Parotid Tumors with Bone Extensions

Parotid tumors may extend during their evolution to the surrounding soft tissues but also to bone structures. Due to anatomical relations of the gland, the most often infiltrated bones are temporal mandibular joint, mandible (ascending ramus or angle), malar bone, and zygomatic arch and rarely temporal bone, mastoid, styloid process, and sphenoid. Surgery is the first option for all resectable parotid tumors with bone involvement. In order to get free margins, the resection specimen must include en bloc the parotid tumor and infiltrated subjacent bone. The reconstructive necessities must take into consideration the status of the patients, the complexity of the defect, and, depending on the histological diagnose and preoperative clinical and paraclinical examination, the need to perform an additional neck dissection. An option to achieve an optimal result is the use of bony free flaps or grafts to reconstruct bone defects. The missing soft tissues may be addressed with local, regional, or microsurgical flaps in order to reestablish facial symmetry. There are cases where the reconstruction of bone defects is not mandatory, such as sphenoid or temporal bone resection, and only bringing enough soft tissue is enough to achieve a good esthetic and functional outcome. In patients where, due to poor general status, a free flap is not possible, pedicle myocutaneous flaps, such as major pectoralis flap, are the method of choice. Latissimus dorsi or other myocutaneous, either pedicle or microsurgical, flaps are very useful for defects which involve the skull base, preventing cerebral fluid leakage. Postoperative complications and sequelae depend directly on the type of bone resected and reconstruction technique.