Submandibular gland flap for reconstruction after parotidectomy

Abstract

Objectives/Hypothesis Description of a novel use of a submandibular gland (SMG) flap pedicled on the facial vessels to restore facial volume after parotidectomy, and comparison of clinical outcomes with alternative modes of reconstruction. Study Design Retrospective chart review. Methods The surgical technique for a SMG flap is described. Retrospective chart review of cases of parotidectomy at a single tertiary medical center was conducted (n = 43). Cases were grouped in three cohorts of consecutive patients depending on reconstruction technique: SMG flap (n = 13), sternocleidomastoid muscle (SCM) flap (n = 15), and no flap (n = 15). Cohort characteristics and complication rates are reported. Results The SMG flap was more often used for a malignant pathology (92%) and in conjunction with a neck dissection (100%), compared to the SCM flap (47% and 15%) or no flap (0% and 0%), respectively. The mean House‐Brackmann score in the immediate postoperative period in the SMG‐flap group was slightly elevated compared to the other groups: 1.6 (standard deviation [SD] ± 0.5) versus 1.1 (SD ± 0.3) and 1.0 (SD ± 0.0). Otherwise, the complication rate was similar across groups. Conclusions The SMG flap is a safe and effective option for volume restoration after parotidectomy. It provides durable volume that will not atrophy and is already exposed in the field of dissection for patients undergoing concurrent level I neck dissection. Level of Evidence 3 Laryngoscope, 130:E155–E162, 2020

What is the best method for prevention of postparotidectomy Frey syndrome? Network meta‐analysis

“…There were 8 RCTs 10,18,32,39,41,48,51,56 and 26 non-RCTs. 6,14,20,[29][30][31][33][34][35][36][37]39,40,[42][43][44][45][46][47]49,50,[52][53][54][55]57 The included studies were published between 1974 and 2019, and compared five common methods for prevention of FS with each other or with NB. A total of 2987 patients underwent parotid surgery and received one of the following interventions: Alloderm (ADM), TPF flap, SCM flap, free fat graft (FFG), and superficial musculoaponeurotic system.…”

“…10,18,32,33,39,41,48,51,53,56 Of them, five studies 33,51,53,56 were assessed as having unclear risk of bias and the other five studies were assessed as having high risk of bias. 10,18,32,41,48 Regarding NOS for the non-RCTs, 6,14,20,[29][30][31][34][35][36][37]39,40,[42][43][44][45][46][47]49,50,52,54,55,57 there were 10 studies assessed as having unclear risk 6,14,29,30,37,40,45,49,…”

Pedicled Cervical Lymphoadipose Tissue for Volume Reconstruction after Superficial Parotidectomy

“…A major drawback of these procedures is the resultant facial contour deformity, especially in the case of extensive resections. Some methods of restoring or minimizing facial contour defects involve adding bulk or volume from acellular dermis, autologous fat, or superficial muscular aponeurotic system flap [ 2 ]. To mitigate volume loss over time, larger defects require more vascularized flaps.…”

“…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.…”