Thesis title: Challenging Reconstruction of Oncologic Defects of the Parotid Lodge
Objectives: Reconstruction of the parotid region is a challenge for the reconstructive surgeon, considering the complex anatomy of the region. The approach to the reconstruction can be simplified and stereotyped by using a classification of the defects deriving from the ablative surgery. The present study aims to create an algorithm and use it to outline recommendations for the best reconstructive option. Materials and Methods: Retrospective observational study that includes all patients diagnosed with a malignant tumor of the parotid gland, who underwent surgery in the Maxillofacial Surgery unit of Policlinico Umberto I between 2000 and 2023. The exclusion criteria were the benignity of the tumor. For every patient the presence of cutaneous, soft tissues, bony and neural invasion was analyzed; type of parotidectomy (superficial, total, radical, radical extended to surrounding tissues) with or without neck dissection; type of reconstruction. Results: 67 patients were enrolled in our study, 35 females and 32 males. The mean age at diagnosis was 55 (SD +/- 16). Primary closure was the most frequent, with 42 cases (65%). In 25 cases (35%) a complex
reconstructive technique was necessary. Nine patients required a complex reconstruction of skin/soft tissue defect, 3 by a cervicofacial local flap, 4 by locoregional pedicled flaps and 2 by free flaps. Five subjects needed a complex reconstruction of bone defect, 2 with DCIA-free flaps. Finally, facial nerve resection was necessary in 25 cases and nerve reconstruction was performed in 11 cases. Conclusions: Key concepts in parotid region reconstruction are avoiding skin tension, minimizing skin color mismatch, restoring volume and restoring nerve function when compromised. This study outlines a reconstructive algorithm that considers the tridimensionality of the defect and is based upon two main criteria: type of resected tissue and volume of the defect.