목적: According to a study, approximately 14.7% of patients with parotid malignancy undergo facial nerve sacrifice for oncologic safety. In such cases, facial nerve reinnervation surgery has been reported as an important intervention. However, most parotid malignancy patients receive postoperative radiation therapy, raising concerns about its potential impact on the outcomes of facial nerve reanimation. In this study, we aim to evaluate the utility of free flap reconstruction in cases where selective reanimation is performed in patients with parotid cancer who have undergone facial nerve sacrifice. 방법:Twelve patients with parotid malignancy requiring facial nerve sacrifice during surgery were included in the study. These patients underwent dual or triple nerve reinnervation simultaneously with parotid cancer surgery, followed by concurrent soft tissue free flap reconstruction. All patients received postoperative radiation therapy. To assess changes in facial paralysis immediately after surgery and at the 1-year after surgery, we analyzed facial photographs taken during rest, eye closure, and big smiles using Emotrics. Additionally, we evaluated the volume changes of the free flap tissue after postoperative radiation therapy immediately after surgery, at 6 months, and at 12 months after surgery. 결과:Eyelid and brow positioning were more symmetric one year after surgery, with the discrepancy between the affected and unaffected sides decreasing from 2.18 to 1.21 mm (p=0.034) and 3.93 to 2.61 mm (p=0.028), respectively. Oral commissure height and position also improved, with the discrepancy decreasing from 5.48 to 4.10 mm (p=0.034) and 22.40 to 7.73 mm (p=0.002). The discrepancy in the upper lip slope improved postoperatively from 30.05 to 7.10 mm (p=0.002). Compared to immediately after surgery, the volume of the free flap decreased by an average of 33.45% at 6 months after surgery and by an average of 37.37% at 1 year after surgery. However, the changes in facial paralysis measurements analyzed using Emotrics and the decrease in free flap volume did not exhibit statistically significant correlations. 결론:In parotid cancer patients who require postoperative radiation therapy, performing selective reinnervation and free flap simultaneously after facial nerve sacrifice is useful technique for improving postoperative facial paralysis