Facial squamous carcinoma with parotid metastasis--closure with cheek-neck rotation

Because squamous carcinoma of the face is usually recognized and treated early, regional metastasis occurs infrequently. However, due to neglect or initial treatment failure, aggressive lesions of the temporal-zygomatic area may metastasize to parotid nodes. These tumors are most effectively treated with en bloc primary excision and regional node dissection, which includes superficial parotidectomy with or without neck dissection. Closure of such large defects presents a technical challenge and often skin grafts are utilized. This report deals with our experience with a large lateral facial squamous carcinoma with parotid metastasis. Surgical options and a method of primary closure with cheek-neck rotation flap are discussed. Controversy exists regarding elective neck dissection and/or postoperative irradiation. Postoperative irradiation is advised for pathological evidence of perineural invasion, multiple positive nodes, extranodal spread, or questionable margins.