Extensive Recurrence of a Parotid Carcinoma After Primary Radiotherapy

Background: Parotid gland malignancies are primarily treated by surgery. Particularly extensive tumor recurrences mostly require very large-scale and cosmetically unfavorable interventions. Unclear anatomic conditions often restrict the intraoperative orientation. This case report demonstrates the markedly improved quality of life achieved despite the complexity of the intervention. Patient: A 62-year-old male patient presented to our emergency room with acute bleeding from a parotid tumor. The clinical examination revealed a 5 cm massively bleeding necrotic tumor crater colonized with fly maggots in the right preauricular region. The patient also had a complete peripheral facial palsy of House-Brackmann Grade VI. Primary irradiation had been performed for a parotid mucoepidermoid carcinoma one and a half years ago. Clinical Course: First, the bleeding was stopped by embolizing the anterior auricular branch of the superficial temporal artery. Restaging yielded a tumor status of kT4 kN2b M0. The subsequent tumor resection included a hemimandibulectomy, a resection of the auricle with the auditory canal and middle ear, a mastoidectomy with microsurgical facial nerve reconstruction, and a modified radical neck dissection on the right side. We used a pectoralis major myocutaneous flap to close the defect after achieving tumor-free resection margins. The lagophthalmos was treated by pretarsal implantation of a platinum chain. Wound healing was uneventful. The histological examination showed the R0 resection of the previously diagnosed mucoepidermoid carcinoma. The patient was discharged in good general condition and is undergoing shortinterval follow-ups in our tumor dispensary. After the tumor resection and primary healing, the patient received an adhesive ear epithesis to improve the aesthetic results. Conclusion: Even patients with tumor recurrence after primary radiation therapy can profit by extensive surgical treatment. The quality of life can thus be markedly improved even in a palliative situation. The option of complex interventions for extensive tumor recurrences should be integrated in an effective overall concept and discussed with the patients.