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[Filling of the residual depression after parotidectomy with a composite arterial subcutaneous flap].

Parotidectomy causes isolation of the facial nerve and an antiaesthetic hollow of the preauricular region. In order to avoid these two sequelae, the author proposes raising of an island subcutaneous flap, as large as required by the area to be filled, from above the resected area, which is then rotated onto the tissue defect. It is an arterial flap, with a superficial temporal artery pedicle and is composed by three superimposed layers: the epicranial aponeurosis (galea capitis); a layer of sub-aponeurotic connective tissue; the periosteum of the cranial bones. The rich blood supply and the fibrous nature of the flap limit its reabsorption and since the flap is drawn from the hair area, the scar is completely concealed.

Humans

Sternocleidomastoid flap following parotidectomy.

The sternocleidomastoid (SCM) muscle has been used in various ways for reconstruction following cancer resections in the head and neck. Its use has been restricted because of the presumed precarious nature of its blood supply and its proximity to disease. Patients with large or recurrent benign parotid tumors were the first in our series to have a SCM muscle flap (either superiorly or inferiorly based) used to improve cosmesis. After demonstrating the utility of these flaps, we extended the indications for their use to include patients with primary or recurrent malignant disease. The flaps provide soft tissue contour, coverage of facial nerves and nerve grafts, act as a healthy bed for skin grafts, and help close salivary fistulas. There were no complications attributed to the flaps. This paper discusses 31 patients with benign and malignant parotid disease in whom the SCM flap was used.

Adolescent

Effects of prolonged parotid duct ligation, parotidectomy and acute hepatitis of rats on amylase activity.

Amylase activity in the parotid gland was extremely reduced (to 2.4 per cent) by prolonged duct ligation but that in the pancreas and serum as similar to controls. The serum amylase activity of parotidectomized rats was remarkably reduced within a week of surgery, but recovered to approximately the previous level in 4 weeks. The amylase activities in the pancreas and liver were not different between control and parotidectomized rats. The serum amylase activity of rats with acute hepatitis (1 day after administration of D-galactosamine) decreased to 18.5 per cent compared with controls; however, the activity recovered to its original level after 4-7 days. There was no pancreatic amylase in the serum either of parotidectomized rats or those with acute hepatitis. These observations show that the parotid glands may not be the only source of serum amylase. Serum amylase is mainly derived from the parotid gland, but liver may contribute to serum amylase in compensation for the parotid glands.

Acute Disease

Preservation of facial contour during parotidectomy.

Parotid surgery often leaves a facial contour deformity. Free abdominal dermal-fat grafts were used to preserve the facial contour of nine patients undergoing parotid surgery. This procedure is simple to perform and provides an improved cosmetic result without significantly increasing operative time or lengthening hospitalization. No troublesome fat absorption occurred postoperatively. The dermal-fat graft also serves as a barrier to regenerating neurons, thereby preventing postoperative gustatory sweating.

Abdomen