What is Radical Parotidectomy?
A radical parotidectomy involves the removal of a portion of or the entire parotid gland, as well as purposeful transection of the facial nerve. This procedure is often reserved for cases where the nerve is infiltrated by a malignant tumor. Given the morbidity associated with transection of the facial nerve, this procedure is reserved for patients in whom it is imperative in order to attempt a cure of a malignant cancer. Unfortunately, this procedure often results in a facial paralysis as well as a contour defect due to volume loss after removal of the parotid gland.
What are the symptoms of Radical Parotidectomy?
Facial nerve paralysis after purposeful transection of the facial nerve.
What causes Radical Parotidectomy?
Malignant cutaneous or intra-parotid cancer.
How can Radical Parotidectomy be treated?
Acute
We recommend cable grafting +/- masseteric nerve transfer at the time of facial nerve resection with possible static reanimation for the lower lip. Use of vascularized fat from the thigh can prevent the worst of the soft tissue atrophy for select patients. Acute post-operative management involves eye care with moisture chamber (or taping the eye shut at night vs. the use of special goggles), refresh tears, and lacrilube to prevent dangerous eyeball drying and corneal ulceration. After a few weeks, once the swelling has resolved, we recommend brow lifting, upper eyelid weighting, and lower eyelid tightening. Please inquire with your reconstructive surgeon if you are a candidate for a temporalis tendon transfer.
Delayed
- Cross facial nerve graft and free gracilis muscle transfer
- Static reanimation with tensor fascia lata
- Orthodromic Temporalis tendon transfer
- Lengthening temporalis myoplasty
- Lateral eyelid coupling
- Fat grafting
See our patient testimonial.
References
- Guntinas-Lichius O, Silver CE, Thielker J, Bernal-Sprekelsen M, Bradford CR, et al. Management of the facial nerve in parotid cancer: preservation or resection and reconstruction. European Archives of Oto-Rhino-Laryngology. 2018. 275:2615-2626.