A 43-year-old female patient, previously treated for a parotid tumor in the deep lobe of 26 mm in diameter and with previous FNAB diagnosed as basal cell adenoma.
A conservative partial parotidectomy was performed and the definitive histology showed a cystic carcinoma pT2N0M0, with a variable histological pattern mostly tubular with solid areas, other trabecular, sparse contact areas.
In the case of involvement of positive or near surgical margins in cystic carcinoma after surgery, there is no standard attitude; both margin enlargement and postoperative radiotherapy or margin enlargement followed by postoperative radiotherapy are valid.
A PET-CT scan showed a slight metabolic increase in the parotid gland without ruling out malignant disease.
She was referred to the Maxillofacial Surgery Service and a total parotidectomy was performed together with excision of the zygomatic, oral and marginal branches of the facial nerve that were included in tumor mass.
An immediate reconstruction was performed with sural nerve graft and filling the defect after parotidectomy with temporoparietal fascia flap.
Intraoperative biopsies of the resected nerve ends were negative for neoplasia, the definitive pathological anatomy of the parotidectomy showed perineural and intraneural invasion adjacent to the tumor.
Postoperative radiotherapy was administered due to histological solid pattern, perineural invasion and margin involvement in the first surgery.
During the clinical follow-up, good function has been achieved at rest on eye closure and on smile, with only a slight deficit in soda after one year of intervention.
An electroneurophysiological study was carried out at 6 months and one year after the intervention, in which a restitution "quasi ad integrum" was established.
In the electroneurogram we obtained at 6 months a amplitude of 0.33 mV and a latency of 5.52 ms; and at one year the values were a amplitude of 1.6 mV and a latency of 2.85 mV for the motor muscle.
