Head/Neck Surgery

Short-scar technique with facial nerve preservation and aesthetic contour restoration

Superficial parotidectomy involves the removal of the parotid tissue superficial to the facial nerve, with meticulous identification and dissection of the nerve trunk and all branches from distal to proximal. Where possible, Dr Sparks employs a short-scar technique that conceals the incision within the pre-auricular crease and hairline, minimising visible scarring while providing adequate access for safe facial nerve dissection.

The depression that results from removal of the parotid gland — the post-parotidectomy contour defect — is addressed at the time of surgery through local soft tissue advancement or targeted fat grafting, restoring the natural facial contour and avoiding the hollowed lateral facial appearance that can otherwise result from parotid removal.

Advanced malignancy — oncologic resection with planned nerve reconstruction

Where high-grade parotid malignancy involves the facial nerve directly, oncologically adequate excision may require sacrifice of the involved nerve segment. In these cases, Dr Sparks plans nerve reconstruction at the time of tumour resection — using cable nerve grafts from the great auricular nerve to bridge the resected segment and restore the potential for facial nerve recovery.

The timing and technique of facial nerve reconstruction are discussed in detail with the patient before surgery and coordinated through the MDT. Where primary nerve reconstruction is not feasible — due to the extent of resection, requirement for adjuvant radiotherapy, or patient factors — staged facial reanimation procedures are planned as part of the longer-term reconstructive pathway.

Targeted removal of specific nodal levels based on drainage patterns

Selective neck dissection removes defined subsets of cervical lymph node levels based on the known or expected drainage pattern of the primary tumour site. It is the most commonly performed neck dissection in contemporary head and neck oncology, preserving the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve while addressing the at-risk nodal basins.

Comprehensive nodal clearance with preservation of non-nodal structures

Modified radical neck dissection removes all five cervical lymph node levels while preserving one or more of the non-nodal structures that are sacrificed in a classical radical dissection (sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve). It is indicated when nodal disease is more extensive but the non-nodal structures are not directly involved.

En bloc resection of all nodal levels and adjacent structures

Classical radical neck dissection removes all five cervical lymph node levels together with the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve. It is reserved for cases where these structures are directly invaded by nodal disease and cannot be safely preserved without compromising oncologic clearance.

Minimally invasive nodal staging for melanoma and Merkel cell carcinoma

Sentinel lymph node biopsy (SLNB) identifies and removes the first-echelon lymph node in the drainage pathway of the primary tumour using preoperative lymphoscintigraphy and intraoperative radioisotope and/or blue dye guidance. For cutaneous melanoma and Merkel cell carcinoma, SLNB provides critical prognostic information and guides decisions about adjuvant systemic therapy, without the morbidity of formal neck dissection in node-negative patients.

Adjacent tissue for optimal colour, texture, and contour match

Local and locoregional flaps — including advancement, rotation, transposition, and interpolation flaps — remain the preferred reconstructive option when the defect size and location permit. Adjacent tissue provides the best match for facial skin colour, texture, and thickness, and avoids the donor-site morbidity of distant flap harvest.

Specific locoregional flaps routinely employed include the paramedian forehead flap for nasal reconstruction, the Karapandzic and Abbe flaps for lip reconstruction, the cervicofacial advancement flap for cheek defects, and the submental flap for oral and perioral reconstruction.

Composite reconstruction of large, functionally critical, or composite defects

Free tissue transfer — the microsurgical transplantation of tissue from a distant donor site using arterial and venous anastomosis under the operating microscope — is the reconstructive standard for complex, composite, or large head and neck defects where locoregional options are insufficient.

Soft tissue free flaps: the radial forearm free flap provides thin, pliable skin well suited to intraoral, pharyngeal, and facial skin defects. The anterolateral thigh (ALT) flap provides larger volumes of soft tissue for extensive facial, neck, and scalp defects.

Bone-containing free flaps: the fibula free flap is the standard for mandibular reconstruction following segmental resection; the scapula and deep circumflex iliac artery (DCIA) flaps provide additional bony reconstructive options for the midface and craniofacial skeleton.

Dr Sparks performs over 50 microsurgical procedures annually and brings specific advanced training in free flap reconstruction from his craniofacial fellowship, including the management of complex composite head and neck defects.

Restoring voluntary facial movement following facial nerve injury or sacrifice

Facial paralysis — whether from planned nerve sacrifice during radical parotidectomy, nerve injury during complex dissection, or progressive nerve involvement by advancing disease — is one of the most functionally and psychologically significant consequences of head and neck cancer surgery. The inability to close the eye, smile symmetrically, or maintain oral competence affects every aspect of daily life and social interaction.

Dr Sparks trained in facial reanimation under Dr Nancy Van Laeken and Dr Asim Bashir in Vancouver, BC — a rapidly emerging international centre of excellence in facial nerve surgery. His reanimation practice integrates the full spectrum of static and dynamic reconstruction:

Static procedures: gold weight implantation for lagophthalmos (incomplete eye closure); lower eyelid support; fascia lata sling for oral commissure suspension and brow elevation. These provide immediate functional improvement and are often the first step in reanimation, particularly in the perioperative period.

Nerve repair and grafting: where the facial nerve has been transected at the time of tumour resection, primary repair or cable nerve grafting (using the great auricular nerve or sural nerve) is performed simultaneously. Recovery of voluntary movement begins at 6–18 months and is dependent on the length and quality of the graft.

Cross-face nerve grafting: in cases of complete facial nerve loss where the proximal stump is unavailable (e.g., following skull base resection), cross-facial nerve grafts can be placed as a first stage to provide axons from the contralateral facial nerve for subsequent muscle transfer.

Dynamic muscle transfer — Modified Dual Vector Gracilis: free functional muscle transfer is the gold standard for restoring spontaneous, emotion-driven facial movement. Dr Sparks employs a Modified Dual Vector Gracilis technique — an approach that addresses both upper lip elevation and commissure movement simultaneously, addressing more directions of movement than single-vector techniques. This procedure requires microsurgical nerve coaptation and vascular anastomosis, and is typically performed 6-12 months after initial nerve grafting or as a primary reconstruction where the nerve to masseter is employed (Moebius syndrome).

Synkinesis management: where facial nerve recovery is complicated by aberrant reinnervation producing synkinetic movements (involuntary co-contraction), selective neurectomy, selective chemodenervation (Botulinum toxin) and physiotherapy-directed neuromuscular retraining are used to support the quality of recovered movement.