Reconstruction of total parotidectomy defects with a de‐epithelialized submental flap

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

Frey's syndrome: A review of the physiology and possible role of neurotrophic factors

“…The most successful methods at preventing FS are temporoparietal fascial flaps, acellular dermal matrices and free fat grafts, with more traditional techniques such as the sternocleidomastoid and superficial musculoaponeurotic system flaps proving less efficient barrier techniques 38 . Recently, a new technique involving a de‐epithelialized sub mental flap has been recommended for reconstruction of parotidectomy defects but has not yet been tested as a method to prevent FS 39 . It could be suggested that creating a physical barrier reduces the incidence of aberrant regeneration by blocking the growth of parasympathetic neurons toward sweat glands.…”

Pedicled Cervical Lymphoadipose Tissue for Volume Reconstruction after Superficial Parotidectomy

“…There are several common locoregional options for relatively small defects including acellular dermis, sternocleidomastoid (SCM) muscle flap, and local fascia flaps [ 5 ]. Other reported regional options include both the submental flap [ 3 ] and submandibular gland (SMG) flap [ 2 ]. In addition, fat grafting is also frequently used but requires an additional operative site.…”

“…To mitigate volume loss over time, larger defects require more vascularized flaps. Pedicled flaps, such as the sternocleidomastoid (SCM) muscle flap, supraclavicular artery flap, and submental flap, and for even larger defects, autologous free tissue flaps, may be required [ 2 , 3 ]. Local pedicled flaps, however, can provide some advantages over utilization of free flaps.…”

“…It is well known that grafts exhibit volume loss over time, with both muscular and fatty tissue atrophy [ 2 , 4 ], but Liang et al found that using nonmuscular tissue, a pedicled submandibular gland flap, provided durable bulk and restored facial contour after parotidectomy. In addition, local pedicled flaps carry the advantage of a single surgical site, sparing the patient the added morbidity of a separate fat graft donor site, as well as reduced operative time and postoperative care compared to free flaps [ 2 , 3 ]. We report two cases of utilizing a cervical lymphoadipose tissue pedicled flap that may have similar advantages for volume restitution following superficial parotidectomy for benign parotid lesions.…”

Transoral robotic salvage oropharyngectomy with submental artery island flap reconstruction

“…The submental artery island flap (SAIF) is a wellestablished reconstructive option for defects of the head and neck; commonly utilized for the oral cavity, temporal bone, parotid, or skin. [1][2][3][4] While free tissue transfer remains the workhorse for reconstructing large defects of the head and neck, the SAIF has demonstrated value for a variety of reconstructive challenges. In comparison with free flaps, the SAIF offers lower procedural time and hospital length of stay (LOS).…”