Drain fluid amylase as a predictor of postoperative salivary fistula in cases with benign parotid tumours

Clinical and patient-reported outcomes between full-endoscopic and conventional parotidectomy: a prospective cohort study

OBJECTIVES

This study investigates the clinical and patient-reported outcomes of full-endoscopic parotidectomy compared to the conventional approach.

METHODS

Between July 2021 and December 2023, patients who underwent parotidectomy were prospectively enrolled and assigned to either the full-endoscopic parotidectomy group (Group I) or the conventional surgery group (Group II). Clinical outcomes were evaluated, and patient-reported outcomes were assessed using a Visual Analogue Scale and five FACE-Q scales.

RESULTS

A total of 293 patients were prospectively included, with 146 in the full-endoscopic group and 147 in the conventional group. Blood loss was significantly lower in the full-endoscopic group (regression coefficient, 0.61; 95% CI, 0.15 to 1.07), as was the rate of immediate facial paralysis (0.76; 95% CI, 0.25 to 1.27). The full-endoscopic group also showed superior outcomes on the Visual Analogue Scale (- 0.14; 95% CI, - 0.23 to - 0.05) and FACE-Q scales for Appearance-Related Psychosocial Distress (1.15; 95% CI, 0.59 to 1.71), Social Function (- 0.37; 95% CI, - 0.59 to - 0.15), Satisfaction with Facial Appearance (- 0.44; 95% CI, - 0.64 to - 0.23), Psychological Function (- 0.39; 95% CI, - 0.58 to - 0.20), and Satisfaction With Outcome (- 0.42; 95% CI, - 0.66 to - 0.19).

CONCLUSIONS

Full-endoscopic parotidectomy yields less blood loss and a reduced incidence of immediate facial paralysis compared to conventional surgery. Patients undergoing full-endoscopic parotidectomy reported better aesthetic and psychological outcomes.

CLINICAL RELEVANCE

The combined analysis of clinical and patient-reported outcomes is valuable in guiding surgical planning. These findings provide valuable insights for patients considering full-endoscopic parotidectomy and underscore the importance of addressing functional, aesthetic, and psychological aspects for both patients and healthcare providers.

Parotideomasseteric fascia flap is an effective management for prevention of postoperative salivary collection arising from radical surgery of oral cancer

Salivary collection (SC) following surgery for oral cancer represents an underreported and unrecognized complication. Our study aimed to evaluate the efficacy of parotideomasseteric fascia flap (PFF) in preventing postoperative SC, comparing its effectiveness with other conventional methods. Between November 2019 and January 2023, 221 patients diagnosed with oral squamous cell carcinoma (OSCC) undergoing wide tumor ablation and neck dissection at Xiangya Hospital were included in the study. Patients were randomly allocated into four groups based on different intraoperative techniques to assess the preventive efficacy of PFF against SC. The incidence of SC in the PFF group was only 5.9%, which was significantly lower than the other three groups (p < 0.05). Among the 221 patients, the highest SC incidence occurred in buccal cancer cases (19.6%). However, in the PFF group, the incidence was not significantly different (9.5%; p > 0.05). Univariate analysis revealed a higher SC incidence associated with advanced clinical T stage (p = 0.02), N(+) stage (p = 0.01), low average serum albumin (SA) level (p = 0.00), and a large parotid wound (p = 0.00). In multivariate analysis, only average SA (p = 0.01; odds ratio [OR] 4.104; 95% CI 0.921-11.746) emerged as the most prevalent factor predisposing to SC. The utilization of PFF demonstrated a notable reduction in the incidence of postoperative SC, establishing it as a safe, effective, and convenient method for patients undergoing radical ablation for OSCC.

The use of bipolar coagulation forceps prevented salivary fistula in patients with parotidectomy: a retrospective study

Background

Salivary fistula is a relatively common complication in patients who have undergone a parotidectomy. The purpose of this study was to investigate the effects of bipolar coagulation forceps use on salivary fistulas.

Methods

From March 2015 to June 2020, 177 patients who underwent a parotidectomy in the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital of Central South University were recruited. The patients were divided into an experimental group and a control group based on whether bipolar coagulation forceps or sutures were used, respectively.

Results

The drainage output of the experimental group was significantly lower than that of the control group (p = 0.04). The duration of dressing pressure applied in the experimental group was significantly shorter than that in the control group (p = 0.0003). Moreover, the incidence of salivary fistula in the experimental group (9.8%, 8/82) was notably lower than that in the control group (34.7%, 33/95) (p < 0.0001). In the logistic regression model for salivary fistula development, both the use of bipolar coagulation forceps (p = 0.0021) and drainage output (p = 0.0237) were associated with the presence of salivary fistulas.

Conclusions

Our findings indicate that the use of bipolar coagulation forceps decreases the incidence of salivary fistula in patients who have undergone a parotidectomy. The use of bipolar coagulation forceps is a safe, effective, and convenient method to prevent salivary fistulas in patients who undergo a parotidectomy.

Trial registration: Current Controlled Trials ChiCTR2100044722, Date: 26/03/2021, Retrospectively registered.