Assessment of the observation management of sialocele after partial superficial parotidectomy

PURPOSE

This study aimed to investigate the usefulness of management of sialocele formation and to evaluate the quality of life of patients under elective management post-parotidectomy.

MATERIALS AND METHODS

A prospective study was performed including patients who underwent postoperative management with either compression therapy or observation. The self-filled questionnaire method was used to assess the quality of life of participants who changed from compression therapy to observation. Demographic and operative data, variables regarding wound complications and scores for quality of life were documented and analysed.

RESULTS

A total of 86 patients met the eligibility criteria. The respective rates of sialocele formation within 1 month were 5.3% in the compression therapy group (2/38) and 16.0% in the observation group (4/25), but no significant difference was observed (p = 0.204). Meanwhile, both groups displayed comparable times of needle aspiration and time for sialocele resolution (p > 0.05). Based on 23 valid paired questionnaires, scores for physical and social-emotional function before changing from compression therapy to observation were significantly lower than scores after the change (p < 0.001).

CONCLUSION

The application of observation after partial superficial parotidectomy appears to have acceptable clinical outcomes and considerable improvements in quality of life.

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.

Application analysis of a modified retroauricular hairline incision in the resection of a benign parotid gland tumor

OBJECTIVES

This study aimed to evaluate the application value of a modified retroauricular hairline incision and a sternocleidomastoid flap with an inferior pedicle in the resection of benign parotid gland tumors.

METHODS

Forty-eight patients with benign parotid gland tumors were retrospectively analyzed: 19 cases were included in the experimental group with an improved retroauricular hairline incision and a sternocleidomastoid flap with an inferior pedicle, and 29 cases were assigned in the control group with a modified facelift incision. Operation time, postoperative drainage, postoperative esthetic degree, and incidence of facial nerve paralysis, salivary fistula, and Frey's syndrome were compared.

RESULTS

After the esthetic procedure, the average score of the experimental group was higher than that of the control group, and the esthetic effect of the former was better than that of the latter (P<0.05). The incidence of the operation time, facial nerve paralysis, salivary fistula, and Frey's syndrome of both groups had no statistically significant differences (P>0.05).

CONCLUSIONS

The modified retroauricular hairline incision and sternocleidomastoid flap with an inferior pedicle can be applied to resect benign parotid gland tumors safely. It shows a better cosmetic effect and does not cause obvious postoperative complications. Therefore, it should be promoted for tumor treatments.

Efficacy of modified face lift incision for the resection of benign parotid gland tumor located anteriorly or superiorly

OBJECTIVES

The goals of resection of benign parotid gland tumor are complete resection of lesion and preservation of the facial nerve function. Traditionally, the bayonet-shaped incision (Blair incision: BI) and the modified face lift incision (mFLI) are commonly used for parotidectomy. However, concerns exist about the adequacy of exposure and identification of the facial nerve in anterior or superior parotid lesions. The aim of this study was to compare the surgical outcomes between BI and mFLI and to evaluate the adequacy, possible indications, and limitations of mFLI for the resection of benign parotid gland tumors located anteriorly or superiorly.

METHODS

This retrospective study analyzed the medical records of 175 patients with various types of benign parotid tumor who underwent partial parotidectomy via BI (97 patients) or mFLI (78 patients). Tumors were divided into five categories depending on their location: anterior, superior, inferior, middle, and deep lobe tumors. The outcomes of operation were analyzed according to tumor location between the incision types.

RESULTS

Tumor locations were not significantly different between the two groups. Transient facial palsy occurred in 23 out of 152 patients (15.1%); permanent palsy was not observed in either group. The incidence rates of facial palsy were higher among patients with superior and deep lobe tumors; in the mFLI and BI groups, proportions of superior tumors were 22.2% and 27.2%, respectively, and those of deep lobe tumors were 35.7% and 23.5%, respectively. With regard to superior and anterior tumors, the incidence rate of postoperative facial palsy was insignificantly lower in the mFLI group (10.5%) than in the BI group (18.2%).

CONCLUSIONS

There were no differences in the incidence rates of postoperative facial palsy between mFLI and BI for any tumor location. Use of the mFLI is feasible for the resection of most benign parotid tumors located anteriorly or superiorly.

Individualized Use of Facelift, Retroauricular Hairline, and V-Shaped Incisions for Parotidectomy

PURPOSE

Despite the increased need for better cosmetic outcomes following parotidectomy, there is no study on the individualized use of esthetic approaches for parotidectomy. We aimed to evaluate the feasibility of individualzsed esthetic approaches for parotidectomy using facelift (FL), retroauricular hairline (RAH), and V-shaped incisions, and compare their surgical and cosmetic outcomes.

METHODS

This was a retrospective cohort study. Between 2015 and 2019, we included patients who underwent parotidectomy using FL, RAH, and V-shaped incisions for the treatment of benign parotid tumors. The surgical approach for parotidectomy was determined based on tumor location and each patient's cosmetic demand, following a comprehensive discussion of available esthetic approaches. Surgical and cosmetic outcomes were assessed as primary outcome variables, which were compared among the 3 incision groups. One-way analysis of variance/Kruskal-Wallis test and the chi-squared test were used to inspect differences in continuous and categorical variables, respectively, among the groups.

RESULTS

A total of 213 patients, consisting of 122, 50, and 41 patients in the FL, RAH, and V-shaped groups, respectively, were included in the present study. In the FL, RAH, and V-shaped groups, the patient age was 53.5, 51.8, and 42.1 years, respectively (P < .001), and the tumor size was 2.8, 2.7, and 1.9 cm, respectively (P < .001). All parotidectomies were successfully completed with no incision extension or major complications. The subjective scar satisfaction scores assessed at 3 months postoperatively were 8.5, 9.1, 9.2 in the FL, RAH, and V-shaped groups, respectively (P < .001). However, the Vancouver scar scale was consistent across all groups.

CONCLUSIONS

Individualized use of esthetic approaches for parotidectomy is feasible and yields improved cosmetic results, leading to high patient satisfaction. Although FL incision is still the standard approach for esthetic parotidectomy, both RAH and the V-shaped incisions could further enhance the cosmetic outcomes of parotidectomy.

Endoscopic versus conventional parotid gland excision: a systematic review and meta-analysis

The objective of this review was to conduct a systematic review and meta-analysis to compare endoscopic with conventional parotid tumour excision. Online databases including MEDLINE, EMBASE, EMCare, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), the World Health Organization International Clinical Trials Registry (ICTRP), and the ISRCTN registry were all searched. All randomised controlled trials and observational studies comparing endoscopic with conventional parotid tumour excision were included. Five studies were identified and analysis was reported in forest plots with 95% confidence intervals. Outcomes of interest included operating time, cosmesis, blood loss, facial nerve injury, Frey syndrome, duration of hospital stay, and tumour recurrence. Endoscopic tumour excision had a comparable operating time to conventional resection with an insignificant mean difference (p=0.08). Scar cosmesis in the endoscopic group was superior (mean difference: 2.95, p<0.05) and it also reported a lower volume of blood loss (mean difference: -31.84, p<0.05). No significant difference was found in the incidence of facial nerve injury or Frey syndrome between the two groups, but overall, fewer miscellaneous complications were observed in the endoscopic cohorts. Endoscopic parotid surgery reported a shorter duration of hospital stay, and tumour recurrence was similar in both treatment arms. Endoscopic parotid gland surgery is an effective alternative to conventional approaches with comparable operating times, reduced blood loss and fewer complications, as well as shorter inpatient stay and improved cosmesis. Further studies are, however, required with longer follow-up periods to assess outcomes between different subtypes of parotid tumour.

Review of publications on the possible advantages of a direct cheek incision for accessory parotid gland masses

Lesions of the accessory parotid gland (APG) are rare and surgical management is generally under-discussed. The surgical approach should provide complete resection, while minimising complications and aesthetic complaints. The current study reviews recent publications on the surgical management of APG masses, and discusses the advantages, and limitations of, and our experience with, direct cheek incision. Papers on the surgical management of APG masses published in the last 10 years were systematically searched. Information was obtained regarding the surgical approach, type of excision, and postoperative complications. In the included studies, 253 APG masses were selected for analysis, whereof six were treated with the direct cheek incision. Although no local recurrence or postoperative complications were observed after this, the approach was usually not recommended due to a higher reported risk of recurrence and complications in older papers. More recent studies, however, indicate that the direct cheek incision should be considered as a valuable alternative to standard approaches in selected patients.

Minor Parotidectomy Complications: A Systematic Review

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.

Parotidectomy via Individualized Mini-Blair Incision

BACKGROUND

The modified Blair incision is the standard facial incision for the vast majority of parotid gland lesions. We utilize three types of incisions: "classic mini-Blair" for parotid body tumors, "cervical mini-Blair" for parotid tail tumors, and "vertical mini-Blair" for anterior parotid tumors. In this study, we describe the surgical and esthetic outcomes of these individually tailored incisions.

METHODS

Patients undergoing parotidectomy between 2011 and 2013 were included. The surgical outcomes and patients' satisfaction were assessed.

RESULTS

Of 122 patients, 89 were included. All patients completed a questionnaire assessing the postoperative course and patients' satisfaction regarding the surgery in general and the scar in particular. Among these patients, 78 (87%) had a benign pathology and 11 (13%) had malignant tumors. The tumors were located at the parotid body in 57 patients (64%), at the parotid tail in 19 (21%), at the deep lobe in 8 (9%), and at the anterior parotid gland in 5 (6%). All tumors were removed successfully with negative margins on pathology. No inadvertent permanent facial nerve paralysis occurred. The median operation time was 72 min (23-211). The average patient scores of satisfaction with the surgical scar and with the surgery were 9.54 and 9.72, respectively.

CONCLUSIONS

Individualized mini-Blair incision is feasible for benign as well as selected malignant parotid tumors.

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.

Use of the facelift incision for excision of non-tuberculous mycobacterial lymphadenitis in children

OBJECTIVES

To present cases of pediatric periparotid nontuberculous mycobacterial lymphadenitis excised through a facelift incision in order to review the advantages of this approach to parotidectomy. We also aim to discuss scenarios in which to forgo the facelift incision in favor of a traditional modified Blair incision.

METHODS

Retrospective series of seven consecutive patients who underwent parotidectomy for nontuberculous mycobacterial lymphadenitis between 2013 and 2018.

RESULTS

The series included three uses of the facelift incision and four uses of the modified Blair incision, which was specifically selected for cases of bulky lymphadenopathy anterior to the masseter muscle. All cases of Modified Blair incision involved circumferential dissection of the marginal mandibular branch of the facial nerve. The facelift incision permitted complete removal of disease in cases located posterior to the masseter as well as neck dissection as inferiorly as level III. Post-operatively, temporary marginal mandibular nerve weakness was seen in all cases of Modified Blair incision. Scar widening was most notable in patients who required skin excision or dermal curettage.

CONCLUSION

The facelift incision offers a more hidden scar. This may serve as an alternative approach to parotid surgery in young children with nontuberculous mycobacterial lymphadenitis, except in cases of bulky disease anterior to the masseter muscle for which optimal exposure of the marginal mandibular nerve via a modified Blair incision is warranted.

Variation of the Great Auricular Nerve and Prediction of the Facial Nerve Trunk Size

Supplemental Digital Content is available in the text.

Background:

This study aimed to reveal the anatomical variation in the great auricular nerve (GAN) and the correlation between the size of the GAN and the facial nerve trunk (FNT), so as to aid surgeons to perform safe facelift surgery and parotidectomy.

Methods:

Sixteen human cadavers were studied on 16 left and 15 right facial sides. The GAN’s branching patterns, location, and the mean width of the GAN and FNT were measured.

Results:

The average distance where the nerve emerged from under the sternocleidomastoid muscle was 87.61 ± 12.13 mm when measured perpendicular to the Frankfort horizontal plane. The branching pattern of the GAN could be classified into 5 types of which the most common was type 3 (30.77%), where the GAN divided into the anterior (superficial) and posterior branches, and then the deep branch originated from the posterior branch of the GAN. The mean width of the GAN and FNT from all the dissections was 3.26 ± 0.67 mm and 3.36 ± 0.71 mm, respectively. There was a significant correlation between the width of the nerves on both facial sides (right: r =0.740, P =0.002; left: r = 0.839, P < 0.001).

Conclusions:

This study revealed the anatomical variation and the width of the GAN, which can strongly predict the width of the FNT. This should be taken into consideration during facelift surgery and parotidectomy, especially in patients with a small GAN to prevent iatrogenic injury to the small FNT.

Robot-assisted submandibular gland excision via modified facelift incision

Background

The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome.

Case presentation

The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar curved scissors and Maryland bipolar forceps) successfully in a 44-year-old female patient who suffered from sialolith and severe atrophic submandibular gland.

Conclusions

If similar studies are done in the future, this robot-assisted sialadenectomy may become established as an alternative to existing disadvantageous surgical methods.

Robot-Assisted Neck Dissection Through a Modified Facelift Incision

Objectives:

The aim of this study is to describe the feasibility as well as oncologic outcomes of robot-assisted neck dissection (RAND) through a modified facelift incision in an American population.

Study Design:

Retrospective case series.

Setting:

University tertiary care hospital.

Methods:

All patients who underwent RAND between November 2012 and December 2014 were included. Medical records were reviewed for demographics, medical histories, staging, operative information, postoperative hospital course and complications, and oncologic outcomes.

Results:

There were 11 RANDs identified among 10 patients. Five patients had known nodal metastasis at the time of surgery. Two patients had been previously irradiated. The average time of surgery was 284.4 ± 72.3 minutes, including other associated procedures. The average lymph node yield was 28.5 ± 9.3 nodes. There were no major complications. Average follow-up was 19.4 months. There was 1 supraclavicular recurrence in a previously irradiated patient. All patients are currently alive and without evidence of disease.

Conclusions:

Robot-assisted neck dissection is a safe and feasible procedure that can be performed by surgeons with familiarity with neck dissection and robot-assisted surgery and who have been trained in RAND. Appropriate oncologic outcomes can be obtained in a patient wishing to avoid a noticeable scar.

Component approach to the temporomandibular joint and coronoid process

Reconstruction of the temporomandibular joint (TMJ) region is challenging. The conventional direct preauricular incision permits only limited access to the TMJ and surrounding structures, therefore risking injury to the facial nerve during retraction. The ideal approach allows sufficient exposure, preservation of underlying neurovascular structures, and achieves an optimal aesthetic outcome. We describe a preauricular posttragal incision with a superficial musculoaponeurotic system flap to allow wide exposure of the zygomatic arch, TMJ, condyle, and coronoid process. We postulate that this approach improves access, lessens the amount of retraction required, and creates a more inconspicuous scar.

Salivary gland pathology in the paediatric population: implications for management and presentation of a rare case

INTRODUCTION

Salivary gland pathology in the paediatric population is rare and can present management challenges regarding both investigation and treatment.

METHOD

Case report and review of available literature.

RESULTS

A seven-year-old, fit, well girl presented with a two-month history of a painless mass over the left parotid area. Ultrasonography confirmed the presence of a well-defined, 1.5 × 2 cm, predominantly solid lesion with minor internal cystic spaces arising from the superficial part of the gland. Magnetic resonance imaging showed no invasion of the deep lobe or skeletal erosion. Superficial parotidectomy was performed via a facelift incision. Histopathology confirmed a diagnosis of pleomorphic adenoma. Review of the literature emphasised important differences in managing this pathology in the paediatric population when compared with adults.

CONCLUSION

We present the youngest reported case of a pleomorphic adenoma of the parotid gland, detail its management, and discuss the general approach to parotid pathology management in the paediatric population.

Cervicomastoidfacial versus modified rhytidectomy incision for benign parotid tumors

The modified rhytidectomy incision is an alternative to the classic cervicomastoidfacial approach for parotid surgery, camouflaging the scar in barely visible areas, resulting in better cosmesis. However, there are very few studies comparing the incidence of complications and functional results of patients submitted to parotidectomy through these two different approaches.

Objective

Compare the incidence of complications and functional results of patients with benign parotid neoplasms submitted to surgery through the classical incision versus the modified rhytidectomy approach.

Method

Retrospective cohort study evaluating the demographics, surgical and post-operative characteristics of an equally distributed group of sixty patients submitted to parotidectomy via cervicomastoidfacial incision or modified rhytidectomy approach.

Results

There were no significant differences in complications rates and functional results between the groups, except for a lower incidence of early facial movement dysfunction for the modified rhytidectomy approach - which was 86% lower in this group of patients.

Conclusion

Modified rhytidectomy incision has shown comparable complication rates to those of the classic approach and a lower incidence of immediate facial movement impairment.

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 surgery for benign tumours

PURPOSE

The majority of parotid tumours are benign, making parotid surgery a compromise between adequate tumour excision and preservation of function and facial harmony. Besides the traditional superficial or total parotidectomy, less invasive techniques have been described with similar recurrent rates. The aim of this review is to assess the evidence in the published literature and to summarise the advantages and disadvantages of the available techniques.

METHODS

A systematic search in Pubmed for studies on surgery of benign parotid tumours (BPTs) published between January 2000 and January 2012 was conducted. Case series with a clear description of the surgical technique and a minimum number of 10 patients were included.

RESULTS

Four hundred sixty-three articles were found, 49 abstracts reviewed and 37 case series were selected for this review. The surgical techniques for benign parotid tumours can largely be grouped into facial nerve dissecting (superficial parotidectomy, partial superficial parotidectomy and total parotidectomy) and non-nerve dissecting techniques (extracapsular dissection). With all of the currently used techniques, a low recurrence (<3 %) with a low incidence of permanent facial nerve morbidity (0.2-4 %) can be achieved. The tumour-facial nerve interface and pseudopodia are areas at risk for positive margins.

CONCLUSION

There is currently no agreement in the literature about the extent of surgery for BPTs to obtain an adequate margin. The tumour nerve interface is the predetermined area at risk for tumour spillage and positive margin. A prolonged follow-up is recommended. Further long-term randomised clinical trials are required to address the question of the extent of the excision in benign parotid surgery.

Parotidectomy by Periauricular Incision

Objective. According to the literature, periauricular combined with submandibular or cervical incision is used in nearly every parotidectomy. The aim of this study was to present the results of the use of only periauricular incision in parotid surgical procedures.

Design. A case series with planned data collection.

Setting. Patients of the author were operated on at the Hospital Santa Casa de Misericórdia de Belo Horizonte, Brazil.

Subjects and Methods. Forty-one consecutive partial or total parotidectomies (27 cases of pleomorphic adenoma, 9 of other benign tumors, 3 of parotid cysts, and 2 of chronic parotiditis) were performed using only periauricular incision.

Results. The parotid tumors were removed in all cases with no need for any further skin procedures, as the incisions produced a good aesthetic result. All patients presented temporary hypoesthesia in the area that had been operated on for no more than 6 months. Ear discomfort was reported by 18 patients for a short period of time. Local infection occurred in 1 case successfully treated with systemic antibiotics.

Conclusion. The results of the present study indicate that periauricular incision is a high-quality and highly aesthetic option for surgical procedures concerning benign conditions of the parotid gland.