Reconstruction of limited parotidectomy defects using the dermofat graft

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Excerpt

Parotidectomy is a relatively common operation undertaken by surgeons who treat tumours of the head and neck. Most publications exploring the morbidity of parotidectomy are appropriately focused on facial nerve outcomes.1 However, in the vast majority of patients where facial nerve function is normal following parotid surgery other issues such as facial contour may be of some concern.2 This is particularly relevant in young to middle‐aged patients with benign disease where recurrence is unlikely.2 Other complications of parotid surgery, such as dysaesthesia and Frey's syndrome, are rarely major issues but can still adversely impact quality of life.2
Several techniques have been described to limit the morbidity of parotid surgery. These can be divided into ablative and reconstructive techniques. The limited parotidectomy described by O'Brien4 and extra‐capsular dissection popularized by McGurk et al.5 both reduce the volume of normal parotid tissue removed and have a reduced incidence of facial nerve dysfunction. However, the limited parotidectomy technique can predispose to a more exaggerated depressed deformity, particularly in patients with bulky parotid tissue. This is due to the interface between removed and intact superficial parotid tissue creating a step deformity. Reconstructive options include fat grafting,8 the sternocleidomastoid muscle (SCM) flap,9 the superficial musculoaponeurotic system (SMAS) flap,13 acellular dermal matrix,15 through to free flap reconstruction17 for complex defects. Each reconstructive approach has its own advantages and drawbacks with regard to defect size, donor site morbidity, complexity and complication rate.8 In many cases, the aim of the reconstruction extends beyond contour restoration to also reduce the incidence and severity of other complications such as Frey's syndrome by hindering the aberrant innervation of dermal sweat glands by salivary parasympathetic nerve fibres.6
The dermofat graft, although only recently used for parotidectomy defect reconstruction,6 is well established for a number of other reconstructive procedures. These include oculoplastic surgery,21 facial aesthetic surgery22 and post‐mastectomy nipple reconstruction.24 The aim of this study is to describe our experience using the dermofat graft for contour restoration following parotidectomy for benign salivary gland tumours with particular reference to patient satisfaction, and complications of the donor and recipient sites.
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