10/06/2024
A key goal of facial is to restore a spontaneous that expresses joy (upper dentition show).
Treatment of including tumors of the gland can yield and facial soft tissue deformity.
Facial reanimation in patients with prior parotid cancer is challenging owing to the combined effects of prior surgery and radiation. The overlying skin flap is often atrophic, contracted, and poorly vascularized. Tissue planes are replete with scar tissue, and donor vessels are limited and tenuous.
Despite the challenges, given proper planning and ex*****on, chimeric multi-vector muscle flaps can be an excellent choice for rehabilitation of smile and facial contour in patients who have undergone radical and adjuvant .
Some pearls:
-The lingual artery and ranine veins are rarely resected as part of a neck dissection for advanced parotid cancer and often out of the radiation field, rendering them suitable as donor vessels in the vessel depleted neck. Retrograde flow from the facial / angular artery is also an excellent source to power free transferred muscle in this cohort of patients
-An adiopocuatneous paddle supplied by perforators coursing through the vascularized fascia between the gracilis and adductor longus muscles (and anterior segment of the gracilis muscle in some instances) can be harvested with functional muscle paddles based off a single vascular pedicle for recontouring of the cheek and provide additional skin to facilitate tensionless closure
-Fascia lata can be used to help re-create a gliding plane between the overlying skin/SMAS flap and the gracilis muscle
-Supercharged cross-facial nerve grafting is a good option for patients over 20 to balance power and spontaneity of reanimated smile
