Principles of Reconstruction: Reconstruction of the Parotid Area

  • Silvano Ferrari
  • Andrea Ferri
  • Bernardo Bianchi
  • Enrico Sesenna


Reconstruction of the parotid area after tumour resection is of primary relevance to ensure satisfactory patient’s quality of life, both from the functional and from the aesthetic point of view. The ideal reconstructive technique should be chosen taking into account the extension of the defect, the structures removed (gland, surrounding soft tissues, skin, facial nerve) and the patient’s profile in terms of age, comorbidities and availability of donor sites. Options may vary from locoregional to pedicled flaps up to microvascular free flaps. Special care should be taken in the replacement of the skin, when needed, in order to achieve the best match with the native one in terms of colour and texture. Special considerations should be also taken into account for what concerns management of the facial nerve when its sacrifice is required for oncological purposes. In these cases, immediate reconstruction techniques offer the best results in terms of functional outcomes.

In this chapter authors present a review of the reconstructive techniques available for parotid area reconstruction, with a specific focus on management of the facial nerve.


Reconstruction Resection Parotid Parotidectomy Facial nerve Minor salivary glands Local flap Pedicled flap Free flap 


  1. 1.
    Ch’ng S, Ashford BG, Gao K, McGuinness J, Clark JR. Reconstruction of post-radical parotidectomy defects. Plast Reconstr Surg. 2012;129:275e–87e.CrossRefGoogle Scholar
  2. 2.
    Bianchi B, Ferri A, Ferrari S, Copelli C, Poli T, Sesenna E. Free and locoregional flap associations in the reconstruction of extensive head and neck defects. Int J Oral Maxillofac Surg. 2008;37(8):723–9.CrossRefGoogle Scholar
  3. 3.
    Irvine LE, Larian B, Azizzadeh B. Locoregional parotid reconstruction. Otolaryngol Clin N Am. 2016;49:435–46.CrossRefGoogle Scholar
  4. 4.
    Bianchi B, Ferri A, Ferrari S, Copelli C, Sesenna E. Improving aesthetic results in benign parotid surgery: statistical evaluation of the facelift approach, sternocleidomastoid flap, and SMAS flap application. J Oral Maxillofac Surg. 2011;69:1235–41.CrossRefGoogle Scholar
  5. 5.
    Pham M, Eviston TJ, Clark JR. Reconstruction of limited parotidectomy defects using the dermofat graft. ANZ J Surg. 2017;87:E256.CrossRefGoogle Scholar
  6. 6.
    Behan FC, Lo CH, Sizeland A, Pham T, Findlay M. Keystone island flap reconstruction of parotid defects. Plast Reconstr Surg. 2012;130:36e–41e.CrossRefGoogle Scholar
  7. 7.
    Shestak KC, Roth AG, Jones NF, Myers EN. The cervicopectoral rotation flap—a valuable technique for facial reconstruction. Br J Plast Surg. 1993;46:375–7.CrossRefGoogle Scholar
  8. 8.
    Liu FY, Xu ZF, Li P, Sun CF, Li RW, Ge SF, Li JL, Huang SH, Tan X. The versatile application of cervicofacial and cervicothoracic rotation flaps in head and neck surgery. World J Surg Oncol. 2011;23:135–8.CrossRefGoogle Scholar
  9. 9.
    Emerick KS, Herr MW, Lin DT, Santos F, Deschler DG. Supraclavicular artery island flap for reconstruction of complex parotidectomy, lateral skull base, and total auriculectomy defects. JAMA Otolaryngol Head Neck Surg. 2014;140:861–6.CrossRefGoogle Scholar
  10. 10.
    Ramirez CA, Fernandes RP. The supraclavicular artery island and trapezius myocutaneous flaps in head and neck reconstruction. Oral Maxillofac Surg Clin North Am. 2014;26:411–20.CrossRefGoogle Scholar
  11. 11.
    Multinu A, Ferrari S, Bianchi B, Balestreri A, Scozzafava E, Ferri A, Sesenna E. The submental island flap in head and neck reconstruction. Int J Oral Maxillofac Surg. 2007;36(8):716–20.CrossRefGoogle Scholar
  12. 12.
    Ferrari S, Copelli C, Bianchi B, Magri AS, Ferri A, Varazzani A, Poli T, Ferri T, Sesenna E. The submental island flap: pedicle elongation and indications in head and neck reconstruction. J Craniomaxillofac Surg. 2014;42(6):1005–9.CrossRefGoogle Scholar
  13. 13.
    Ioannides C, Fossion E. Reconstruction of extensive defects of the parotid region: experience with the pectoralis major and free latissimus dorsi flaps. J Craniomaxillofac Surg. 1997;25:57–62.CrossRefGoogle Scholar
  14. 14.
    Fritz MA, Rolfes BN. Microvascular reconstruction of the parotidectomy defect. Otolaryngol Clin N Am. 2016;49:447–57.CrossRefGoogle Scholar
  15. 15.
    Dinner MI, Guyuron B, Labandter HP. The lower trapezius myocutaneous flap for head and neck reconstruction. Head Neck Surg. 1983;6:613–7.CrossRefGoogle Scholar
  16. 16.
    Ou KL, Dai YH, Wang HJ, Chen TM, Dai NT, Chang SC, Deng SC, Tzeng YS, Wang CH, Chen SG. The lower trapezius musculocutaneous flap for head and neck reconstruction: two decades of clinical experience. Ann Plast Surg. 2013;71(Suppl 1):S48–54.CrossRefGoogle Scholar
  17. 17.
    Elliott RM, Weinstein GS, Low DW, Wu LC. Reconstruction of complex total parotidectomy defects using the free anterolateral thigh flap: a classification system and algorithm. Ann Plast Surg. 2011;66:429–37.CrossRefGoogle Scholar
  18. 18.
    Bianchi B, Ferri A, Ferrari S, Copelli C, Boni P, Ferri T, Sesenna E. The free musculocutaneous anterolateral thigh free flap for head and neck reconstruction: one surgeon’s experience in 92 cases. Microsurgery. 2012a;32(2):87–95.CrossRefGoogle Scholar
  19. 19.
    Bianchi B, Ferri A, Sesenna E. Facial animation after nerve sacrifice in the treatment of head and neck cancers. Curr Opin Otolaryngol Head Neck Surg. 2012b;20:114–9.CrossRefGoogle Scholar
  20. 20.
    Renkonen S, Sayed F, Keski-Säntti H, Ylä-Kotola T, Bäck L, Suominen S, Kanerva M, Mäkitie AA. Reconstruction of facial nerve after radical parotidectomy. Acta Otolaryngol. 2015;135:1065–9.CrossRefGoogle Scholar
  21. 21.
    Biglioli F, Colombo V, Pedrazzoli M, Frigerio A, Tarabbia F, Autelitano L, Rabbiosi D. Thoracodorsal nerve graft for reconstruction of facial nerve branching. J Craniomaxillofac Surg. 2014;42:e8–14.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Silvano Ferrari
    • 1
  • Andrea Ferri
    • 1
  • Bernardo Bianchi
    • 1
  • Enrico Sesenna
    • 1
  1. 1.Maxillo-Facial Surgery Division, Head and Neck DepartmentUniversity Hospital of ParmaParmaItaly

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