Parotidectomy via Individualized Mini-Blair Incision

Efficacy of digital zoning design for the resection of benign parotid gland tumor

The objective of this study is to verify the role of digital modified parotid tumor zoning method in modified parotid incision. The data of patients with parotid benign tumors from November 2021 to December 2023 were collected. Through the use of digital technology for soft tissue reconstruction, the parotid tumor was divided into four areas according to the digital image marker points. We designed the surgical incision according to the parotid gland division, found that it was feasible to guide the incision selection by division, and summarized the common incision and division corresponding, zone I was I and V-shaped incision, zone II was V incision, zone III was V and C- shaped incision, and zone IV was C- shaped incision. We conclude that the digital modified parotid gland zoning method can provide a better distinction in the surgical incision, and provide a better cosmetic incision and prognosis.

Factors influencing Frey syndrome after parotidectomy with acellular dermal matrix

BACKGROUND

Frey syndrome, also known as ototemporal nerve syndrome or gustatory sweating syndrome, is one of the most common complications of parotid gland surgery. This condition is characterized by abnormal sensations in the facial skin accompanied by episodes of flushing and sweating triggered by cognitive processes, visual stimuli, or eating.

AIM

To investigate the preventive effect of acellular dermal matrix (ADM) on Frey syndrome after parotid tumor resection and analyzed the effects of Frey syndrome across various surgical methods and other factors involved in parotid tumor resection.

METHODS

Retrospective data from 82 patients were analyzed to assess the correlation between sex, age, resection sample size, operation time, operation mode, ADM usage, and occurrence of postoperative Frey syndrome.

RESULTS

Among the 82 patients, the incidence of Frey syndrome was 56.1%. There were no significant differences in sex, age, or operation time between the two groups (P > 0.05). However, there was a significant difference between ADM implantation and occurrence of Frey syndrome (P < 0.05). ADM application could reduce the variation in the incidence of Frey syndrome across different operation modes.

CONCLUSION

ADM can effectively prevent Frey syndrome and delay its onset.

Analysis of the High Submandibular Approach: A Critical Reapprasail of a Transfacial Access to the Mandibular Skeleton

AIM

In 2006 following the development of dedicated osteosynthesis plates, Meyer and colleagues reported a successful clinical study of condylar fractures treated by a modified submandibular approach; it was called high submandibular approach or "Strasbourg approach." The aim of this study is to describe the high submandibular approach step by step.

CASE SERIES

Between January 2010 and December 2015 at the Maxillofacial Unit of the Hospital "Policlinico San Martino" 13 patients affected by subcondylar fracture underwent open reduction and internal with high submandibular approach. Surgery was uneventful in all patients; no infections occurred in any of the cases; the mean procedure duration was 89 minutes, ranging from 66 to 125 minutes. The mean hospital stay was 2.9 days, ranging from 2 to 6 days. At the 1-year follow-up, all patients had stable occlusion with a natural, well-balanced morphology of the face and adequate dynamic excursion of the mandible.

CONCLUSIONS

The morbidity is negligible in terms of damage to the facial nerve, vascular injuries, and aesthetic deformity. The authors think that further prospective clinical trials are necessary to assess and eventually develop this approach.

Drainless parotidectomy using tissue fibrin sealant - A retrospective case-control study

The aim of this study was to evaluate the impact of drainless parotidectomy using fibrin sealant on length of stay, post-operative seroma and related complications. For this purpose, a retrospective matched case-control series was held in a single academic center. All patients who underwent drainless parotidectomies, including deep lobe tumors and revision surgeries, were compared to matched controls in which a suction drain was inserted. Main outcomes were length of hospital stay and post-operative seroma. A total of 123 patients (41 cases and 82 controls) were included in the study. Fibrin sealant group had higher rates of total parotidectomy compared with the control group (25.0% vs. 10.5%, p = 0.054). Length of stay was significantly shorter in the fibrin sealant group (1.0 ± 0.3 days vs. 1.5 ± 0.6 days, p < 0.001, respectively). No statistically significant difference was found between the fibrin sealant group and the control regarding post-operative seromas (9.8% vs. 14.6%, p = 0.574, respectively), aspirations rate (7.3% vs. 14.6%, p = 0.381), and infection rates (0% vs.3.7%, p = 0.550). In conclusion, drainless parotidectomy does not increase post operative seroma rates and related complications, and can also be implemented for revision surgery.

Modified Blair Approach for the Treatment of Mandibular Condyle Fractures

PURPOSE

The management of fractures of the condyle of the mandible has been a topic of debate and still no consensus exists in the literature about the most appropriate approach. The objective of this study was to evaluate the efficacy and safety of the modified Blair approach for the open reduction and internal fixation of mandibular condyle fractures.

METHODS

A retrospective study was conducted on 18 patients with 20 mandibular condyle fractures from 2014 to 2020. All patients were treated surgically using the modified Blair approach. Postoperative occlusion status and mouth opening were assessed for treatment outcomes. Also, the rate of complications such as facial nerve paralysis, wound infection, hematoma, salivary fistula, Frey syndrome, and greater auricular nerve paraeesthesia evaluated.

RESULTS

Seventeen out of 18 patients (94.4%) achieved their original pretraumatic occlusion after the surgery. One patient (5.5%) had postoperative occlusal interference due to premature dental contact. The maximal postoperative interincisal distance was measured with a range between 33 and 41 mm (mean 37.6 mm). One patient (5.6%) had transient facial nerve palsy. Also, salivary fistula developed in 1 (5.6%) patient in the postoperative period.

CONCLUSION

The results of this study revealed that the modified Blair approach provides satisfactory clinical outcomes with low complication rates and may offer an alternative, safe, and effective method for open reduction and internal fixation of mandibular condyle fracture.

Excising Parotid Benign Mass With a Minimal Incision

We report a case of a 30-year-old man who presented with a one-year history of a right-sided parotid mass that was asymptomatic but slowly increasing in size. On examination, there was a 2 × 2 cm superficial, soft, painless, and mobile mass in the right parotid region. Computed tomography revealed a benign mass in the right parotid tail measuring 2 × 3 cm, and a fine needle aspiration biopsy revealed a Warthin’s tumor. The patient was managed surgically using a new approach that involved complete excision of the mass via minimal cosmetic incision parotidectomy. Parotidectomy was performed using an incision that only involved the pre- and postauricular areas over the sulcus without any extensions, and the operation proceeded smoothly without any complications. The patient was discharged without postoperative complications

Incisions for Parotidectomy: A Narrative Review

ABSTRACT

In the last 2 decades, authors have gained considerable interest in modifying the age-old classical parotidectomy incisions to address cosmetic concerns of their patients. The article reviews all the incisions that have been introduced over time after modified facelift and Blair incision for performing parotidectomy. These include retroauricular hairline approach, Arden technique, trichophytic incision, periauricular incision, intraauricular modification of facelift approach, endaural approach, postaural approach, Panda technique, preauricular crutch approach, and mini Blair incision. Although these have been reported to be safe, feasible, and cosmetically better approaches, at present, the absence of well-designed prospective observational and interventional studies do not warrant them to be widely used in clinical practice. This will guide surgeons in making patient curated parotidectomy incisions under special circumstances. Currently, these remain limited to the hands of experienced surgeons in high volume centers.