied Health) (1982 to September 2007), and PsychINFO (1806 to September 2007). Outcomes instruments were categorized as patient-reported or clinical efficacy measures (observer-reported or objective measures). Instruments were then categorized to include relevant details on the intervention, degree of validation, and subsequent use. RESULTS Sixty-eight distinct instruments were identified (23 patient-reported, 35 observer-reported, and 10 objective measures), with some overlap among categories. Most patient-reported measures (76%) and half observer-reported instruments (51%) were developed in the past 10 years. The rigor of validation varied widely among measures, with formal validation being most common among the patient-reported outcome measures. CONCLUSIONS Validated outcomes measures are present for many common facial plastic surgery conditions and have become more prevalent during the past decade, especially for patient-reported outcomes. Challenges remain in harmonizing patient-reported, observer-based, and other objective measures to produce standardized clinically meaningful outcome measures.
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Affiliation(s)
- John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Conger BT, Gourin CG. Free Abdominal Fat Transfer for Reconstruction of the Total Parotidectomy Defect. Laryngoscope 2008; 118:1186-90. [DOI: 10.1097/mlg.0b013e31816dd2e9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reconstruction after total parotidectomy using a de-epithelialized free flap. J Craniomaxillofac Surg 2007; 35:364-8. [DOI: 10.1016/j.jcms.2007.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Accepted: 07/06/2007] [Indexed: 11/24/2022] Open
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Hyodo I, Ozawa T, Hasegawa Y, Ogawa T, Terada A, Torii S. Management of a Total Parotidectomy Defect With a Gastrocnemius Muscle Transfer and Vascularized Sural Nerve Grafting. Ann Plast Surg 2007; 58:677-82. [PMID: 17522494 DOI: 10.1097/01.sap.0000239844.57064.ed] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immediate facial nerve reconstruction is very demanding after total parotidectomy. Under such conditions, we reconstructed facial nerves using vascularized sural nerve with free lateral gastrocnemius muscle flap. The patient was a 14-year-old male diagnosed with mucoepidermoid carcinoma of the right parotid gland. We reconstructed zygomatic, buccal, and mandibular branches of facial nerve using 2 vascularized sural nerves, medial sural cutaneous nerve, and the lateral sural cutaneous nerve. The postoperative course was good, and there was no flap trouble. The reinnervated nerve recovered from 3 months after the operation. In 6 months after operation, almost normal animation was recovered, except for the corners of the patient's mouth. The advantages of this flap are feasible harvesting in the supine position, feasible filling of the dead space, possible harvesting of 2 series of lateral sural cutaneous nerve and median sural cutaneous nerve, and less sacrifice of the donor site. The disadvantage of this method is that the diameter of the pedicle is smaller than that of the medial pedicle. But the diameters of the lateral sural artery and vein are suitable to anastomose the cervical artery and vein. This flap is one of the good options for reconstruction of facial nerves after total parotidectomy.
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Affiliation(s)
- Ikuo Hyodo
- Department of Head and Neck Surgery and Reconstructive Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
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Haas F, Ensat F, Windhager R, Stammberger H, Koch H, Scharnagl E. Reconstructive potential of the lateral arm flap after tumor resection. Microsurgery 2007; 27:166-73. [PMID: 17326197 DOI: 10.1002/micr.20326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The reconstruction of extended tumor-related defects in different anatomic regions requires a versatile and reliable flap. For many surgeons, the lateral arm flap has become the technique of choice in the reconstruction of small- to medium-sized defects. The aim of this study was to analyze the reconstructive potential of the lateral arm flap after cancer ablation in various indications. Between 1998 and 2006, 14 patients underwent reconstruction with differently composed and designed lateral arm flaps at our institution. Complete coverage of all defects was achieved with a single surgical procedure. With a flap survival rate of 100% in our series, excellent long term results and high patient satisfaction combined with low donor site morbidity, we can recommend the use of the lateral arm flap in tumor patients.
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Affiliation(s)
- Franz Haas
- Division of Plastic Surgery, Department of Surgery, Karl-Franzens University Hospital, Graz, Austria.
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