Retroauricular endoscope-assisted versus conventional submandibular gland excision for benign and malignant tumors

Full endoscopic submandibular gland excision through the retroauricular hairline approach: A cohort study

INTRODUCTION

Submandibular gland (SMG) excision can be achieved by conventional approach (Conv) through a cervical incision or endoscopic surgery (Endo). The aim of this study was to propose a new concept and technique of full endoscopic SMG excision through the retroauricular hairline incision and investigate its safety and feasibility.

MATERIALS AND METHODS

A total of 141 patients with SMG diseases treated at our department from 2021 to 2024 were retrospectively enrolled in the Endo group (n = 74) and the Conv group (n = 67). Interested variables included age, sex, pathological diagnosis, incision length, intraoperative bleeding, operation duration, hospitalization stay, complications, and aesthetic satisfaction score. SPSS software 26.0 and G power 3.1.9 were used for analysis.

RESULTS

There were no significant differences between the two groups in age, sex, follow-up period, pathological type, incision length or postoperative complications. Significant differences were found for the amount of bleeding [Endo: 12.5 (10.0) mL; Conv: 20.0 (20.0) mL, P < 0.001] and aesthetic satisfaction score [Endo: 8.8 ± 1.3; Conv: 7.5 ± 1.8, P < 0.001]. The operation duration of the Endo group was longer for early cases [Endo: 110.0 (27.5) min; Conv: 87.0 (40.0) min, P < 0.001], yet there was no significant difference from the thirtieth case [Endo: 85.0 (20.0) min; Conv: 89.0 (52.5) min, P = 0.894]. No recurrence of SMG diseases occurred during the follow-up period.

DISCUSSION

Full endoscopic SMG excision through the retroauricular hairline approach results in less intraoperative bleeding, invisible scars, and greater patient satisfaction, achieving ideal clinical and cosmetic outcomes.

Gasless Endoscopic Submandibular Gland Excision Through Hairline Approach

BACKGROUND

The aim of this study was to evaluate the therapeutic effect of gasless endoscopic submandibular gland excision through hairline approach and the safety, feasibility and practicability of this technique.

METHODS

Twenty-five patients with submandibular gland lesions who underwent gasless endoscopic submandibular gland excision through hairline approach at the Department of Head and Neck Oncology of the West China Hospital of Stomatology from May 1 st 2021 to May 31 st 2022 were included in this prospective study. The variables were analyzed statistically with SPSS software version 23.0 (IBM Corp, Armonk, New York, USA).

RESULTS

There was a female predominance (72%), female to male ratio was 2.6. The mean age was 30.6±10.2 years (range: 11 to 52 year). All 25 cases of endoscopic submandibular gland excision through hairline approach were done without conversion to conventional approach. This approach was indicated in 14 cases (56%) for pleomorphic adenoma, 8 cases (32%) for chronic sialadenitis, 2 cases (8%) for adenoid cystic carcinoma, and 1 case (4%) for lymphadenitis. The incision length mean was 4.8±0.4 mm (range: 4 to 5 mm); the operation duration mean was 100.6±39.7 min (range: 51 to 197 min); the intraoperative bleeding mean was 13.2±5.7 ml (range: 5 to 20 ml); the hospital length of stay mean was 4.5±0.8 days (range: 3 to 6 days). The follow-up mean was 10±3.4 months (range: 5 to 16 months). The patients were very satisfied with postoperative cosmetic result (score mean: 9.2±1). No recurrence of disease and complications such as postoperative bleeding, hematoma, nerve damage, skin necrosis, infection, and hair loss occurred.

CONCLUSIONS

Gasless endoscopic submandibular gland excision through hairline approach is safe, feasible and practicable, resulting in a very satisfied cosmetic result without significant complications; the intraoperative bleeding is less, the operative field is clear, the operation duration decreases with accumulation of experience.

Postauricular incision versus conventional transcervical incision in submandibular gland excision: A systematic review and meta-analysis

Surgical removal of the submandibular gland is indicated for different conditions affecting the gland, such as neoplasm, sialadenitis, and sialolithiasis, and different types of surgical approaches have been reported. The purpose of this meta-analysis was to evaluate the differences between the postauricular approach and conventional transcervical approach in submandibular gland excision. A systematic review was performed using PubMed, Embase and the Cochrane Library to identify studies comparing outcomes of submandibular gland surgery via the postauricular approach and conventional transcervical approach. The data of interest were analyzed with Comprehensive Meta-Analysis software (version 3; Biostat, Englewood, NJ). Dichotomous data and continuous data were analyzed by calculating the risk difference (RD) and the mean difference (MD) with the 95% confidence interval (CI), respectively. The results show that the postauricular incision is a feasible approach to access the submandibular gland, and compared with the conventional transcervical approach, it requires a longer operative duration but has a similar complication rate and yields better cosmetic outcomes.

Variants and Modifications of the Retroauricular Approach Using in Temporomandibular Joint Surgery: A Systematic Review

Introduction: The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar. One of its characteristics is an excellent posterolateral view of the mandibular head, which allows for the preservation of the lateral temporomandibular joint ligaments in the course of open intracapsular surgery. Aim: The aim of this study is to systematically review the currently used variants and modifications of RA. Materials and Methods: The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was performed based on the PubMed and BASE search engines; furthermore the authors performed a more detailed search in the Google Scholar article database as well as a loop search within the references of papers included in the systematic review. Results: Searching medical articles databases, Google Scholar, and references yielded a total of 85 records. First the titles and abstracts were blindly screened which was followed by a full-text eligibility check resulting in eventually including and qualifying 7 articles for detailed analysis. Discussion: All known variants and modifications of RA are characterized by high safety for the facial nerve and an aesthetically hidden scar. There were no reports of auricle necrosis in the collected material. Conclusions: In this systematic review, 2 variants and 2 modifications of RA that allow for open temporomandibular joint surgery have been identified; all of them together cover a large spectrum of indications for joint surgery, including reposition and osteosynthesis of mandibular head fractures, eminoplasty, or eminectomy and treatment of some forms of ankylosis.

"Stealth" retro-auricular endoscopic surgery for a submandibular mass

INTRODUCTION

With the need for increased cosmesis, it is the desire of patients all over the world to avoid an unsightly scar over the neck, face, or any of the exposed areas. This popularised the concept of "stealth" surgery.

CASE DETAILS

A 42 year-old gentleman underwent a stealth surgery for a painless progressively growing mass in the left submandibular triangle, which was provisionally diagnosed as a Lymphoma. As he desired a scarless procedure, a linear incision in the neck was avoided, and the surgical team opted for a Retro-Auricular HairLine (RAHL) approach, with a combination of balloon spacing and ultrasonic shears dissection.

DISCUSSION

The procedure was performed with perfect hemostasis, and is being reported as the first case of stealth RAHL (scarless) surgery in the United Arab Emirates for a submandibular mass. This article has been reported in line with the SCARE criteria [1]. "Stealth" surgery is becoming increasingly popular as it helps to avoid unsightly incisions in exposed areas of the body. The term was first used by by the paediatric surgical department of John Hopkins hospital, and it caught the fancy of the public as well as the surgeons.

CONCLUSION

A retro-auricular endoscopic excision of a submandibular mass is being reported in this article for its feasibility and cosmesis. Following the principles of "stealth" surgery, invisible port site incisions were used to complete the surgery successfully. The purpose of this case report was to illustrate the feasibility and safety of the endoscopic resection using the retro-auricular approach for submandibular mass excision.

Robotic neck dissection: state of affairs

PURPOSE OF REVIEW

The progressive growth of endoscopic and robotic-assisted procedures provided the tools for development of remote approaches to the neck, which could avoid a visible large neck scar usually necessary for neck dissections. This review explores the current experience with robotic neck dissection, looking for pros and cons in surgical, oncologic and aesthetic outcomes.

RECENT FINDINGS

Robotic neck dissection was shown to be feasible and well tolerated, with adequate oncological outcomes in different tumours. Although difficult to objectively analyse, cosmetic satisfaction seems to be significatively higher in patients submitted to this procedure when compared with those submitted to conventional neck dissection. The only consistently reported disadvantage was longer operative time. Other potential advantages beyond cosmesis such as improvements on oedema, fibrosis, neck movement, sensory loss and social interactions were not well explored so far.

SUMMARY

Surgical treatment of neck metastasis had several evolutions in the last decades. Robotic neck dissection emerged as an option to avoid extensive visible neck scars, improving cosmesis and probably other functional outcomes, although securing oncologic effectiveness. Technological innovation is increasingly dynamic, promising progressive evolution in robotic surgery. Together, the lack of objective data on functional outcomes warrants the need for further investigation on robotic neck dissection.