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Boschetti CE, Vitagliano R, Cornacchini N, Santagata M, Caliendo V, Belfiore MP, Colella G, Tartaro G, Cappabianca S. Safety and Aesthetics of Autologous Dermis-Fat Graft after Parotidectomy: A Multidisciplinary Retrospective Study. J Pers Med 2023; 13:1200. [PMID: 37623451 PMCID: PMC10456015 DOI: 10.3390/jpm13081200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: In surgical procedures for maxillofacial tumours, it is challenging to preserve functional and cosmetic properties in the affected patients. The use of fat grafting is considered as a valuable alternative to overcome postoperative aesthetic asymmetry problems. (2) Methods: In this study, we enrolled thirty patients with parotid gland tumours in which a partial or complete parotidectomy was performed with positioning in the parotid bed of autologous dermis-fat grafts. We evaluated the satisfaction rate of the patients and the objective efficacy in solving the deformity by comparing MRI data before and after surgery. (3) Results: Twenty-six patients showed a satisfying cosmetic result with proper facial symmetry between the affected side and the healthy one. Two patients presented mild postsurgical complications such as haematomas, and two patients reported temporary weakness of the facial nerve related to the parotidectomy. (4) Conclusions: Based on the imaging data obtained via MRI before and after surgery, we can assess that the employment of fat grafts in parotidectomy surgical procedures gives good cosmetic results and does not affect the post operative management and follow up of oncologic patients.
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Affiliation(s)
- Ciro Emiliano Boschetti
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Rita Vitagliano
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Nicola Cornacchini
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Mario Santagata
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Valentina Caliendo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (V.C.); (M.P.B.); (S.C.)
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (V.C.); (M.P.B.); (S.C.)
| | - Giuseppe Colella
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Gianpaolo Tartaro
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.E.B.); (N.C.); (M.S.); (G.C.); (G.T.)
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (V.C.); (M.P.B.); (S.C.)
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Fawzy A, Balbaa MA, Hagag M. Evaluation of functional and aesthetic outcomes of free dermal fat graft versus superficial musculoaponeurotic system flap after superficial parotidectomy: randomized clinical trial. BJS Open 2023; 7:7156603. [PMID: 37151084 PMCID: PMC10165060 DOI: 10.1093/bjsopen/zrac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/12/2022] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Parotidectomy is the standard procedure for treatment of many parotid lesions; however, it has several drawbacks. Facial asymmetry and Frey's syndrome are the most annoying complications to patients. Insertion of interpositioning grafts into the parotidectomy bed can decrease these complications significantly. Free dermal fat graft (FDFG) and superficial musculoaponeurotic system (SMAS) flap have very promising results. This RCT aimed to compare these two techniques regarding functional and aesthetic outcomes. METHODS Between February 2016 and October 2021, adult patients undergoing superficial conservative parotidectomy in a single centre for a benign indication were randomized into two equal groups using a closed envelope method. In one group, FDFG was inserted at the parotidectomy bed, whereas, in the other group, SMAS flap was performed. Preoperative, operative, and postoperative data were recorded and analysed. The primary outcome was the development of Frey's syndrome. RESULTS Seventy-eight patients were randomized into two equal groups of 39 patients. There was no significant difference between the two groups regarding development of Frey's syndrome. There was no significant statistical difference between study groups regarding demographic data, co-morbidities, parotid pathologies, specimen volumes, total operating time, and postoperative complications. A tendency for over correction was observed in FDFG and under correction in SMAS flap. There was no statistically significant difference between the study groups regarding the patients' aesthetic satisfaction with the majority displaying excellent satisfaction with no poor results. CONCLUSION FDFG and SMAS flap are simple, rapid, and reliable procedures and are effective in improving both functional and aesthetic outcomes post-parotidectomy. They have comparable results; however, selection of either procedure can be determined according to patient and tumour characteristics. Registration number: NCT05452837 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Ahmed Fawzy
- Department of General Surgery, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, Egypt
| | - M Ashraf Balbaa
- Department of General Surgery, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, Egypt
| | - Mahmoud Hagag
- Department of General Surgery, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, Egypt
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Management of Aesthetical and Functional Complications after Total Parotidectomy. First Long-Term Experiences with Dermal Matrix Surgimend ® in Patient Affected by Malignant Parotid Tumors. J Maxillofac Oral Surg 2022. [DOI: 10.1007/s12663-022-01761-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Abstract
Background
This is an observational cohort study on patients affected by malignant parotid tumors treated with total parotidectomy. The aim of our work is to analyze and compare the effects and complications after parotidectomy, using or not SurgiMend ®.
Methods
40 patients were retrospectively enrolled between September 2014 and June 2020. Basing on the placement of SurgiMend ® for parotid lodge reconstruction, the samples were divided into two groups. Thus, the incidence rate of complications after the surgical procedure was analyzed between the two groups.
Results
Patients in whom SurgiMend ® was used reported a lower rate of complications. The ANOVA test (p = 0.05) revealed a significant difference of Vancouver Scar Scale (VSS) between the two groups, representation as vascularity and pigmentation improvement, changing scar color, scar height reduction, and increased pliability.
Conclusion
Although many techniques are available to fill the parotidectomy defect, improve facial contour and prevent Frey’s syndrome, the use of SurgiMend ® matrix is one of most effective and reliable method to address these complications, with the advantage of decreased operative time due to not require an additional surgical donor site.
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Kadota H, Yoshida T. Infrahyoid myofascial flap transfer for the prevention of concave deformity and gustatory sweating after parotidectomy. Auris Nasus Larynx 2021; 49:484-494. [PMID: 34772563 DOI: 10.1016/j.anl.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/09/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Concave deformities and gustatory sweating are the most common complications that cause substantial patient dissatisfaction after parotidectomy. Various surgical methods to prevent these complications have been described. However, effective techniques have not been established, especially in patients with medium- to large-sized parotidectomy defects. We evaluated the utility of infrahyoid myofascial flap reconstruction of parotidectomy defects for the prevention of these complications. METHODS We conducted a retrospective case series study in patients with a benign or malignant parotid tumor measuring over 4 cm who underwent immediate pedicle infrahyoid myofascial flap reconstruction after total or subtotal parotidectomy or total resection of either the superficial or deep parotid gland at our hospital. Subjective analyses of facial symmetry, postoperative concave deformities of the anterior neck, gustatory sweating, voice disorders, odynophagia, neck scarring in the parotid and anterior neck areas, sensory disorders, pain, and neck stiffness were performed using patient interview data. Objective evaluations of facial symmetry were made by the first or second author. Both analyses were performed after a follow-up of more than six months. Additionally, patient demographic data, clinicopathological factors, parotidectomy and skin incision types, flap survival, and postoperative complications were evaluated. RESULTS We included eight patients (male, n=5; mean age, 69.3 years [range, 37-93 years]). Procedures included total or subtotal parotidectomy (n=4), superficial lobe parotidectomy (n=2), and deep lobe parotidectomy with partial superficial lobe parotidectomy (n=2). Infrahyoid myofascial flaps reached the cranial tip of the parotid defect without tension, and their volume sufficiently filled the parotidectomy defect in all patients. There were no local signs of insufficient blood flow within the transferred flaps. OBJECTIVE AND SUBJECTIVE: assessments were made after a mean duration of 1.2 years (range, 0.6-1.8). Postoperatively, no patient subjectively reported facial asymmetry. Objectively, facial symmetry was "good" in four patients and "fair" in four patients. No distinctly visible concave deformity in the parotid or anterior neck area occurred in any patient. Gustatory sweating occurred in one patient; this individual had the largest parotidectomy defect. Only one patient experienced donor site morbidity (mild anterior neck stiffness) related to infrahyoid myofascial flap elevation. CONCLUSION Although complete prevention of gustatory sweating was unsuccessful, infrahyoid myofascial flap reconstruction of medium- to large-sized parotidectomy defects led to postoperative facial symmetry with minimal donor site morbidity.
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Affiliation(s)
- Hideki Kadota
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Japan; Department of Otorhinolaryngology and Head and Neck Surgery, Sasebo Kyosai Hospital, Japan.
| | - Takamasa Yoshida
- Department of Otorhinolaryngology and Head and Neck Surgery, Sasebo Kyosai Hospital, Japan
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Mianroodi AA, Mohtashami S, Romero N, Fuson A, Joshi A, Sadeghi N. Autologous Free Dermal-Fat-Fascial Graft for Parotidectomy Defects: A Case Series. Ann Otol Rhinol Laryngol 2021; 130:1171-1180. [PMID: 33657862 PMCID: PMC8385583 DOI: 10.1177/0003489421999542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Frey’s syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, and prevent Frey’s syndrome. Free dermal-fat-fascial graft (DFFG) is one such technique; however, its use is largely undocumented in the literature. In this case series, we investigate the efficacy of free DFFG in reconstructing parotidectomy defects at 2 tertiary care centers. Materials and methods: Medical records of 54 patients who underwent primary parotidectomy and immediate reconstruction with autologous abdominal free DFFG by 2 surgeons in George Washington University Hospital and McGill University Health Centre between 2007 and 2019 were collected prospectively. Patients responded to 2 questionnaires addressing postoperative outcomes. Results: Fifty-four patients were included; 32 superficial parotidectomies and 22 total parotidectomies were performed for 39 benign and 15 malignant tumors. Thirty-seven patients could be reached. Out of 37 patients who responded to the first questionnaire, 59% (22) reported complete facial symmetry, 27% (10) reported mild hollowness, and 14% (5) reported mild fullness. None declared noticeable hollowness or fullness. While 81% (30) did not experience Frey’s syndrome, 5.4% (2) experienced mild symptoms without disability, and 13.5% (5) experienced debilitating symptoms. Out of 37 patients, 8 patients responded to a second questionnaire addressing the outcome of the abdominal graft donor site. In regard to the donor site, 87.5% (7) were satisfied or very satisfied from its cosmetic appearance, 75% (6) were not bothered by its cosmetic appearance, and 87.5% (7) had no discomfort at the graft donor site. Patients did not report any other symptom at the graft donor site. Conclusion: In this large series of total parotidectomies including malignant pathologies, autologous abdominal free DFFG effectively prevented Frey’s syndrome and preserved facial cosmesis in most patients.
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Affiliation(s)
- Aliasghar A Mianroodi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA
| | - Sadaf Mohtashami
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Nahir Romero
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA
| | - Andrew Fuson
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA
| | - Arjun Joshi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
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De Virgilio A, Costantino A, Russo E, Ferreli F, Pellini R, Petruzzi G, Zocchi J, Spriano G, Mercante G. Different Surgical Strategies in the Prevention of Frey Syndrome: A Systematic Review and Meta-analysis. Laryngoscope 2021; 131:1761-1768. [PMID: 33502015 DOI: 10.1002/lary.29414] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/17/2020] [Accepted: 01/12/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS To define the best surgical technique able to reduce Frey syndrome (FS) incidence after parotidectomy. STUDY DESIGN Systematic review and network meta-analysis. METHODS An arm-based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were the incidence of subjective (clinical) and objective (positive starch-iodine test result) FS, respectively. RESULTS A total of 3830 patients with a median age of 50.35 years (n = 2323; IQR 44.25-54.18) were included for six interventions [temporoparietal fascia (TPFF), free fat graft (FFG), acellular dermal matrix (ADM), sternocleidomastoid muscle (SCM) flap, and superficial musculoaponeurotic system (SMAS) flap]. If compared to no treatment, the greatest reduction of subjective (clinical) FS incidence was measured for the TPFF (OR: 0.07, CI: 0.004-0.57), the ADM (OR: 0.09, CI: 0.02-0.35), and the FFG (OR: 0.11, CI: 0.03-0.42) techniques. However, a significant difference was measured also for the SCM flap (OR: 0.38, CI: 0.18-0.73) and for the SMAS flap (OR: 0.42, CI: 0.19-0.97). All treatments showed a significant reduction of the objective FS incidence if compared to no treatment (FFG, OR: 0.06, CI: 0.002-0.62; TPFF, OR: 0.07, CI: 0.01-0.33; ADM, OR: 0.11, CI: 0.03-0.44; SMAS, OR: 0.36, CI: 0.17-0.71; SCM, OR: 0.40, CI: 0.19-0.74). CONCLUSIONS TPFF, ADM, and FFG seem to be the best treatment strategies to prevent FS after parotidectomy. Further randomized controlled trials comparing these techniques should be conducted to define specific indications. Laryngoscope, 131:1761-1768, 2021.
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Affiliation(s)
- Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
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Lambiel S, Dulguerov N, Courvoisier DS, Dulguerov P. Minor Parotidectomy Complications: A Systematic Review. Laryngoscope 2020; 131:571-579. [PMID: 32678921 DOI: 10.1002/lary.28912] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To report descriptive statistics for minor parotidectomy complications. METHODS A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor. RESULTS The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4-3.5), wound infection 2.3% (95% CI: 1.8-2.9), sialocele 4.5% (95% CI: 3.5-5.7), salivary fistula 3.1% (95% CI: 2.6-3.7), flap necrosis 1.7% (95% CI: 1.1-2.5), scar issues 3.6% (95% CI: 2.4-5.4), numbness 33.9% (95% CI: 25.6-43.4), and deformity 11.8 (95% CI: 6.9-19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections. CONCLUSIONS Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 131:571-579, 2021.
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Affiliation(s)
- Silvia Lambiel
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Nicolas Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | | | - Pavel Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland.,Center for Otorhinolaryngology-Maxillofacial and Head and Neck Surgery, La Tour Hospital, La Tour Medical Group, Meyrin, Switzerland
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Petrides GA, Subramaniam N, Pham M, Clark JR. Reducing the morbidity of parotidectomy for benign pathology. ANZ J Surg 2020; 90:2315-2321. [PMID: 32483863 DOI: 10.1111/ans.16008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Conservative surgical approaches, reconstructive techniques and technology are increasingly used in parotid surgery. The aim of this study was to determine the surgeon-modifiable factors which impact the rates of post-operative complications following parotidectomy for benign pathology. METHODS A retrospective cohort study of patients undergoing parotidectomy for benign pathology by or under the supervision of the senior author between 2006 and 2019 was performed. Clinicopathological variables, operative techniques and post-operative complications were recorded using standardized templates. Multivariable logistic regression models were used to obtain odds ratios (ORs) whilst adjusting for the effect of other clinically relevant covariates. RESULTS In total, 357 parotidectomies were performed. Independent factors associated with post-operative facial paresis were re-operative surgery (OR 3.51, 95% CI 1.19-10.33, P = 0.023), nerve integrity monitoring (OR 0.50, 95% CI 0.26-0.99, P = 0.046) and operation type, with focused tumour dissection (FTD) having the lowest rate of paresis (OR 0.19, 95% CI 0.040-0.92, P = 0.038) compared to limited parotidectomy. Factors associated with reduced wound complications on adjusted analysis were dermofat grafting (OR 0.10, 95% CI 0.01-0.72, P = 0.023), lesion size (OR 0.68, 95% CI 0.50-0.92, P = 0.01) and FTD (OR 0.16, 95% CI 0.05-0.59, P = 0.005) compared to limited parotidectomy. CONCLUSION FTD, nerve integrity monitoring and dermofat grafting are surgeon-modifiable variables associated with lower rates of post-operative complications following parotidectomy for benign pathology. However, the benefit of these operative techniques relies on their appropriate utilization by performing surgeons.
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Affiliation(s)
- George A Petrides
- Department of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Narayana Subramaniam
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - My Pham
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Issa SAA, Jameel ME. Free Dermal Fat Graft for Reconstruction of Soft Tissue Defects in the Maxillofacial Region. Craniomaxillofac Trauma Reconstr 2020; 13:260-266. [PMID: 33456697 DOI: 10.1177/1943387520910678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Study Design Facial contour deformities are a very challenging issue for aesthetic and reconstructive surgeons. Free dermal fat graft is a composite graft used for the reconstruction of soft tissue defects in the maxillofacial region. The free dermal fat graft is easily adapted and contoured intraoperatively and provides a soft, natural, and favorable appearance after augmentation of the soft tissue defects. Objective To assess the use of free dermal fat graft for reconstruction of soft tissue defects in the maxillofacial region in regard to graft success, percentage of overcorrection, any associated complications, and cone beam computed tomography scan linear measurements for defect's depth. Methods This is a prospective study that included a patients were grafted with free dermal fat graft for correction of facial soft tissue defects from November 2017 to July 2019. All patients possess a depression defect and facial asymmetry due to congenital facial deformities, post-traumatic deformities, and post-ablative surgical deformities. Results Eleven patients (8 males and 3 females) with a mean age of 33.7 years were enrolled in this study. Five regions in the maxillofacial area were grafted in 11 patients. The mean of the postoperative follow-up was 6 months. The percentage of graft overcorrection was 15%. The mean for graft survival was 94.4% with no serious complications reported. Conclusions The autologous FDFG is a versatile and less invasive method in the reconstruction of facial soft tissue defects with a very good survival rate.
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Affiliation(s)
- Sabah Abdul-Aziz Issa
- Iraqi Board For Medical Specializations, Department of Oral and Maxillofacial Surgery, Medical City Complex, Baghdad, Iraq
| | - Mustafa Emaduldeen Jameel
- Iraqi Board For Medical Specializations, Department of Oral and Maxillofacial Surgery, Medical City Complex, Baghdad, Iraq
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10
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Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases. J Otolaryngol Head Neck Surg 2019; 48:64. [PMID: 31744535 PMCID: PMC6862743 DOI: 10.1186/s40463-019-0387-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy. METHODS A retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events. RESULTS There were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation. CONCLUSIONS There are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting.
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A multicentre retrospective clinico-histopathological review of 250 patients after parotidectomy. Int J Oral Maxillofac Surg 2019; 49:149-156. [PMID: 31375455 DOI: 10.1016/j.ijom.2019.03.963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/07/2019] [Accepted: 03/17/2019] [Indexed: 01/09/2023]
Abstract
A clinicopathological review of parotid tumours treated surgically in two oral and maxillofacial surgery departments was conducted. The performance of fine needle aspiration cytology (FNAC) was also assessed. This retrospective study included 250 consecutive patients treated surgically for parotid gland-related tumours. Benign tumours (n=211, 84.4%) were more prevalent than malignancies (n=39, 15.6%). A predominance of pleomorphic adenoma (48.8%) was identified, and epithelial-myoepithelial carcinoma (3.6%) was the most common malignant tumour. Overall, the sensitivity and specificity of FNAC were 64% and 99%, respectively. Subgrouping resulted in sensitivity and specificity of 50% and 100% for clinically assisted FNAC versus, 72% and 99% for ultrasound guidance. Surgically, 31.6% underwent complete superficial parotidectomy and 28.4% underwent extracapsular dissection. Overall, facial nerve palsy was the most prevalent postoperative complication, affecting 29.2% (70/240); loss of function was transient in 21.2% (51/240) and permanent in 7.9% (19/240). Extracapsular dissection and superficial parotidectomy with facial nerve preservation were the treatments of choice when a benign tumour was suspected. Facial nerve palsy was quite frequent; treatment options however are scarce. Preoperative diagnostic workup using imaging and ultrasound-guided FNAC was essential in identifying malignancy so that surgical planning could be adapted.
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Use of Parotid Gland Fascia in the Prevention of Frey Syndrome After Parotidectomy. J Craniofac Surg 2019; 30:1009-1011. [DOI: 10.1097/scs.0000000000005458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Autologous Free Fat Graft for Repair of Concave Deformity After Total Parotidectomy. J Craniofac Surg 2019; 30:834-837. [DOI: 10.1097/scs.0000000000005178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Baum SH, Mohr C. Autologous dermis-fat grafts in head and neck patients: Indications and evaluation in reconstructive surgery. J Craniomaxillofac Surg 2018; 46:1834-1842. [DOI: 10.1016/j.jcms.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 06/11/2018] [Accepted: 07/16/2018] [Indexed: 12/09/2022] Open
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Fiacchini G, Cerchiai N, Tricò D, Sellari-Franceschini S, Casani AP, Dallan I, Seccia V. Frey Syndrome, First Bite Syndrome, great auricular nerve morbidity, and quality of life following parotidectomy. Eur Arch Otorhinolaryngol 2018; 275:1893-1902. [DOI: 10.1007/s00405-018-5014-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
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Baum SH, Rieger G, Pförtner R, Mohr C. Correction of whistle deformity using autologous free fat grafting: first results of a pilot study and review of the literature. Oral Maxillofac Surg 2017; 21:409-418. [PMID: 28920163 DOI: 10.1007/s10006-017-0648-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Whistle deformities are frequent sequelae after surgical correction of cleft lip, trauma, or tumor excision. The aim of this study was to examine the role of autologous free fat grafting in the reconstruction of whistle deformity. PATIENTS Fifteen patients with whistle deformity were enrolled in this pilot study. The mean follow-up period was 19 months. Liposuction was done followed by the replantation of an average of 2.2 ml autologous fat per patient (range 0.7-4 ml). An overcorrection was performed in all patients. RESULTS All the patients showed improvements in whistle deformity. The mean resorption rate was 53% (range 30-80%). Three patients (20%) were not satisfied with the postoperative result. Six complications were assessed (4× feeling of pressure [27%], one hematoma [7%], one recurrent pain [7%]), but a major complication did not occur. REVIEW We also present a review of the literature with different techniques that were described in the last 20 years. CONCLUSION Autologous free fat graftings for reconstruction of whistle deformity represent a reliable method with a low complication rate. However, the resorption rate is unpredictable. If necessary, several autologous fat transplantations should be conducted at an interval of at least 6 months.
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Affiliation(s)
- Sven Holger Baum
- Department of Oral and Maxillofacial Surgery, University Essen, Kliniken-Essen-Mitte, Henricistr. 92, 45136, Essen, Germany.
| | - Gunnar Rieger
- Department of Oral and Maxillofacial Surgery, University Essen, Kliniken-Essen-Mitte, Henricistr. 92, 45136, Essen, Germany
| | - Roman Pförtner
- Department of Oral and Maxillofacial Surgery, University Essen, Kliniken-Essen-Mitte, Henricistr. 92, 45136, Essen, Germany
| | - Christopher Mohr
- Department of Oral and Maxillofacial Surgery, University Essen, Kliniken-Essen-Mitte, Henricistr. 92, 45136, Essen, Germany
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Baum SH, Schmeling C, Pförtner R, Mohr C. Autologous dermis - Fat grafts as primary and secondary orbital transplants before rehabilitation with artificial eyes. J Craniomaxillofac Surg 2017; 46:90-97. [PMID: 29195722 DOI: 10.1016/j.jcms.2017.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 09/16/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the role of autologous dermis-fat grafts in the reconstruction of orbital soft-tissue defects. PATIENTS Thirty-six patients (3-84 years) were enrolled in this retrospective study from 2002 to 2014. The dermis-fat graft was primarily transplanted in seven cases, and secondarily in 29 patients. All the patients were evaluated for complications, adequate prosthetic cavity, possibility of artificial eye supply and movement, as well as cosmetic results. Follow-up periods ranged from 25 to 144 months. RESULTS All the patients could be supplied with an artificial eye in the long term after dermis-fat transplantation. The clinical evaluation revealed 17 complications allocated to 11 patients. A major complication occurred in three patients (8.3%) so that a surgical correction was necessary. Thirty-three patients (91.7%) showed an aesthetically stable long-term outcome. CONCLUSION Dermis-fat grafts for reconstruction of anophthalmic orbit represent a reliable method with a low complication rate and good cosmetic and functional results. The graft can be used as primary and secondary transplants. The stable long-term results and high aesthetic satisfaction lead us to recommend this method as a routine operation.
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Affiliation(s)
- Sven Holger Baum
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Christopher Mohr), University of Duisburg-Essen, Kliniken-Essen-Mitte, Henricistr. 92, 45136, Essen, Germany.
| | - Claus Schmeling
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Christopher Mohr), University of Duisburg-Essen, Kliniken-Essen-Mitte, Henricistr. 92, 45136, Essen, Germany
| | - Roman Pförtner
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Christopher Mohr), University of Duisburg-Essen, Kliniken-Essen-Mitte, Henricistr. 92, 45136, Essen, Germany
| | - Christopher Mohr
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Christopher Mohr), University of Duisburg-Essen, Kliniken-Essen-Mitte, Henricistr. 92, 45136, Essen, Germany
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Reconstruction of parotidectomy and lateral skull base defects. Curr Opin Otolaryngol Head Neck Surg 2017; 25:431-438. [DOI: 10.1097/moo.0000000000000391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gao L, Ren W, Li S, Yan X, Li F, Yuan R, Shang W, Zhi K. Comparing Modified with Conventional Parotidectomy for Benign Parotid Tumors. ORL J Otorhinolaryngol Relat Spec 2017; 79:264-273. [DOI: 10.1159/000479742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
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