PDF(Pubmed)
Abstract：
Background: Parotidectomies are indicated for a variety of reasons. Regardless of the indication for surgery, facial reanimation may be required because of facial nerve sacrifice or iatrogenic damage. In these cases, facial restoration performed concurrently with ablative surgery is considered the gold standard, and delayed reanimation is usually not attempted. Methods: A retrospective review of all patients who underwent parotidectomies from 2009 to 2022 in a single institution was performed. Indications, surgical techniques, and outcomes of an algorithmic template were applied to these cases using the Sunnybrook, Terzis scores, and Smile Index. A comparison was made between immediate vs. late repairs. Results: Of a total of 90 patients who underwent parotidectomy, 17 (15.3%) had a radical parotidectomy, and 73 (84.7%) had a total or superficial parotidectomy. Among those who underwent complete removal of the gland and nerve sacrifice, eight patients (47.1%) had facial restoration. There were four patients each in the immediate (n = 4) and late repair (n = 4) groups. Surgical techniques ranged from cable grafts to vascularized cross facial nerve grafts (sural communicating nerve flap as per the Koshima procedure) and vascularized nerve flaps (chimeric vastus lateralis and anterolateral thigh flaps, and superficial circumflex perforator flap with lateral femoral cutaneous nerve). Conclusions: The algorithm between one technique and another should take into consideration age, comorbidities, soft tissue defects, presence of facial nerve branches for reinnervation, and donor site morbidity. While immediate facial nerve repair is ideal, there is still benefit in performing a delayed repair in this algorithm.
摘要：
背景：由于各种原因，需要进行腮腺切除术。不管手术指征如何,由于面部神经损伤或医源性损伤，可能需要面部复活。在这些情况下,与消融手术同时进行的面部修复被认为是黄金标准，和延迟的动画通常不会尝试。方法：对2009年至2022年在单个机构中接受腮腺切除术的所有患者进行回顾性分析。指示,外科技术,使用Sunnybrook将算法模板的结果应用于这些情况，泰齐斯得分，微笑指数在即时与后期维修。结果：在90例接受腮腺切除术的患者中，17例（15.3%）进行了根治性腮腺切除术，73例（84.7％）进行了全腮腺切除术或浅表切除术。在那些接受完全切除腺体和神经牺牲的人中，8例(47.1%)患者面部恢复。立即修复（n=4）和晚期修复（n=4）组中各有4名患者。手术技术范围从电缆移植物到血管化的交叉面神经移植物（根据Koshima手术的腓肠交通神经皮瓣）和血管化的神经皮瓣（嵌合股外侧肌和股前外侧皮瓣，和带有股外侧皮神经的浅回旋穿支皮瓣）。结论：一种技术与另一种技术之间的算法应考虑年龄，合并症,软组织缺损,存在用于神经支配的面神经分支，和供体部位发病率。虽然立即修复面神经是理想的，在此算法中执行延迟修复仍然有好处。
