PMC9929665_01
Pre-operative examination revealed an ulcerative mass of irregular border and shape, lobulated surface, measuring 6 cm x 4 cm, located at left angle of mandible, extending to left mastoid region. The edge of the ulcer appeared to be everted and the base was filled with tumor tissues. Multiple naevi of varying sizes distributed over the entire facial region. There was no cervical or supraclavicular lymphadenopathy. Facial nerve function was intact. There was a well-healed mature surgical scar of previous modified rhomboid flap surgery at left cheek. The images are published with the patient's consent.
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There was a well-healed mature surgical scar of previous modified rhomboid flap surgery at left cheek (Figure 1).
Contrast enhanced CT scan of brain and neck, (A) axial view, and (B) coronal view, demonstrated an ill-defined, enhancing, lobulated, heterogenous, hypodense lesion at left parotid gland (white arrows), measuring 2.5 cm x 3.2 cm x 2.5 cm, with infiltration into left sternocleidomastoid muscle posteriorly, associated with multiple subcentimeter left parotid periglandular, submental, submandibular and cervical lymph nodes enlargement. CT, computed tomography.
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Contrast enhanced computer tomography scan of head and neck demonstrated an ill-defined, enhancing, lobulated, heterogenous, hypodense lesion at left parotid gland, measuring 2.5 cm x 3.2 cm x 2.5 cm, with infiltration into left sternocleidomastoid muscle posteriorly, associated with multiple subcentimeters left parotid periglandular, submental, submandibular and cervical lymph nodes enlargement (Figure 2).
Preoperative marking and surgical field post total parotidectomy and ipsilateral modified radical neck dissection (Type II). (A) Surgical marking for wide local excision of ulcerative mass with a margin of 2 cm, including the left ear lobule. The marking also extended superiorly to pre-auricular region and inferiorly to left neck, providing access for total parotidectomy and modified radical neck dissection (B) Surgical field post total parotidectomy and ipsilateral modified radical neck dissection (Type II). The transverse cervical vessels (white arrowheads) were prepared as recipient vessels. Both the facial nerves and its rami (white arrow) as well as spinal accessory nerve (black arrowhead) had been preserved. The images are published with the patient's consent.
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II), and soft tissue coverage with right free anterolateral thigh fasciocutaneous flap. Intra-operatively, the ulcerative mass was resected with a margin of 2 cm, including left ear lobule (Figure 3A). Facial nerve and its rami were identified and preserved during parotidectomy (Figure 3B). During ipsilateral modified radical neck dissection, left sternocleidomastoid muscle, level I to level V cervical lymph nodes and left submandibular gland were removed, while preserving spinal accessory nerve, carotid sheath contents (internal jugular vein, carotid artery and vagus nerve), phrenic nerve, hypoglossal nerves and transverse cervical vessels (Figure 3B).
Follow-up images of both recipient (A,B) and donor sites (C) at post-operative one month. Both donor and recipient wounds had healed well. The images are published with the patient's consent.
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Both donor and recipient wounds had healed well and patient felt satisfied with the outcomes (Figure 4).