Li Sean S, Mangialardi Maria L, Nguyen Quyen T, Orosco Ryan K, Honart Jean F, Qassemyar Quentin, Kolb Frederic J
From the UC San Diego Division of Plastic Surgery, San Diego, CA.
Plastic Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France.
Ann Plast Surg. 2021 May 1;86(5S Suppl 3):S379-S383. doi: 10.1097/SAP.0000000000002746.
Total parotidectomy with facial nerve sacrifice creates 2 challenging reconstructive problems: restoration of facial contour and facial nerve rehabilitation. Strong evidence suggesting that vascularized nerve grafts are superior to nonvascularized nerve grafts motivated our team to develop a chimeric scapulodorsal flap combining the usual harvestable local tissues with the vascularized latissimus dorsi motor nerve (SD-LDVxN). We present our experiences developing a new program at University of California, San Diego, highlighting our first case here, and present preliminary retrospective results focusing on the functional outcomes of facial nerve reanimation.
The first case performed in the United States was a 57-year-old woman with stage IVA left parotid adenoid cystic carcinoma and House-Brackmann grade 6 facial palsy. She underwent total parotidectomy with facial nerve sacrifice and a free chimeric SD-LDVxN flap reconstruction. She had an unremarkable postoperative course, and 3- and 6-month follow-up functional results are reported. Preliminary functional results from our total series of 25 patients were reported.
At her 3-month follow-up, she was a House-Brackmann 5 with a static eFACE score of 37, dynamic eFACE score of 31, and smile eFACE score of 48. At her 6-month follow-up, she was a House-Brackmann 5 with a static eFACE score of 50, dynamic eFACE score of 27, and smile eFACE score of 53. Preliminary results from our total series of 25 patients with an average of 5 years of follow-up were a House-Brackmann 2.5 and eFACE scores of 83.1 for static facial symmetry, 67.5 for dynamic facial symmetry, and 77.7 for smile score. Twenty of the 25 patients had postoperative radiotherapy. No local tumor recurrence had been reported. The average reinnervation time was 9 months and ranged from 3 to 15 months.
The SD-LDVxN flap is a highly resourceful solution to reconstruct complex parotid defects, especially those that sacrifice the facial nerve. The vascularized nerve graft allows for primary facial reanimation. Nerve recovery may be superior to what could be expected with a conventional nerve graft.
牺牲面神经的全腮腺切除术会带来两个具有挑战性的重建问题：面部轮廓的恢复和面部神经的修复。有力证据表明，带血管神经移植优于不带血管神经移植，这促使我们团队开发一种嵌合肩胛背皮瓣，将通常可获取的局部组织与带血管的背阔肌运动神经（SD-LDVxN）相结合。我们介绍了在加利福尼亚大学圣地亚哥分校开展新项目的经验，重点介绍了我们在此的首例病例，并展示了聚焦于面神经修复功能结果的初步回顾性结果。
在美国进行的首例病例是一名57岁女性，患有IVA期左腮腺腺样囊性癌且House-Brackmann分级为6级面瘫。她接受了牺牲面神经的全腮腺切除术及游离嵌合SD-LDVxN皮瓣重建术。她术后恢复过程顺利，报告了3个月和6个月的随访功能结果。报告了我们总共25例患者的初步功能结果。
在3个月随访时，她的House-Brackmann分级为5级，静态eFACE评分为37分，动态eFACE评分为31分，微笑eFACE评分为48分。在6个月随访时，她的House-Brackmann分级为5级，静态eFACE评分为50分，动态eFACE评分为27分，微笑eFACE评分为53分。我们总共25例患者平均随访5年的初步结果是House-Brackmann分级为2.5级，静态面部对称性的eFACE评分为83.1分，动态面部对称性的评分为67.5分，微笑评分为77.7分。25例患者中有20例术后接受了放疗。未报告局部肿瘤复发情况。平均再支配时间为9个月，范围为3至15个月。
SD-LDVxN皮瓣是重建复杂腮腺缺损，尤其是那些牺牲面神经的缺损的极具创造性的解决方案。带血管神经移植可实现一期面部修复。神经恢复可能优于传统神经移植的预期效果。
