Key Points:
• This approach could potentially achieve the maximal oncological resection without compromise of carotid artery blood flow.
•This approach reduces the incidence of potential risk of cerebrovascular complications.
• This approach may be more beneficial in cases with less optimal condition for vascular reconstruction, or the potential of R0 tumor resection.
• This approach could still be used to complete tumor resection without the possibility of major blow-out risk in some cases of recurrence after radiotherapy.
• The pedicled pectoralis major musculocutaneous flap was used to repair the defect, which not only protected the exposed carotid artery, but also provided rich vascularity.