Surgical Excision of Huge Recurrent Parotid Carcinoma and Reconstruction Using Supraclavicular Artery Island Flap: A Case Report

• Shadi Awny

  Surgical Oncology Department, Mansoura University Oncology Centre, Egypt.

  https://orcid.org/0000-0003-3694-8699 (unauthenticated)

• Ahmad M Eid

  Surgical Oncology Department, Mansoura University Oncology Centre, Egypt.

  https://orcid.org/0000-0002-6450-2371 (unauthenticated)

• Doaa Khedr

  Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Egypt.

  https://orcid.org/0000-0001-8610-6807 (unauthenticated)

• Fatma El-Husseiny

  Pathology Department, Faculty of Medicine, Mansoura University, Egypt.

  https://orcid.org/0000-0002-4371-0622 (unauthenticated)

• Mona Gad

  Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Egypt.

  https://orcid.org/0000-0001-5467-6565 (unauthenticated)

• Manar Mansour

  Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Egypt.

  https://orcid.org/0000-0002-0961-6464 (unauthenticated)

• Hadeel G Elghamery

  Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Mansoura University, Egypt.

  https://orcid.org/0000-0001-9337-6506 (unauthenticated)

• Mohamed A Elbanna

  Surgical Oncology Department, Mansoura University Oncology Centre, Egypt.

  https://orcid.org/0000-0002-3199-8120 (unauthenticated)

• Omar Hamdy

  Surgical Oncology Department, Mansoura University Oncology Centre, Egypt.

  https://orcid.org/0000-0002-2924-4207 (unauthenticated)

Background: Acinic cell carcinoma (ACC) is an uncommon salivary gland neoplasm that is characterized by its slow growth rate and good survival.  The presence of locally aggressive ACC is not a common occurrence.

Case Presentation: A 62-year-old male patient with a medical history of left parotid swelling that underwent a superficial parotidectomy and lymph node dissection one year earlier elsewhere. The postoperative pathology revealed acinic cell carcinoma and negative lymph nodes (LNs). Two months later, the patient exhibited a left external auditory canal swelling. The swelling was excised elsewhere, and the postoperative pathology revealed ceruminous glands adenocarcinoma. Subsequent to a period of four months, a substantial fungating mass manifested on the entire left side of the face and neck. The patient received three cycles of chemotherapy, yet no satisfactory response was observed. The patient underwent a palliative resection of the fungating parotid lesion. The procedure included a wide local excision (WLE), which entailed the removal of the lesion and surrounding tissue, as well as the excision of the left external ear and facial nerve branches. Additionally, a left lateral block neck dissection was performed, followed by reconstruction using a supraclavicular artery island flap. Postoperative pathology revealed a diagnosis of acinic cell carcinoma, with infiltration of one out of three dissected lymph nodes in the main specimen by tumor tissue. Furthermore, there was infiltration of the surrounding fibrofatty tissue and muscle fibers by tumor tissue. However, the sent 17 cervical lymph nodes were found to be free from tumor deposits. Postoperatively, the patient exhibited optimal wound healing, with no flap loss, and a satisfactory cosmetic outcome when compared to the preoperative status. The patient received postoperative concurrent chemoradiotherapy, then developed lung metastasis five months after surgery. For this subsequent metastasis, the patient received chemotherapy followed by sorafenib. Notwithstanding, the patient's condition ultimately deteriorated, necessitating referral for best supportive care. The patient died one year after the surgery.

Conclusion: ACC is a rare salivary gland tumor that typically requires surgical resection. Inappropriate management can result in severe disfigurement. In such cases, supraclavicular artery island flap (SCAIF) can serve as a viable reconstructive option.

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Copyright (c) 2025 Shadi Awny, Ahmad M Eid, Doaa Khedr, Fatma El-Husseiny, Mona Gad, Manar Mansour, Hadeel G Elghamery, Mohamed A Elbanna, Omar Hamdy

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