Comprehensive approach to reestablishing form and function after radical parotidectomy

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Head and Neck Surgery

Background:

• Radical parotidectomy necessitates reconstruction to restore facial symmetry, reanimation, and oral competence.
• The anterolateral thigh (ALT) free flap, orthodromic temporalis tendon transfer (OTTT), and facial nerve cable grafting are presented as a combined reconstructive approach.

Purpose of the Study:

• To evaluate the efficacy of a combined reconstructive technique using ALT free flap, OTTT, and facial nerve cable grafting following radical parotidectomy.
• To assess the outcomes in terms of facial symmetry, reanimation, oral competence, and patient morbidity.

Main Methods:

• Seventeen patients underwent radical parotidectomy with immediate reconstruction using ALT free flap, OTTT, and facial nerve cable grafting between 2010 and 2016.
• The ALT flap addressed volume and skin defects, OTTT restored oral competence and smile, and facial nerve grafting facilitated reanimation.
• Key procedures included ALT flap anastomosis, temporalis tendon to orbicularis oris fixation, and motor nerve to vastus lateralis cable grafting.

Main Results:

• The combined approach achieved symmetry in most patients, with only one failure attributed to OTTT dehiscence.
• All patients regained oral competence and a dynamic smile following OTTT activation.
• Facial nerve recovery was observed in 8 patients, with 5 achieving a House Brackman Score of 3. Donor site seromas and wound infections were infrequent.

Conclusions:

• Simultaneous ALT free flap, OTTT, and facial nerve cable grafting effectively reestablish facial symmetry, reanimation, and oral competence post-parotidectomy.
• This reconstructive strategy offers early functional and aesthetic restoration with minimal associated morbidity.