Dermal Fat Grafting to Reconstruct the Parotidectomy Defect Normalizes Facial Attention

Anderies, Barrett J.; Dey, Jacob K.; Gruszczynski, Nelson; Price, Daniel L.; Moore, Eric J.; Janus, Jeffrey R.

doi:10.1002/lary.28890

Cited by 12 publications

(12 citation statements)

References 44 publications

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“…Surgical techniques to restore the facial contour after parotidectomy include fat grafting, fascia lata graft, acellular dermal matrix, dermofat graft, SMAS flap, SCM flap (superiorly or inferiorly based), platysma muscle flap, and temporoparietal fascia flap through free tissue transfer [1,6,7]. Although reconstruction is important, the optimal modality for parotid region reconstruction remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…The parotid gland, the largest salivary gland, is the most common gland harboring tumors, with a reported incidence of 75% in the United States [1]. Both malignant and benign tumors are removed through different parotidectomy types, depending on the extent of the tumor.…”

Section: Introductionmentioning

confidence: 99%

“…Both malignant and benign tumors are removed through different parotidectomy types, depending on the extent of the tumor. Postoperatively, 70% patients exhibit facial contour defects in the form of concave deformities, which are negatively correlated, esthetically, with the resection depth of the parotid gland [1]. Reconstructive options such as local and regional flaps, vascularized tissue flap transfer, acellular dermal matrix, filler, and abdominal dermal fat have been reported [1].…”

Section: Introductionmentioning

confidence: 99%

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Combined sternocleidomastoid and superficial muscular aponeurotic system flap reconstruction after malignant parotid tumor excision: a case report

AlQuniabut

Choi

2022

J Cosmet Med

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The parotid gland, which is the largest salivary gland, is the most common gland harboring tumors. Parotidectomy frequently alters facial appearance, particularly in terms of leading to deformities and scars. A 38-year-old male with a large malignant right parotid tumor underwent resection of the tumor leading to a significant soft tissue depression and defect over the parotid region. We successfully reconstructed the defect using a combined superficial musculoaponeurotic system flap and a superiorly based partialthickness myocutaneous sternocleidomastoid muscle flap reinforced with the platysma. Postoperatively, the patient received radiotherapy and exhibited good esthetics and facial harmony.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combined sternocleidomastoid and superficial muscular aponeurotic system flap reconstruction after malignant parotid tumor excision: a case report

AlQuniabut

Choi

2022

J Cosmet Med

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Section: Methodsmentioning

confidence: 99%

“…Abdominal dermal fat grafts are ideal reconstructive options due to predictable contour results, ease of harvest, biocompatibility, and low incidence of morbidity from both the donor and recipient sites. 14,18 Data Collection Demographic information and modifiable risk factors were collected, including age, gender, body mass index (BMI), history of radiation, smoking status, alcohol consumption status, and adjuvant radiation therapy. Alcohol consumption was divided into 3 categories: never alcohol drinker, occasional or social alcohol drinker, and frequent alcohol drinker.…”

Section: Dermal Fat Graftmentioning

confidence: 99%

Rate of Fat Graft Volume Loss After Parotidectomy

Sagalow

Christopher

Banoub

et al. 2022

Journal of Craniofacial Surgery

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Background: Reconstruction after parotidectomy can include fat grafting, which allows for symmetry, but grafts have demonstrated volume loss over time. Objectives: To provide quantitative evidence for the rate of volume loss of fat grafts. Methods: Patients who received parotidectomy with fat graft reconstruction at a single institution from August 2016 to October 2020 were identified. Relationships between clinical factors and the logarithmic rate of fat graft volume loss were analyzed. Results: Twelve patients received parotidectomy, fat graft reconstruction, and underwent a postoperative magnetic resonance imaging (MRI) scan. Rate of fat graft volume loss was a mean of 1.8% per month (standard deviation [SD]: 2.1% per month). Total parotid fat graft volume loss was a mean of 57.4% (SD: 67.5%). The mean follow-up time was 35.5 months (range: 9–89.8 months). Correlations between body mass index (BMI), history of smoking, and history of alcohol consumption and logarithmic rates of fat graft volume loss were increased but not significantly. Conclusions: Fat grafts have the potential of 60% volume loss at approximately 1 year. If there is clinical suspicion that patients will require adjuvant radiation or have clinical factors such as a smoking or alcohol-use history, volume requirements may be even greater to maintain adequate parotid volume for aesthetic purposes.

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Selective Deep Lobe Parotidectomy vs Total Parotidectomy for Patients With Benign Deep Lobe Parotid Tumors

Wallerius,

Xie,

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceLimited literature exists on surgical outcomes after selective deep lobe parotidectomy (SDLP) with preservation of superficial lobe for patients with benign deep lobe tumors.ObjectiveTo compare the following factors for SDLP vs total parotidectomy for patients with benign tumors in the deep lobe: postoperative complications, including facial nerve paresis or paralysis, Frey syndrome, first bite syndrome, cosmetic defect, sialocele formation, and wound infection; and tumor control and recurrence.Design, Setting, and ParticipantsThis case series included 273 adults who underwent SDLP (n = 177) or total parotidectomy (n = 96) at a single tertiary care institution for benign parotid tumors located in the deep lobe or deep lobe and parapharynx from January 1, 2000, to December 31, 2020.ExposureSelective deep lobe parotidectomy vs total parotidectomy.Main Outcomes and MeasuresIncidence of postoperative complications and tumor recurrence.ResultsAmong 273 patients (SDLP, 177 [65%]; 122 women [69%]; median age at surgery, 58 years [IQR, 46-67 years]; total parotidectomy, 96 [35%]; 57 women [59%]; median age at surgery, 59 years [IQR, 40-68 years]), the most common tumor was pleomorphic adenoma (SDLP, 128 of 177 [72%]; total parotidectomy, 62 of 96 [65%]). An abdominal dermal fat graft was less commonly performed for patients who underwent SDLP than those who underwent total parotidectomy (2 of 177 [1%] vs 20 of 96 [21%]; difference, −20% [95% CI, −28% to −11%]). The rate of great auricular nerve preservation was higher in the SDLP group than in the total parotidectomy group (84 of 102 [82%] vs 20 of 34 [59%]; difference, 24% [95% CI, 5%-42%]). No meaningful difference in length of hospital stay was found. The percentage of patients with House-Brackmann grade I immediately after surgery was 48% (85 of 177) in the SDLP group and 21% (20 of 96) in the total parotidectomy group (difference, 28% [95% CI, 16%-40%]). There were no clinically meaningful differences in rates of hematoma, sialocele, seroma, ear numbness, wound infection, or unplanned return to emergency department or operating room. The SDLP group reported a lower rate of Frey syndrome than the total parotidectomy group (1 of 137 [1%] vs 12 of 78 [15%]; difference, −15% [95% CI, −23% to −7%]), as well as a lower rate of facial contour defect (28 of 162 [17%] vs 25 of 84 [30%]; difference, −13% [95% CI, −24% to −1%]) and a higher rate of first bite syndrome (34 of 148 [23%] vs 7 of 78 [9%]; difference, 14% [95% CI, 5%-23%]). The percentage of patients with House-Brackmann grade I at their first follow-up visit was 67% (118 of 177) in the SDLP group compared with 49% (47 of 96) in the total parotidectomy group (difference, 17% [95% CI, 4%-30%]). There was no clinically meaningful difference in House-Brackmann grade after 1 year.Conclusions and RelevanceFindings of this case series study suggest that SDLP can be considered an effective and even superior technique for management of benign tumors in the deep parotid lobe. Advantages associated with SDLP include reduction in need for reconstruction for facial contour defect and reduction in complications, such as immediate facial nerve weakness and Frey syndrome. The incidence of first bite syndrome was higher in the SDLP group. Tumor control was not compromised by SLDP.

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Dermal Fat Grafting to Reconstruct the Parotidectomy Defect Normalizes Facial Attention

Cited by 12 publications

References 44 publications

Combined sternocleidomastoid and superficial muscular aponeurotic system flap reconstruction after malignant parotid tumor excision: a case report

Combined sternocleidomastoid and superficial muscular aponeurotic system flap reconstruction after malignant parotid tumor excision: a case report

Rate of Fat Graft Volume Loss After Parotidectomy

Selective Deep Lobe Parotidectomy vs Total Parotidectomy for Patients With Benign Deep Lobe Parotid Tumors

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