Pectoralis Major Flap as a Reconstructive Alternative for Cervical Skin Defects Following Oncologic Parotid Surgery: A Case Report
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Abstract
Background: Malignant neoplasms of the parotid gland constitute an uncommon and heterogeneous group of head and neck tumors. Their management is challenging because of the gland’s close anatomical relationship with the facial nerve, major cervical vessels, and regional lymph nodes. In locally advanced tumors, oncologic resection may result in extensive cervicofacial defects that require immediate reconstruction with vascularized tissue.
Case Report: A 62-year-old female patient was diagnosed with a high-grade malignant neoplasm of the left parotid gland. Computed tomography revealed a solid, irregular, hypodense lesion within the parotid space, with loss of the interface with the sternocleidomastoid muscle, coarse calcification, and cervical lymph node conglomerates. During surgical exploration, an approximately 12 × 8 cm stony-hard mass was identified, involving the facial nerve, internal jugular vein, and sternocleidomastoid muscle. A left total parotidectomy combined with a modified radical neck dissection was performed. The resection resulted in a complex cervicofacial defect measuring approximately 12 × 8 cm, with loss of cutaneous coverage and exposure of cervical structures. Immediate reconstruction was achieved using a left pectoralis major myocutaneous flap, transferred through a cervicothoracic subcutaneous tunnel. The flap provided stable coverage, well-vascularized tissue, and sufficient bulk to protect the exposed structures and partially restore the cervicofacial contour. The postoperative course demonstrated satisfactory flap integration and viability.
Conclusion: The management of locally advanced high-grade parotid malignancies requires the integration of radical oncologic resection with an immediate reconstructive strategy. The pectoralis major myocutaneous flap represents a reliable, versatile, and technically reproducible option for reconstructing extensive cervicofacial defects, obliterating dead space, and protecting vital neurovascular structures, particularly when rapid reconstruction is required or microvascular free tissue transfer is not feasible.
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References
I. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer Journal for Clinicians. 2024.
II. Steuer CE, Griffith CC, Nannapaneni S, et al. The evolving landscape of salivary gland tumors. CA Cancer Journal for Clinicians. 2023.
III. Geiger JL, Ismaila N, Beadle B, et al. Management of Salivary Gland Malignancy: ASCO Guideline. Journal of Clinical Oncology. 2021.
IV. van Herpen C, Locati LD, Buti S, et al. Salivary gland cancer: ESMO–EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up. ESMO Open. 2022.
V. Varoquaux AD, Fakhry N, Baujat B, et al. Diagnostic imaging of salivary gland cancers: REFCOR recommendations by the formal consensus method. European Annals of Otorhinolaryngology, Head and Neck Diseases. 2024.
VI. Barry B, Verillaud B, Jegoux F, et al. Surgery of major salivary gland cancers: REFCOR recommendations by the formal consensus method. European Annals of Otorhinolaryngology, Head and Neck Diseases. 2024.
VII. Baujat B, Vergez S, Jegoux F, et al. Lymph node surgery for salivary gland cancer: REFCOR recommendations by the formal consensus method. European Annals of Otorhinolaryngology, Head and Neck Diseases. 2024.
VIII. Chabrillac E, Vergez S, Barry B, et al. Post-treatment monitoring of salivary gland cancer: REFCOR recommendations by the formal consensus method. European Annals of Otorhinolaryngology, Head and Neck Diseases. 2024.
IX. Skálová A, Bell D, Agaimy A, et al. Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: salivary glands. Virchows Archiv. 2022.
X. Rached L, Quer M, Vander Poorten V, et al. Salivary gland carcinoma: Towards a more personalised management? Cancer Treatment Reviews. 2024.
XI. Pusztaszeri M, Faquin WC, Rossi ED. Update on Salivary Gland Fine-Needle Aspiration and the Milan System for Reporting Salivary Gland Cytopathology. Archives of Pathology & Laboratory Medicine. 2024.
XII. Friedman E, Osborn V, Rao V, et al. Imaging of Major Salivary Gland Lesions and Disease. Radiologic Clinics of North America. 2023.
XIII. Gaudino C, Ralli M, Longo L, et al. High Field MRI in Parotid Gland Tumors: A Diagnostic Algorithm. Cancers. 2024.
XIV. Mahmoud E, Abdel Razek AAK, Samir S. Beyond Ultrasound: Multimodal Cross-Sectional Imaging of Parotid Tumors. Reports. 2024.
XV. Lee HJ, Kim H, Park YH, et al. MRI and CT imaging characteristics in parotid tumors with pleomorphic adenoma, Warthin tumor, and malignant tumors associated with clinical outcomes. 2024.
XVI. Rao Y, Zhang M, Liu J, et al. Performance of radiomics in the differential diagnosis of parotid gland tumors: a systematic review. Frontiers in Oncology. 2024.
XVII. Nakajima R, De Jesus O, Glastonbury C, et al. Diagnostic and Prognostic Utility of 18F-FDG PET/CT in Recurrent Salivary Gland Cancer. American Journal of Roentgenology. 2021.
XVIII. Jansen L, et al. Incidence and survival of primary major salivary gland carcinoma. European Journal of Cancer. 2026.
XIX. Hernández-Morales A, et al. Incidence and Mortality of Salivary Gland Cancer Associated With Tobacco Consumption and Human Development Index. 2024.
XX. Żurek M, et al. Salivary gland pathologies: evolution in classification and association with unique genetic alterations. European Archives of Oto-Rhino-Laryngology. 2023.
XXI. Utsumi Y, Nakaguro M, Tada Y, et al. High-grade salivary carcinomas: A current insight on diagnostic pathology and the key to clinical decision making. Seminars in Diagnostic Pathology. 2024.
XXII. Dimovska EOF, et al. The pectoralis major myocutaneous pedicled flap—Its past and current practice in a dedicated microsurgery service. Review of the literature, and debunking controversies. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2025.
XXIII. Falade IO, Murphy AI, Switalla KM, et al. Functional donor-site morbidity following reconstruction with pectoralis major flaps: A systematic review. JPRAS Open. 2024.
XXIV. Barter L, et al. Role of the Pectoralis Major Muscle Flap in the Thoracic Cavity and Neck. Plastic and Reconstructive Surgery Global Open. 2024.
XXV. Gora BS, et al. Bipaddle Pectoralis Major Myocutaneous Flap for Complex Composite Oral Cavity Defects: An Experience of a Tertiary Cancer Centre. 2024; Nandy K, et al. Bilobed Pectoralis Major Myocutaneous Flap Reconstruction: a Single Institution Experience of 150 Patients and Methods to Prevent Complications. 2024; Singhal PM, et al. Can Lateral Thoracic Artery Preservation Improve Results in Large PMMC Flaps? 2024.