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Mentions: A radical parotidectomy and modified radical neck dissection with spinal accessory nerve preservation was planned under general anesthesia. A preauricular incision that curved under the ear lobule was made in extension with the neck dissection incision. A skin subcutaneous flap was raised over the parotid until the distal branches of the facial nerve were seen to exit the gland. The mandibular, buccal, and zygomatic branches were incised and tagged with fine silk sutures for later grafting [Figure 1A]. As the main trunk was considered to be encased by the tumour, a mastoidectomy was performed, to identify the main trunk of the facial nerve, increase the length of the proximal nerve stump for grafting, and also to provide adequate surgical margin. Once the main trunk was identified, extensive resection was performed to remove the parotid neoplasm. Frozen sections from the facial nerve confirm uninvolved nerve margins. After resection of the parotid neoplasm, modified neck dissection was subsequently added and the donor nerve graft was prepared from the great auricular nerve [Figure 1B]. The greater auricular nerve was traced proximally until additional branches coming off the cervical nerve roots were isolated. After freshening the cable nerve graft ends as well as the proximal and distal facial nerve branches with a scalpel, microscopic epineural repair was performed with an interrupted 8-0 monofilament nylon suture, with three to five sutures used at each anastomosis. The distal part of the graft was anastomosed to the main trunk of the facial nerve and the proximal branches coming off the cervical nerve roots were anastomosed to peripheral stumps [Figure 1C].
Adenoid cystic carcinoma of the parotid gland: Anastamosis of the facial nerve with the great auricular nerve after radical parotidectomy
Bottom Line: The proximal main trunk and each distal branch of the facial nerve were coapted with the greater auricular nerve.The patient received radiotherapy after surgery and was seen to achieve grade IV facial function one year after surgery.Thus, the great auricular nerve is appropriate grafting material for coaptation of each distal branch of the facial nerve.
Adenoid cystic carcinoma of the parotid gland is a rare and slowly growing, but highly malignant tumor. Surgical resection of a malignant parotid tumor should include resection of the facial nerve when the nerve is involved in the tumor. Facial nerve reconstruction is required after nerve resection. A 14 year-old female presented with complaints of painless enlargement of the right parotid gland and facial asymmetry. Physical examination revealed a firm mass in the region of the parotid gland as well as right facial paralysis. Biopsy obtained from the mass showed an adenoid cystic carcinoma of the parotid gland. A radical parotidectomy with a modified radical neck dissection was carried out. Grafting material for the facial reconstruction was harvested from the great auricular nerve. The proximal main trunk and each distal branch of the facial nerve were coapted with the greater auricular nerve. The patient received radiotherapy after surgery and was seen to achieve grade IV facial function one year after surgery. Thus, the great auricular nerve is appropriate grafting material for coaptation of each distal branch of the facial nerve.