Surgical resection of tumors in the periauricular area often results in extensive and composite soft tissue defects involving facial nerve sacrifice. These composite defects lead to facial contour deformities due to lack of volume and functional deficits. We present a clinical scenario that illustrates a single-stage reconstruction of a composite defect in this area including facial nerve reconstruction. The patient is a 37-year-old male diagnosed with metastasis in the parotid gland after a teratocarcinoma in the ethmoidal sinus. Surgical treatment was planned involving total parotidectomy, mastoidectomy, facial nerve sacrifice, and neck dissection with preservation of internal jugular vein and spinal accessory nerve.
In order to restore the composite defect, a free fasciocutaneous ALT flap was decided to resurface the external defect and to provide volume into the neck. Facial nerve reconstruction was planned at the same time of oncological resection, with masseter nerve transfer to buccal branch, and separated eye closure with interposition of lateral femoral cutaneous nerve from the facial nerve stump to zygomatic and frontalis branches.
Postoperative recovery was uneventful. 13 months after surgery, the cosmetic and functional results were excellent, with restoration of contour in the neck and periauricular area and recovery of facial symmetry, smile, and blink functions.
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