Adenoid cystic carcinoma (ACC) is a bad cancer. During my last trip, we enountered 4 cases-all of the parotid gland. The surgery is difficult. It requires dissecting the facial nerve from the tumor. A simple mistake can injure the facial nerve and result in paralysis of all or part of half the face. This patient's tumor was relatively small (by NCH standards) and the dissection went well. There is very few things more pleasing to a head and neck surgeon then seeing a symetric smile on a postoperative parotid patient. I hope she is cured. 

The next patient was not so fortunate. She presented with recurrent ACC (My ego forces me to state that I did not do the first surgery). The surgery was actually relatively easy since her nerve was already non-functioning. We resected the tumor and did a radical neck dissection. We will send her for radiation but, unfortunately, the tumor is radio-resistant. In addition, radiation improves local control but probably does not improve survival.

This last patient arrived at NCH in 2010. She had a large fungating ACC. 

We did a radical resection which left a large defect of skin. After the patient recovered for a few days, we took her back to surgery and performed a pectoralis major myocutaneous flap to close the wound.

Pectoralis major myocutaneous flap
After the second surgery, she asked me to call her brother in the USA. Amazingly, he lives only four hours from my house. When I returned to the USA, he came to visit me and we have become great friends! Unfortunately, this nice lady died from metastatic disease about one year after surgery. 
Skin defect closed with flap