Selective deep lobe parotidectomy via retroauricular hairline (Roh's) incision for deep lobe parotid pleomorphic adenoma

Three-dimensional digital model of the facial nerve assisted in the excision of benign parotid tumors based on 3D-DESS-WE-MRI

This study proposes a novel surgical technique for the excision of benign parotid tumors, utilizing a extracapsular dissection guided by a three dimensional digital model of the facial nerve(3DFN-ECD) and compares its clinical efficacy with the extracapsular dissection (ECD) method. This prospective study included 68 patients with benign parotid tumors. The control group (40 patients) received the ECD treatment, while the experimental group (28 patients), underwent the 3DFN-ECD approach proposed in this study. Preoperative three-dimensional double-echo steady-state water excitation sequence (3D-DESS-WE) of MRI was employed to visualize the tumor and facial nerve, and the Mimics software was used to reconstruct a three-dimensional digital model of the facial nerve and parotid tumor. The surgical incision and facial nerve dissection were planned based on the relationship between the tumor and the facial nerve. Postoperative facial nerve function and aesthetic outcomes of the incisions were compared between the two surgical techniques. There was no significant difference in the postoperative complications between the two groups. Postoperative facial nerve function scores in the 3DFN-ECD group were significantly higher than those in the control group at 1 week (p < 0.001) and 4 weeks (p < 0.001). The incidence of temporary facial nerve paralysis was significantly lower in the 3DFN-ECD group (P = 0.036), and the visual analogue scale score for aesthetic outcomes of the surgical incision was significantly improved (p < 0.001). The novel 3DFN-ECD surgical approach proposed in this study significantly reduces the risk of facial nerve injury and improves the aesthetic outcomes of the parotid tumor surgical incision.

Selective Deep-Lobe Parotidectomy for Benign Parotid Gland Tumors

BACKGROUND

Deep-lobe tumors have been shown to possess a significantly thicker capsule with less tumor penetration compared to superficial tumors. Thus, more conservative surgical approaches, rather than aggressive methods, have been proposed for treating benign deep-lobe tumors of the parotid gland.

AIM

To evaluate the surgical outcomes and oncological safety of selective deep-lobe parotidectomy (SDLP) in patients with benign lesions located in the deep lobe of the parotid gland.

METHODS

Twenty-two patients who underwent SDLP were enrolled in the study. Data on age, sex, tumor size, hospitalization duration, recurrence, cosmetic outcomes, and complications-including facial nerve (FN) impairment, Frey's syndrome (FS), sialocele, first-bite syndrome (FBS), wound infection, hematoma, and seroma -were retrospectively evaluated from hospital records. Facial contour symmetry was rated by each patient using a 0-10 VAS score at least six months post-surgery.

RESULTS

Final histopathological examination revealed that the most common tumor was pleomorphic adenoma (PA) (59.1%). Three patients (13%) experienced temporary paralysis of the marginal branch of the FN, with a House-Brackman Grade III, which resolved spontaneously within two months post-surgery. No cases of permanent FN paralysis, FS, FBS, or sialocele were observed in any patients. The mean VAS score for facial contour symmetry was 9.43 ± 0.78. No recurrence were noted in any patients over a median follow-up period of 71.7 ± 21.2 months.

CONCLUSION

SDLP may facilitate the safe surgical removal of benign lesions located in the deep lobe of the parotid gland, with oncological safety, reduced complication rates, and improved cosmetic outcomes.

Gland-preserving surgery of benign parotid tumours via postauricular sulcus incision: Is it safe and effective with the scarless incision?

Gland-preserving surgery has been introduced to reduce the complications of conventional parotidectomy that requires removal of total superficial or entire parotid gland along with the tumour. Several cosmetic incisions have also been developed along with conservative parotid surgery involving partial dissection of the facial nerve and gland. The incision length in the cosmetic approaches is gradually shortened from facelift to periauricular incision, and endoscopic parotidectomy techniques emerged. A more functional approach via postauricular sulcus incision was also introduced to remove benign parotid tumours with high cosmetic satisfaction and oncological safety. Therefore, this article presents the surgical procedures, potential indications, pros and cons of the postauricular sulcus approach.