Parotidectomy: Assessment of a surgical technique including facelift incision and SMAS advancement

Effects of acellular dermal matrix on the prevention of complications and esthetic outcome after parotidectomy: A propensity score matched analysis

OBJECTIVE

The present study was designed to investigate whether acellular dermal matrix (ADM) grafts could prevent Frey's syndrome (FS) and improve esthetic scores following parotidectomy.

METHODS

From January 2015 to December 2019, 175 patients underwent parotidectomy. We divided the patients into two groups: the ADM group and the control group. We included in each group 30 patients according to a propensity score matched analysis.

RESULTS

FS was subjective in 1 patient (3%) from the ADM group and 9 patients (30%) from the control group (P=0.015). Patients in the ADM group had a subjective esthetic score of 6.1 + 1.7 compared with 5.2 + 1.7 in the control group. The subjective esthetic score for patients in the ADM group was higher than that for patients in the control group (P =0.040).

CONCLUSION

The present clinical study suggests that ADM grafts are effective in preventing FS and improving esthetic scores after parotidectomy.

Facelift: Assessment of Total Platysma Muscle Transection to Prevent the Recurrence of Platysmal Bands

INTRODUCTION

Determining which facelift technique yields the most effective long-term rejuvenation results and ensures optimal stability over time remains a significant question in cosmetic surgery: Does the most invasive surgery lead to the best long-term outcomes? This study aims to evaluate the authors' approach using total platysma muscle transection to prevent platysma band recurrence, and to provide anatomical observations supporting and justifying their procedure.

MATERIAL AND METHODS

A preliminary study in anatomical basic sciences was conducted to establish the rationale for our method. A prospective single-blind study was conducted, involving eighty patients seeking facial rejuvenation with platysmal band correction. They underwent face and neck-lift procedures with total platysma transection by the same surgeon between May 2013 and May 2016. Cosmetic outcomes were assessed using the Face and Neck-Lift Objective Photo-Numerical Assessment Scale. Scores by three blind evaluators before surgery, at 1 and 5 years postoperatively, were compared using a matched T Test (p < 0.05).

RESULTS

The preliminary anatomical study revealed a consistent anastomotic system between the cervical branch of the facial nerve and the branches of the cervical plexus. Incomplete platysma section during a facelift might contribute to platysma band recurrence. The clinical study demonstrated satisfactory outcomes, with significant overall appearance improvement (p < 0.00001) and no platysma band recurrence. Complication rate was low.

CONCLUSION

The authors' technique achieved satisfactory long-term results with minimal complications. However, due to the lengthy operating time and steep learning curve, it should be reserved for highly motivated patients.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Postauricular Incision Versus Modified Blair Incision in Parotidectomy: A Systematic Review and Meta-Analysis

OBJECTIVE

The mainstay of first-line treatment of parotid tumors is adequate surgical removal. The present study was conducted to compare the differences between parotidectomy with postauricular incision (PI) and modified Blair incision (MBI).

DATA SOURCES

A systematic search of PubMed, Embase and the Cochrane Library was performed.

METHODS

The data of interest and study characteristics were extracted from the included studies. Statistical analysis was performed with Comprehensive Meta-Analysis software (version 3; BioStat, Englewood, NJ). Dichotomous data and continuous data were analyzed by calculating the risk difference and the mean difference with the 95% confidence interval respectively.

RESULTS

Four retrospective studies were included in the present meta-analysis. The pooled results revealed that the cosmetic satisfaction score was higher in the PI group (MD = 2.67; 95% CI, 2.12 to 3.23) and that intraoperative blood loss was lower in the PI group (MD =  -55.35; 95% CI, -100.33 to -10.36). The operative duration (MD  =  -5.15; 95% CI, -24.06 to 13.75), tumor size (MD  =  -.07; 95% CI, -.27 to .13) and incidences of common postoperative complications were comparable between the two groups.

CONCLUSIONS

According to these findings, the use of PI in parotidectomies may be one of the options for improving cosmetic outcomes. This technique may be considered if oncological safety can be secured.

Effectiveness of the Fibrinogen-Thrombin-Impregnated Collagen Patch in the Prevention of Postoperative Complications after Parotidectomy: A Single-Blinded, Randomized Controlled Study

We investigated whether a fibrinogen-thrombin collagen sponge patch reduces postoperative complications of parotid gland surgery. This single-blinded, randomized controlled study included 165 patients who underwent parotid surgery for benign tumors (2018–2019) at a tertiary center. Primary outcomes were postoperative drain amount, days until drain removal, and discharge. Patients were scheduled for follow-up at 1 and 4 weeks, and 3 months after surgery. Complications including surgical site infection, pain, seroma, sialocele, salivary fistula, facial nerve palsy, Frey’s syndrome with subjective symptoms, and facial asymmetry were analyzed. After identifying confounding variables, multivariate approaches were used. Histologic analysis was performed in a mouse model of salivary gland surgery. In total, 162 patients (77, fibrinogen-thrombin collagen patch group; 85, controls) were included, with no significant between-group differences other than resected tissue. Among postoperative total drain amount and days until drain removal and discharge, the only postoperative total drain was significantly lower in the patch group than in the control group in the adjusted model. Additionally, although validation through robust trials with longer follow-up is needed, we found the potential benefit of the fibrinogen patch on Frey’s syndrome and facial asymmetry. In conclusion, fibrinogen-thrombin-impregnated collagen patches in parotidectomy can reduce postoperative drainage and improve outcomes.

Systematic review and meta-analysis of modified facelift incision versus modified Blair incision in parotidectomy

Surgical removal is the treatment of choice for many neoplasms of the parotid gland. This meta-analysis aimed to evaluate the differences between parotidectomy using a modified facelift incision (MFI) and parotidectomy using a modified Blair incision (MBI). A systematic search of the available literature in PubMed, Embase and the Cochrane Library was performed. Studies of adult patients who underwent open parotidectomy with presumed benign parotid neoplasms based on preoperative examinations were reviewed. The surgical outcomes of the MFI and MBI groups were collected. Intraoperative and postoperative parameters, including operative time, tumor size, cosmetic satisfaction, and incidences of facial palsy, Frey's syndrome and salivary complications, were compared. 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. Seven studies were included in the final analysis. The pooled analysis demonstrated that the cosmetic satisfaction score was significantly higher in the MFI group (MD = 1.66; 95% CI 0.87-2.46). The operative duration in the MFI group was significantly longer than that in the MBI group (MD = 0.07; 95% CI 0.00-0.14). The MFI group exhibited a smaller tumor size (MD = - 2.27; 95% CI - 4.25 to - 0.30) and a lower incidence of Frey's syndrome (RD = - 0.18; 95% CI - 0.27 to - 0.10). The incidence of postoperative temporary facial palsy (RD = - 0.05; 95% CI - 0.12 to 0.03), permanent facial palsy (RD = - 0.01; 95% CI - 0.06 to 0.03) and salivary complications (RD = - 0.00; 95% CI - 0.05 to 0.05) was comparable between the two groups. Based on these results, MFI may be a feasible technique for improving the cosmetic results of patients who need parotidectomy when oncological safety can be ensured.

Modified facelift incision and superficial musculoaponeurotic system flap in parotid malignancy: a retrospective study and review of the literature

Background

Data reporting the use of modified facelift incision (MFI) approach with or without superficial musculoaponeurotic system (SMAS) reconstruction in parotid malignancy are limited. To enhance the limited knowledge in this subject, the authors of the current study report quality data of MFI in patients with parotid malignancy with or without SMAS reconstruction.

Methods

We performed a retrospective review of parotid malignancy patients treated with the MFI over a 5-year period (2015–2019) in the 1st ENT University Department, University of Athens, Greece.

Results

We identified five patients with parotid malignancy. We performed MFI parotidectomy in 5/5 patients and SMAS reconstruction in 2/5 patients. All tumors were classified as T1N0M0. After a mean follow-up of 43.6 months (minimum, 36; maximum, 55), we noted no recurrence. The patients reported no Frey’s syndrome.

Conclusions

The authors of the current study suggest consideration of the MFI approach in parotid malignancy. A MFI approach should at least favor small parotid tumors without neck metastatic disease (T1cN0). Surgeons could also address larger tumors with a MFI approach. Surgeons should reconstruct the parotid lodge with a SMAS advancement flap in tumors not in proximity with the SMAS.

Complications after superficial parotidectomy for pleomorphic adenoma

Background

The significance of complications after superficial parotidectomy remains unclear, since prospective studies are lacking. The aim of this study was to evaluate facial nerve dysfunction and other postoperative complications after superficial parotidectomy for pleomorphic adenoma of the superficial lobe and to identify the associated risk factors.

Material and Methods

Prospective and descriptive clinical study on 79 patients undergoing formal superficial parotidectomy with the modified facelift incision, dissection of the facial nerve and reconstruction with the superficial musculoaponeurotic system flap. Function of the facial nerve using the House-Brackmann scale and the intra- and postoperative complications were recorded at 1 week and 1, 3, 6 and 12 months. A descriptive, inferential and binary logistic regression analysis were performed for the variables facial nerve dysfunction, tumor size and location, clinical presentation and duration of surgery.

Results

77.2% of the patients presented facial paresis at 1 week, with the marginal-mandibular branch being the most commonly affected (64.5%). 94.9% recovered the facial function at 6 months and 100% at 12 months. A statistically significant relationship was found between the appearance of facial paresis and tumor location in the superior lateral area of the superficial lobe, size >2 cm and prolonged operative time. None of the remaining variables showed significant differences at any study timepoint. At 12 months, 57% of patients had recovered tactile sensitivity in the earlobe. The clinical occurrence of Frey’s syndrome was 11.4%.

Conclusions

Despite the high incidence of postoperative facial paresis at 1 week, its magnitude was low and the recovery time was short. Tumor location in the parotid superficial lobe upper area, size and prolonged operative time are risk factors that can worsen facial paresis at different study timepoints. The knowledge of these complications is relevant for patient´s counseling and to achieve better long-term outcomes.

Key words:Superficial parotidectomy, pleomorphic adenoma, parotid gland, facial nerve paralysis, postoperative complications.

A Minimally Invasive Endoscopic Approach to Midcheek Mass: Showcase for Technical Description

BACKGROUND

Surgical approaches to the midcheek area are challenging. This area is included between the lower eyelid above, and the upper lip below. The peculiar anatomical location makes it really important for attractiveness, thus the need to obtain a correct balance between the operation's safety and minimally invasive aspect. To the authors' knowledge, this is the first showcase and technical description of a novel minimally invasive endoscopic approach for midcheek mass removal.

METHODS

Making 3 incisions in concealed area an endoscopically aided facial dissection was performed to remove a solitary venus malformation of the left midcheek region.

RESULTS

After the surgical procedure was performed, no hematoma, no edema, or facial nerve paralysis were observed. To date, during the follow-up period, no recurrence of the lesion has been observed, and the quality of life of the patient was good with a minimally scar outcome. Magnetic resonance imaging, performed 2 weeks postoperatively, demonstrated a complete removal of the mass CONCLUSION:: The authors' finding experience suggests that the minimally invasive approach provides an excellent surgical window that achieves greater exposure for the dissection of the midcheek area. Further clinical applications are required to assess advantages and/or limitations of this procedure.

Use of the SMAS flap for reconstruction of the parotid lodge

The purpose of our study was to evaluate the benefits of the SMAS flap in patients with benign tumours of the parotid gland treated by superficial parotidectomy. We carried out a retrospective chart review on 123 patients suffering from benign tumours of the parotid gland admitted to our Institution between March 1997 and March 2010. A superficial parotidectomy was performed in all the cases reported. Our sample was divided in two groups basing SMAS flap reconstruction done (Group 2) or not (Group 1) after superficial parotidectomy. Reconstruction using SMAS flap was accomplished in 64 patients. Chi-square test was used to assess statistical difference between the two groups. The level of statistical significance was P < 0.05. No significant differences concerning hematoma, wound infection and facial paralysis were observed between the first and second group (3.38 vs 1.56% [P > 0.05], 8.47% vs 4.68% [P > 0.05], 5.08% vs 0.00% [P > 0.05]). Transient facial nerve weakness, fistula, dip skin and Frey's syndrome were significantly more frequent without SMAS flap reconstruction (10.16% vs 3.125% [P < 0.05], 13.55% vs 3.125% [P < 0.05], 13.55% vs 3.125% [P < 0.05], 20.33% vs 0% [P < 0.05] respectively). The use of the SMAS flap is able to reduce the cosmetic and functional complications that occur after the removal of a benign tumour of the parotid through the superficial parotidectomy technique, above all, it reduces the occurrence of Frey's syndrome.

Quality of life after surgery for benign disease of the parotid gland

Objective:

To evaluate quality of life after surgery for benign neoplastic disease of the parotid gland.

Patients and methods:

A quality of life questionnaire, which was created from the Hebrew version of the University of Washington Quality of Life prototype, was applied to 55 patients who underwent surgery for benign neoplastic parotid disease. All patients were examined in Baskent University Adana Teaching and Medical Research Center, where all except 10 subjects (who responded by phone) completed the quality of life questionnaire.

Results:

The highest overall score was 96.3 indicating no salivary fistula. Only one patient complained of salivary secretion through the wound scar. The lowest overall score was 59.5 indicating loss of sensation. Although no post-surgical pain was reported by 32 (58 per cent) patients, 16 (29 per cent) patients reported a post-surgical change in their appearance. Scarring and surgical site depression were reported by 26 (47 per cent) and 17 patients (30 per cent), respectively. Facial nerve impairment was reported by seven patients (13 per cent) during the early post-operative period; these patients recovered from that impairment. The only significant statistical correlations were noted between general health and gender, and between post-surgical pain and gender. There was not any statistical correlation between all data and age, tumour type and education level.

Conclusion:

The general status of patients who have undergone surgery for a benign parotid neoplasm can be assessed with a quality of life questionnaire. Patients' post-surgical quality of life can be improved by the correct choice of surgical approach and reconstructive method.

Anteriorly Based Partial Thickness Sternocleidomastoid Muscle Flap Following Parotidectomy

The anteriorly based partial thickness sternocleidomastoid (SCM) muscle flap is among the various methods described to correct parotidectomy defects, but its indications and limitations are not clearly demonstrated in several reports. This study was done to test the aesthetic outcome of this method, its indications and limitations. At Dr. Babasaheb Ambedkar Memorial hospital, Mumbai, 20 patients presenting with benign parotid tumors underwent parotidectomy. 16 underwent superficial parotidectomy and 3 underwent adequate parotidectomy, 1 had total parotidectomy. The anteriorly based partial thickness SCM muscle flap was used to correct the contour deformity and to prevent Frey syndrome. The aesthetic result was evaluated by assessing and scoring the overall appearance of the scar, the degree of symmetry of the reconstructed parotid region and the site of the donor muscle in comparison to their contralateral normal sides. The overall aesthetic appearance was good in 17 patients, and moderate in 3 patients. 17/20 patients had an overall deep satisfaction with the result. The residual hollowness following total parotidectomy defect and the poor quality of scars were the main reasons affecting the aesthetic outcome. Superficial parotidectomy through modified Blair's incision with immediate reconstruction with anteriorly based partial thickness SCM flap allows a satisfactory aesthetic outcome and minimal donor site morbidity. Scores of the above two parameters were accessed. Patients' satisfaction was assessed by patients questionnaire.

Effectiveness of platysma muscle flap in preventing Frey syndrome and depressive deformities after parotidectomy

BACKGROUND

Frey syndrome (FS) or depressive deformity (DD) occurring after parotidectomy significantly reduces a patient's quality of life. However, there seems to be no effective treatment strategy against these complications. In this study, we report our experience of using platysma muscle flap (PMF) to prevent the development of FS and DD after parotidectomy, and evaluate its effect subjectively and objectively.

METHODS

Superficial parotidectomy was performed for eight cases of parotid gland tumor, and a PMF was transferred to cover the site. The incidence of FS and DD were evaluated subjectively, using a questionnaire to the patients and board-certified reconstructive surgeons, and objectively, using Minor's starch-iodine test.

RESULTS

In seven patients, the defect could be completely covered with PMF, and none of them developed FS or obvious DD. However, in one patient, the defect could be only partially covered, and the patient developed complications in the exact site that the flap did not cover. Overall scores from the questionnaire were high in relation to both cosmetic and functional perspectives from most of the patients and all the surgeons. No patients had major postoperative complications requiring revision.

CONCLUSIONS

PMF can be useful to cover the defect and prevent complications after parotidectomy. PMF is relatively easy to perform with fewer complications; however, a complete coverage of the defect should be ensured to obtain optimal results.

Facelift- and circum-occipital incision placement for fat extirpation of the neck in Madelung's disease - a two-case report

Benign symmetric lipomatosis (Madelung's disease) is a rare disorder of fat metabolism that is characterized by progressive symmetrical formation of unencapsulated and painless excess fat masses around the neck and trunk that result in cosmetic disfiguration and functional impairment. Since the disorder is incompletely understood and causal therapy is unavailable, surgical removal of fatty masses is the mainstay of treatment. In this paper the authors describe their use of the classical facelift incision placement as well as a horizontal circum-occipital incision to approach and excise excess fat of the anterior and posterior neck in two patients. This method yielded satisfying results with a combination of good access to fat masses, smooth trimming and redraping of redundant skin, in addition to fairly inconspicuous scarring post-operatively. After removal of 1.5 kg of fat from each patient and a period of uncomplicated wound healing, both patients showed no signs of relapsing fatty growth. Although more challenging than most conventional approaches, the authors' technique has shown good outcomes in those treated with this condition.

Facelift approach for parotidectomy: an evolving aesthetic technique

OBJECTIVE

To systematically review the literature on the modified facelift incision for parotidectomy and to identify the scope and safety of this approach, along with cosmetic outcomes. Where available, a direct comparison was made with Blair's incision (BI).

DATA SOURCES

Medline, PubMed, Cochrane, and CINHAL databases for English-language studies published between 1960 and 2011 on the facelift approach for parotidectomy.

REVIEW METHODS

Exclusion criteria were studies reporting on concurrent facelift, studies that used synthetic material for reconstruction of the surgical bed, descriptive studies, and studies with duplicate patient data. Outcome measures were candidacy for surgery, variations in incision, cosmetic outcomes, surgical time, complication rates, and limitations.

RESULTS

Of the initial 139 studies, 11 studies encompassing 628 patients were included. Male-to-female ratio was 0.49:1, and average age was 47.1 years. In total, 582 surgeries were performed for benign lesions. Only 10 studies specified the extent of surgery: 8 authors used it for performing superficial/partial parotidectomy, and 2 described 17 cases of total parotidectomy. Tumors up to 8 cm have been excised, with a median value of 4 cm. Operative time, formally analyzed in 3 studies, was not significantly different when compared with BI. Complication rates were not increased with this approach. Aesthetic outcomes pertaining to postoperative scar were good, as reported by the patients.

CONCLUSION

The facelift approach is a cosmetically superior approach to parotid tumors as proven by objective data. Most publications in the literature pertaining to the modified facelift incision for parotidectomy have been in the past decade, lending credence to its rising popularity.

Improving the quality of life of parotid surgery patients through a modified facelift incision and great auricular nerve preservation

Postoperative quality of life after parotidectomy depends not only on surgical outcomes, such as the complete removal of a tumour, non-recurrence and the preservation of facial nerve function, but also on scar satisfaction and the degree of sensory dysfunction in the upper cervical area and at the ear lobe. Especially young patients and women consider the scar in the infra-auricular area and in the neck region to be distressing and even disfiguring. Resection of the great auricular nerve leads to paraesthesia and hypoesthesia, which leads to discomfort in many patients especially when using the telephone, shaving or wearing earrings. A modified approach to the parotid gland via a facelift incision and the careful exposure of the great auricular nerve can reduce the aforementioned problems considerably and improve postoperative quality of life. We present our experiences with the modified approach at our institution.

[Parotid tumors: a two-year experience of Otolaryngology Department at MSS Hospital in Warsaw]

THE AIM OF THE STUDY

Tumors of the salivary glands represent about 3% of head and neck neoplasms. Most of theme--up to 80%--originate from the parotid gland. The aim of the study is to present current epidemiological data, most frequent complains, our surgical technique, histopathological diagnosis, complications rate and follow-up.

MATERIAL AND METHODS

Retrospective analysis of 100 patients, operated at our department from 01.2007 to 03.2009, was performed. We analyzed the age, sex, symptoms of the dissease, histopathological findings, complications and follow-up. All of the patients had ultrasound examination prior to operation to estimate the spread and the type of the tumor. In doubtful cases the ultrasound-guided fine-needle aspiration for biopsy and cytology, computer tomography and magnetic resonance were performed.

RESULTS

The frequency of incidence of benign tumours was 90% and the most frequent histopathological diagnosis was pleomorphic adenoma (49%) and adenolymphoma (42%). By 6% of our patients malignant neoplasms were developed and tumours of non-neoplastic origin by 4% of theme. The most frequent complication was sensory deficit about the cheek and ear (35%), temporary facial nerve paresis (5%), hematoma (1%), salivary fistula (1%).

CONCLUSION

Superficial and total parotidectomy are safe procedures of treatment in case of salivary gland tumors. Using the microscope during parotidectomy is extremely useful in order to preserve the continuity of the facial nerve branches.

Superficial parotidectomy versus retrograde partial superficial parotidectomy in treating benign salivary gland tumor (pleomorphic adenoma)

PURPOSE

Of all benign salivary gland tumors of the parotid gland, pleomorphic adenoma (mixed tumor) is the most common. It accounts for 60% to 70% of all benign tumors of the parotid gland. This neoplasm arises in patients in the fourth to sixth decade of life, with a female predominance. The surgical excision of this lesion continues to be the subject of major debate. The goal is to avoid facial disability yet attain complete resection without perforation of the capsule/pseudocapsule. The purpose of our study is to compare 2 surgical techniques performed at the Ear, Nose, and Throat and Maxillofacial Departments, Rambam Medical Center, Haifa, Israel, and determine which is preferable in treating this lesion.

PATIENTS AND METHODS

We reviewed 48 patients who underwent excision of pleomorphic adenoma of the parotid gland between 1996 and 2005 at Rambam Medical Center: 18 were treated surgically with the classical superficial parotidectomy (SP) technique, using an anterograde approach, and 30 were treated with retrograde partial superficial parotidectomy (PSP). We compared the 2 surgical techniques in terms of surgical time, histopathologic size of the lesion, amount of excised healthy parotid tissue, histologic margin, and the preservation of the capsule/pseudocapsule. We also made clinical records of temporary or definitive injury to the facial nerve, which branches of the facial nerve were temporarily or definitively injured, the occurrence of Frey syndrome, esthetic satisfaction, and the amount of recurrence or infection after surgery.

RESULTS

Of the 48 patients, 19 (39.6%) were male and 29 (60.4%) were female, with a mean age (+/- SD) of 43.8 +/- 16.97 years (median, 50 years; range, 12-79 years). We found a significant difference (P = .029) in mean surgical time (+/- SD): 171 +/- 49.7 minutes (median, 165 minutes) when performing the classical SP and 145 +/- 42.7 minutes (median, 130 minutes) when performing the retrograde PSP. Much more healthy parotid tissue was taken out with the classical procedure (mean, 51.4 +/- 13.6 mm; median, 50 mm) than with the retrograde PSP technique (mean, 39.2 +/- 11.8; median, 35 mm) (P = .01). There was a significant difference (P = .0003) in facial nerve injuries: 39% of patients did not report any facial deficit in the SP group compared with 90% in the PSP group. In the SP group, only 3 patients reported a permanent deficit, and in the PSP group, only 3 patients had a temporary deficit (compared with 8 in the SP group). The main injuries occurred in the mandibular branch with both techniques: 6 SP and 2 PSP. There was no difference in esthetic satisfaction: 72.2% of patients in the SP group and 80% in the PSP group had no esthetic complaints. In the SP group, patients mainly complained about swelling (3 patients), and in the retrograde PSP group, the main complaint was depression (4 patients). Frey syndrome was found in 9 patients in the retrograde PSP group and 4 in the classical SP group (with an overall rate of 27.7%). The lesion recurred in only 2 patients--1 in each group.

CONCLUSION

With both of the techniques, we found satisfactory results. In the majority of cases, retrograde PSP is a superior technique to the classical SP, although Frey syndrome is more often observed with the former.

[Facelift incision parotidectomy: preliminary report]

INTRODUCTION

Traditional approaches parotidectomy leaves a visible scar and a hollow on the face and neck, which might be dissappointing to some patients.

AIM OF THE STUDY

Assessment of usefulness of facelift approach to the parotid gland

PATIENT AND METHODS

A retrospective study was performed. In June 2009 eight patients with benign parotid tumour underwent superficial parotidectomy. Four of them were included in the rhytidectomy approach parotidectomies and SMAS advancement flap was carried out to reconstruct the parotid bed and prevent Frey's syndrome. The latter patients underwent the classical technique parotidectomies. After two months from the operation both groups of patients were asked to assess the cosmetic outcome of the surgery in five degree scale.

RESULTS

The duration of the operation increased by an average of 20 minutes in the rhytidectomy approach group. No major difficulties in exposing the facial nerve and its branches were observed. Patients were more satisfied when facelift approach was performed.

CONCLUSION

A rhytidectomy approach to the parotid gland seems to be safe method and aesthetic results are more satisfactory as comparing to classical approach.

Distal facial nerve exposure: A key to partial parotidectomy

Objectives: 1) Compare outcomes of distal facial nerve identification with antegrade exposure in partial parotidectomy; 2) Be able to incorporate other modifications of parotidectomy including preservation of the great auricular nerve, superficial musculo-aponeurotic system (SMAS), and parotid duct.

Study Design: Case series with chart review of partial parotidectomy for benign neoplasms and intraparotid lymph nodes, using antegrade (Group 1) or distal (Group 2) facial nerve exposure, and those conserving the great auricular nerve, SMAS, and parotid duct (Group 3).

Subjects and Methods: Outcomes for the three groups were reviewed. The great auricular nerve, parotid duct, and SMAS were preserved when possible. Outcomes examined included postoperative facial nerve function, earlobe sensation, allograft use for SMAS defects, surgical duration, sialocele, or salivary fistula.

Results: No difference in facial nerve function was found between the groups. Group 3 had better ear lobule cutaneous sensation. No sialoceles occurred in the 10 of 14 Group 3 cases in which parotid ducts were preserved.

Conclusions: Partial parotidectomy utilizing distal facial nerve exposure can reduce the extent of surgical dissection, facilitate preservation of the parotid duct and great auricular nerve, and allow greater flexibility in the choice of skin and SMAS incisions.

Minimally Invasive Endoscope-Assisted Parotidectomy: A New Approach

OBJECTIVE

To evaluate the benefits of a new approach, endoscopic parotidectomy through a postauricular skin incision by using an ultrasonically activated scalpel.

STUDY DESIGN

An investigation of the outcome of endoscopic parotidectomy at a tertiary referral medical center.

METHODS

Fourteen operations for selected patients presenting with benign parotid tail disease were performed via minimally invasive endoscopic resection by a single surgeon (MK Chen).

RESULTS

All 14 operations were successfully performed endoscopically, and no conversions to conventional open resection were necessary. The procedures lasted 60 to 160 minutes. Two patients had transient grade II facial paresis. The scars were almost invisible due to their concealed location behind the ear.

CONCLUSIONS

Minimally invasive endoscope-assisted parotidectomy is a feasible method for treatment of benign lesions located in the parotid tail. The main advantage of this procedure is that the small operative scar is concealed in the postauricular area resulting in improved cosmetic results.