Parotidectomy - Defect Reconstruction

Considerations

• • Qualify and quantify the defect

    • Radical vs superficial parotidectomy 

      • Skin 

      • Soft tissue volume 

      • Facial nerve 

  • Principles of reconstruction: Form and function

    • Form: Color, contour, symmetry

    • Function: Innervation, movement

      • Goals: Protect the eye, oral competence, nasal airway, tone and position, smile movement  

  • Re-innervation

    • Vein sleeve graft over primary neurorrhaphy

    • Cable grafting: May be better with a motor nerve over a sensory nerve (nerve to vastus lateralis, sural nerve)  

    • Transfer: Nerve to masseter, hypoglossal, cross facial  

    • Orthodromic temporalis tendon transfer  

    • Gracilis free flap 

  • Static sling

    • Alloderm: Three vector 

    • Fascia 

  • Synkinesis - always a post op issue 

    • Treat with Botox - focus on the ipsilateral side and zygomaticus major on the contralateral side 

  • Peri-orbital 

    • Postpone weight placement 2-3 weeks 

    • Platinum chains are ideal 

  • Forehead 

    • Should also be postponed 2-3 weeks 

    • Direct (mid forehead) lift is often ideal 

Preparation

Procedure

Sample operative report

Post-op

Pearls & Pitfalls

High-Yield

Links