Clinical efficacy analysis of temporal bone-parotid composite defect repair strategy:Surgical selection and functional evaluation based on 17 cases
10.16066/j.1672-7002.2025.07.002
- VernacularTitle:颞骨-腮腺复合缺损修复策略的临床疗效分析:基于17例病例的术式选择与功能评价
- Author:
Zheng YANG
1
;
Xiaolian FANG
;
Jing ZHOU
;
Xuejun CHEN
;
Xiaohong CHEN
;
Pingdong LI
Author Information
1. 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京 100730
- Keywords:
Parotid Neoplasms;
Microsurgery;
Surgical Flaps;
temporal bone defect;
local muscle flap;
free flap;
repair and reconstruction
- From:
Chinese Archives of Otolaryngology-Head and Neck Surgery
2025;32(7):413-417
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To systematically evaluate the repair strategies for temporal bone-parotid composite defects,compare the clinical applicability of local muscle flaps and free flaps,and provide references for optimizing the reconstruction of complex head and neck defects.METHODS We retrospectively analyzed the medical records of 17 patients with postoperative defects in the temporal bone-parotid region treated at Beijing Tongren Hospital,Capital Medical University,between January 2018 and June 2023.There were 11 males and 6 females,with a median age of 58 years(range:42-72 years).All patients had undergone radical resection.Defects were reconstructed with local flaps in 13 cases(temporalis muscle flap,n=6;sternocleidomastoid flap,n=3;submental platysma flap,n=2;submental island flap,n=2)and with free flaps in 4 cases(anterolateral thigh fascial flap,n=1;anterolateral thigh flap,n=1;free abdominal adipofascial flap,n=2).RESULTS The primary diseases of the 17 patients were malignant tumors of the external auditory canal and parotid gland(6 cases of squamous cell carcinoma,6 cases of adenoid cystic carcinoma,and 3 cases of ductal carcinoma).All flaps survived completely.One patient with temporalis muscle flap repair developed postoperative wound infection,which healed after debridement and dressing change.The median follow-up period was 16 months(4-29 months).Two cases(11.8%)of external auditory canal squamous cell carcinoma had local recurrence,one case(5.9%)of parotid ductal carcinoma developed pulmonary metastasis 9 months after surgery and died at 15 months.The remaining 14 cases(82.4%)were tumor-free survivors.Functional evaluation showed that the local tissue flap group had a shorter repair time,but was limited by muscle flap rotation arc;the free flap group could accurately match the defect shape,but the surgical time was prolonged to 3.5-4.5 hours.Fourteen cases(82.4%)received postoperative adjuvant radiotherapy.None of the tissue flaps developed radiation necrosis after radiotherapy.CONCLUSION Temporal bone-parotid composite defects need to balance the dual requirements of surgical cavity coverage and cosmetic repair.Local muscle flaps are easy to operate and have reliable blood supply,suitable for small and medium-sized defects;free tissue flaps have better shape adaptability in complex three-dimensional defect reconstruction,but require microsurgical technical support.The repair plan should be comprehensively decided based on the defect range,vascular conditions,and radiotherapy plan.The data of this group confirmed that both techniques can achieve stable therapeutic effects.
