1
|
Roh JL. Feasibility and safety of preauricular incision for extracapsular dissection in benign parotid tumors. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-09002-3. [PMID: 39356358 DOI: 10.1007/s00405-024-09002-3] [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: 05/30/2024] [Accepted: 09/20/2024] [Indexed: 10/03/2024]
Abstract
PURPOSE Parotidectomy techniques continuously evolve to improve outcomes while minimizing morbidity. This study investigates the rationale behind developing and evaluating the feasibility and safety of extracapsular dissection (ECD) via preauricular incision for benign parotid tumors in the anterior or superior part of the parotid gland. METHODS The preauricular approach is developed to address the increasing demand for minimally invasive techniques that prioritize both functional and aesthetic outcomes. Minimizing visible scarring and preserving facial nerve function offers a compelling solution for patients seeking optimal cosmetic results without compromising surgical efficacy. Patient assessments included cosmetic contentment, functional repercussions, and disease management throughout the follow-up. RESULTS Eight patients underwent ECD via the preauricular approach, demonstrating favorable outcomes with preserved facial nerve function and minimal complications. CONCLUSION This study highlights the potential of the preauricular approach as a preferred option for managing benign parotid tumors in the anterior or superior parotid region, emphasizing aesthetic outcomes and preserving gland function. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, 13496, Gyeonggi-do, Republic of Korea.
- Department of Biomedical Science, General Graduate School, CHA University, Pocheon, Republic of Korea.
| |
Collapse
|
2
|
Ghenni S, Del Grande J, Gravier Dumonceau R, Haddad R, Giorgi R, Michel J, Fernandez R, Fakhry N. Parotid cancer: analysis of preoperative parameters for adaptation of the therapeutic strategy. Eur Arch Otorhinolaryngol 2024; 281:3207-3218. [PMID: 38568298 DOI: 10.1007/s00405-024-08607-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/06/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To establish typical clinical and radiological profiles of primary low-grade parotid cancers in order to tailor therapeutic strategy. MATERIALS AND METHODS Retrospective study of 57 patients operated on for primary parotid cancer between 2010 and 2021, with review of preoperative MRI and histopathology according to a standardized scoring grid. OBJECTIVE To study prognostic factors and determine the preoperative clinical and radiological profile of low-grade cancers. RESULTS Good prognostic factors for specific survival were: staging ≤ cT3 (p = 0.014), absence of adenopathy on cN0 MRI (p < 0.001), superficial lobe location (p = 0.033), pN0 (p < 0.001), absence of capsular rupture (p = 0.004), as well as the absence of peri-tumoral nodules (p = 0.033), intra-parotid adenopathies (p < 0.001), vascular emboli (p < 0.001), peri-neural sheathing (p = 0.016), nuclear atypia (p = 0.031), and necrosis (p = 0.002). It was not possible to define a reliable clinical and radiological profile for low-grade cancers (sensitivity 38%, specificity 79%). CONCLUSION Our study demonstrated multiple factors of good prognosis, but it was not possible to define a clinical and radiological profile of patients likely to benefit from more limited surgery, nor to diagnose, a priori, low-grade cancers.
Collapse
Affiliation(s)
- Samia Ghenni
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, LPL, Marseille, France.
| | - Jean Del Grande
- Department of Anatomopathology, Centre Hospitalier Universitaire (CHU) la Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Aix Marseille Univ, Marseille, France
| | - Robinson Gravier Dumonceau
- APHM, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Aix Marseille Univ, Marseille, France
| | - Ralph Haddad
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, LPL, Marseille, France
| | - Roch Giorgi
- APHM, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Aix Marseille Univ, Marseille, France
| | - Justin Michel
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, LPL, Marseille, France
- APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS Department, Aix Marseille Univ, Marseille, France
| | - Rémi Fernandez
- Department of Radiology, Centre Hospitalier Universitaire (CHU) la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Aix Marseille Univ, Marseille, France
| | - Nicolas Fakhry
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, LPL, Marseille, France.
| |
Collapse
|
3
|
Ali HM, Keaton AB, Rourk K, Lohse C, Tasche KK, Price DL, Van Abel KM, Yin LX, Moore EJ. Partial superficial parotidectomy for pleomorphic adenoma of the parotid gland: Early post-operative outcomes. Am J Otolaryngol 2024; 45:104185. [PMID: 38104469 DOI: 10.1016/j.amjoto.2023.104185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION There has been historical controversy regarding the extent of resection in the management of pleomorphic adenomas. This study aims to evaluate the extent of surgery and short-term postoperative outcomes of partial superficial parotidectomy (PSP) for the management of pleomorphic adenomas at a tertiary, high-volume center. METHODS A retrospective chart review of patients who underwent PSP was performed. Variables included demographics, pre-operative facial nerve function, operative techniques, postoperative complications/facial nerve function, and recurrence. RESULTS 151 adults who underwent PSP for pleomorphic adenoma from January 1st, 2000 to December 31st, 2022 were identified. Median age was 55 (IQR 40-66) years with females representing 74 % of the cohort. Median tumor size at presentation was 1.8 (IQR 1.3-2.3) cm. Baseline facial nerve function was excellent for most patients (House-Brackmann I, 99 %). Most patients underwent a superficial inferior parotidectomy (88 %). Modified Blair incision (70 %) was the most common incision. Intraoperatively, the facial nerve was identified in 149 (99 %) patients. The main trunk was identified in 126 (85 %) patients. No patient had tumor spillage. Only two patients required parotid bed reconstruction. The most common complication was ear numbness (60 %). Postoperatively, 114 patients were House-Brackmann grade I at both preoperative and postoperative assessment, 8 went from grade I to II, and 1 went from grade VI to II (Bell's palsy that resolved to grade II following surgery). Median follow-up was 1(IQR 1-5) month. CONCLUSION PSP is efficacious in the management of pleomorphic adenomas with preservation of facial nerve function, and minimal post-operative complications. Future study is needed to assess long term recurrence risk.
Collapse
Affiliation(s)
- Hawa M Ali
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Aniya B Keaton
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States; University of Tennessee, Knoxville, TN, United States
| | - Katelyn Rourk
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
| | - Christine Lohse
- Department of Quantitative Health Sciences, Rochester, MN, United States
| | - Kendall K Tasche
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Daniel L Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Kathryn M Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Linda X Yin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States.
| |
Collapse
|
4
|
Hughes E, Velazquez-Castro OS, Cates D, Squires L. Introducing Sialendoscopy in a Veteran Population: Effect on Benign Salivary Disease Treatment. Am J Otolaryngol 2024; 45:104189. [PMID: 38142609 DOI: 10.1016/j.amjoto.2023.104189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/09/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE To compare rates of sialadenectomy in a veteran population before and after introduction of sialendoscopy. MATERIALS AND METHODS All Veterans Affair (VA) Northern California Healthcare System (NCHS) encounters from 2006 to 2021 for benign obstructive salivary etiologies were identified using International Classification of Disease 9/10 codes. This cohort was then cross referenced with Current Procedural Terminology codes to identify patients who underwent a procedure for their salivary pathologies. The rates of sialadenectomy and minimally invasive procedures were measured before and after sialendoscopy was introduced to the VA NCHCS in 2016. Data was obtained via chart review and demographic information, diagnosis, and procedure type were extracted. Rates of sialadenectomy, minimally invasive procedures, and other patient and procedural characteristics were compared between the Pre-Sialendoscopy Era (PSE) and Sialendoscopy Era (SE). Statistical analysis was performed using Microsoft Excel (Microsoft, version 16.66). RESULTS An increasing number of patients per year sought care for benign obstructive salivary pathology in the SE when compared to the PSE cohort and a higher rate of female patients were treated in the SE cohort. A simultaneous reduction in sialadenectomy rates and increase in minimally invasive procedure rates was observed in the SE. Sialendoscopy represented most of the increase in minimally invasive techniques, but there was a slight increase in other procedure types. Submandibular gland obstructive pathologies required the most procedures and resulted in the most gland excisions. CONCLUSION This retrospective review strongly suggests introducing sialendoscopy reduced the incidence of sialadenectomy for benign non-tumor obstructive pathology in this VA NCHS population. Further prospective studies are needed to evaluate this in a more generalized setting.
Collapse
Affiliation(s)
- Emelia Hughes
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, United States of America.
| | - Oscar Santiago Velazquez-Castro
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, United States of America
| | - Daniel Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, United States of America; Veterans Affairs Northern California Healthcare System, Sacramento, CA 95655, United States of America
| | - Lane Squires
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, United States of America; Veterans Affairs Northern California Healthcare System, Sacramento, CA 95655, United States of America
| |
Collapse
|
5
|
Roh JL. Gland preservation with postauricular sulcus approach for benign parotid tumors. J Plast Reconstr Aesthet Surg 2024; 89:33-39. [PMID: 38128372 DOI: 10.1016/j.bjps.2023.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/09/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Gland-preserving surgery has gained popularity for treating benign parotid tumors, offering potential benefits by preserving facial nerve function and salivary secretion while reducing complications. This study aims to evaluate the functional, cosmetic, and disease control outcomes of gland-preserving surgery via a postauricular sulcus incision. METHODS An observational longitudinal investigation encompassed 46 patients undergoing gland-preserving surgery for benign parotid tumors via the postauricular sulcus incision approach. Patient assessments included cosmetic contentment, functional repercussions, and disease management throughout the follow-up. RESULTS Predominantly, tumors were situated in the superficial lobe, with successful application observed in 8 instances (17%) within the deep lobe. Notably, no tumor recurrences were detected during the follow-up period. Postoperative pain remained minimal, accentuated by high patient satisfaction regarding the incision scar and facial symmetry. Furthermore, preservation of facial nerve functionality and salivary secretion was observed. CONCLUSION Gland-preserving surgery via the postauricular sulcus incision technique exemplifies advantageous functional and cosmetic outcomes when addressing benign parotid tumors. This approach presents a secure and efficient alternative, facilitating effective local management.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Biomedical Science, General Graduate School, CHA University, Seongnam, Republic of Korea.
| |
Collapse
|
6
|
Han SH, Lee J, Kang JW, Kim H, Lee DJ, Kim JH, Park IS. Comparison of Partial Versus Superficial or Total Parotidectomy for Superficial T1-2 Primary Parotid Cancers. Clin Exp Otorhinolaryngol 2024; 17:78-84. [PMID: 38228134 PMCID: PMC10933808 DOI: 10.21053/ceo.2023.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/10/2023] [Accepted: 12/24/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVES This study aimed to compare the oncological outcomes of partial versus superficial or total parotidectomy for superficial T1 or T2 primary parotid cancers and investigate their prognostic factors and recurrence patterns. METHODS The medical records of 77 patients with T1-2 primary parotid malignancies between May 2003 and March 2022 were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the prognostic factors associated with overall survival, disease-free survival, and local and distant recurrence. RESULTS The average follow-up duration was 70.2 months (range, 12-202 months). The 5-year overall and disease-free survival rates were 88.7% and 77.1%, respectively. Twenty-two patients underwent partial parotidectomy, and 55 underwent superficial or total parotidectomy. There were no significant differences in the disease recurrence (P=0.320) and mortality rates (P=0.884) of the partial and superficial or total parotidectomy groups. The mean duration of surgery was shorter and the overall complication rates were significantly lower in the partial group than in the superficial or total parotidectomy group (P=0.049). Sixteen cases of recurrence occurred during the study period (20.8%). Univariate analyses showed that high-grade tumors (P=0.006), lymphovascular invasion (P=0.046), and regional lymph node metastasis (P=0.010) were significant risk factors for disease recurrence. Multivariate analysis identified regional lymph node metastasis as an independent prognostic factor for disease recurrence (P=0.027), and lymphovascular invasion as an independent prognostic factor for overall survival (P=0.033). CONCLUSION The conservative surgical approach of partial parotidectomy can yield oncological outcomes comparable to those of superficial or total parotidectomy with careful patient selection in T1-2 parotid cancers.
Collapse
Affiliation(s)
- Seung Hoon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jihae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jeong Wook Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Dong Jin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin Hwan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| |
Collapse
|
7
|
Roh JL. Extracapsular dissection versus total excision for benign submandibular gland tumors. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107928. [PMID: 38157650 DOI: 10.1016/j.ejso.2023.107928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/24/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Benign submandibular gland tumors pose challenges in balancing treatment effectiveness and preserving gland function. This study aimed to compare gland-preserving surgery, extracapsular dissection (ECD), with total excision in managing these tumors, focusing on function preservation and recurrence rate. METHODS Fifty consecutive patients with treatment-naïve benign submandibular gland tumors were alternatively allocated to receive ECD (n = 25) or total excision (n = 25) without randomization procedures. Intraoperative findings, postsurgical complications, subjective satisfaction, and gland function were assessed. Follow-up data were collected for a median duration of 55 months (24-80 months) to monitor recurrences. RESULTS ECD demonstrated significant advantages, including shorter operation time, reduced bleeding, and preservation of the facial artery and vein (P < 0.05). Both groups exhibited acceptable postsurgical pain and taste sensations. Complications were minimal and similar between the two groups. ECD resulted in superior facial contour satisfaction (P = 0.030) and preserved gland function, as evidenced by salivary scintigraphy. No recurrences were observed in either group during the follow-up period. CONCLUSIONS ECD is a practical approach for benign submandibular gland tumors, offering favorable functional outcomes, reduced surgical morbidity, shorter operation times, and improved cosmetic results.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Biomedical Science, General Graduate School, CHA University, Pocheon, Republic of Korea.
| |
Collapse
|
8
|
Roh JL. Extracapsular dissection via single cervical incision for parotid pleomorphic adenoma. Clin Oral Investig 2023; 28:40. [PMID: 38151592 DOI: 10.1007/s00784-023-05420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/21/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Surgical management of parotid pleomorphic adenoma ranges from total parotidectomy to extracapsular dissection (ECD). Minimalistic techniques aim to preserve function and minimize the rate of recurrence. This study assesses functional, aesthetic, and disease control outcomes post-ECD through a sole transverse cervical incision for parotid pleomorphic adenoma. MATERIALS AND METHODS This longitudinal analysis enrolled 36 consecutive patients with pleomorphic adenoma who underwent ECD via a single cervical incision. Complications, satisfaction, salivary function, and tumor recurrence were evaluated. Salivary gland function was assessed using scintigraphy at 6 months post-surgery. RESULTS Tumors occurred in superficial (83%) or deep (17%) parotid inferior parts according to the European Salivary Gland Society level classification. The median tumor size was 2.8 cm (1.8-6.0 cm); the median operation time was 42 min (30-65 min). No tumor spillage or facial nerve injuries occurred. Facial nerve paralysis was only temporary in two (6%) patients, with minimal other complications. Operated parotid gland function matched the unoperated side. No recurrence was found during the median follow-up of 44 months (24-60 months). CONCLUSIONS ECD via a single transverse cervical incision is a safe approach for benign parotid tumors, yielding excellent functional and disease control outcomes. CLINICAL RELEVANCE These findings can provide clinically meaningful minimally invasive recommendations to treat pleomorphic adenoma with minimal complications.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, 13496, Republic of Korea.
- Department of Biomedical Science, General Graduate School, CHA University, Seongnam, Republic of Korea.
| |
Collapse
|
9
|
Liu HT, Jiang WP, Xia G, Liao JM. Evaluation of the effectiveness of superficial parotidectomy and partial superficial parotidectomy for benign parotid tumours: a meta-analysis. J Otolaryngol Head Neck Surg 2023; 52:86. [PMID: 38135871 PMCID: PMC10740346 DOI: 10.1186/s40463-023-00679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/06/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To quantify the results of superficial parotidectomy (SP) and partial SP (PSP) for benign parotid tumours using a systematic evaluation method. METHODS A systematic search of English and Chinese databases (PubMed, Web of Science, Cochrane Library, China Knowledge Network, Wanfang and Vipshop) was conducted to include studies comparing the treatment outcomes of SP with PSP. RESULTS Twenty-three qualified, high-quality studies involving 2844 patients were included in this study. The results of this study showed that compared to the SP surgical approach, the PSP surgical approach reduced the occurrence of temporary facial palsy (OR = 0.33; 95% confidence interval [CI] 0.26-0.41), permanent facial palsy (OR = 0.28; 95% CI 0.16-0.52) and Frey syndrome (OR = 0.36; 95% CI 0.23-0.56) in patients after surgery, and the surgery operative time was reduced by approximately 27.35 min (95% CI - 39.66, - 15.04). However, the effects of PSP versus SP on salivary fistula (OR = 0.70; 95% CI 0.40-1.24), sialocele (OR = 1.48; 95% CI 0.78-2.83), haematoma (OR = 0.34; 95% CI 0.11-1.01) and tumour recurrence rate (OR = 1.41; 95% CI 0.48-4.20) were not statistically significant. CONCLUSION Compared with SP, PSP has a lower postoperative complication rate and significantly shorter operative time, suggesting that it could be used as an alternative to SP in the treatment of benign parotid tumours with the right indications.
Collapse
Affiliation(s)
- Hai-Tao Liu
- Department of Oral and Maxillofacial Surgery, First People's Hospital of Jiujiang City, No.48 of Taling South Street, Jiujiang, 332000, Jiangxi, China
| | - Wei-Peng Jiang
- Department of Oral and Maxillofacial Surgery, First People's Hospital of Jiujiang City, No.48 of Taling South Street, Jiujiang, 332000, Jiangxi, China.
| | - Gang Xia
- Department of Oral and Maxillofacial Surgery, First People's Hospital of Jiujiang City, No.48 of Taling South Street, Jiujiang, 332000, Jiangxi, China
| | - Jia-Min Liao
- Department of Oral and Maxillofacial Surgery, First People's Hospital of Jiujiang City, No.48 of Taling South Street, Jiujiang, 332000, Jiangxi, China
| |
Collapse
|
10
|
Zhu R, Gong Z, Dai Y, Shen W, Zhu H. A novel postoperative nomogram and risk classification system for individualized estimation of survival among patients with parotid gland carcinoma after surgery. J Cancer Res Clin Oncol 2023; 149:15127-15141. [PMID: 37633867 DOI: 10.1007/s00432-023-05303-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Parotid gland carcinoma (PGC) is a rare but aggressive head and neck cancer, and the prognostic model associated with survival after surgical resection has not yet been established. This study aimed to construct a novel postoperative nomogram and risk classification system for the individualized prediction of overall survival (OS) among patients with resected PGC. METHODS Patients with PGC who underwent surgery between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were randomized into training and validation cohorts (7:3). A nomogram developed using independent prognostic factors based on the results of the multivariate Cox regression analysis. Harrell's concordance index (C-index), time-dependent area under the curve (AUC), and calibration plots were used to validate the performance of the nomogram. Moreover, decision curve analysis (DCA) was performed to compare the clinical use of the nomogram with that of traditional TNM staging. RESULTS In this study, 5077 patients who underwent surgery for PGC were included. Age, sex, marital status, tumor grade, histology, TNM stage, surgery type, radiotherapy, and chemotherapy were independent prognostic factors. Based on these independent factors, a postoperative nomogram was developed. The C-index of the proposed nomogram was 0.807 (95% confidence interval 0.797-0.817). Meanwhile, the time-dependent AUC (> 0.8) indicated that the nomogram had a satisfactory discriminative ability. The calibration curves showed good concordance between the predicted and actual probabilities of OS, and DCA curves indicated that the nomogram had a better clinical application value than the traditional TNM staging. Moreover, a risk classification system was built that could perfectly classify patients with PGC into three risk groups. CONCLUSIONS This study constructed a novel postoperative nomogram and corresponding risk classification system to predict the OS of patients with PGC after surgery. These tools can be used to stratify patients with high or low risk of mortality and provide high-risk patients with more directed therapies and closer follow-up.
Collapse
Affiliation(s)
- Runqiu Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, 310058, People's Republic of China
| | - Zhiyuan Gong
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, 310058, People's Republic of China
| | - Yuwei Dai
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, 310058, People's Republic of China
| | - Wenyi Shen
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, 310058, People's Republic of China
| | - Huiyong Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China.
| |
Collapse
|
11
|
Wallerius KP, Xie KZ, Lu LY, Lohse CM, Yin LX, Price DL, Van Abel KM, Moore EJ. Selective Deep Lobe Parotidectomy vs Total Parotidectomy for Patients With Benign Deep Lobe Parotid Tumors. JAMA Otolaryngol Head Neck Surg 2023; 149:1003-1010. [PMID: 37768672 PMCID: PMC10540055 DOI: 10.1001/jamaoto.2023.2981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/06/2023] [Indexed: 09/29/2023]
Abstract
Importance Limited literature exists on surgical outcomes after selective deep lobe parotidectomy (SDLP) with preservation of superficial lobe for patients with benign deep lobe tumors. Objective To compare the following factors for SDLP vs total parotidectomy for patients with benign tumors in the deep lobe: postoperative complications, including facial nerve paresis or paralysis, Frey syndrome, first bite syndrome, cosmetic defect, sialocele formation, and wound infection; and tumor control and recurrence. Design, Setting, and Participants This case series included 273 adults who underwent SDLP (n = 177) or total parotidectomy (n = 96) at a single tertiary care institution for benign parotid tumors located in the deep lobe or deep lobe and parapharynx from January 1, 2000, to December 31, 2020. Exposure Selective deep lobe parotidectomy vs total parotidectomy. Main Outcomes and Measures Incidence of postoperative complications and tumor recurrence. Results Among 273 patients (SDLP, 177 [65%]; 122 women [69%]; median age at surgery, 58 years [IQR, 46-67 years]; total parotidectomy, 96 [35%]; 57 women [59%]; median age at surgery, 59 years [IQR, 40-68 years]), the most common tumor was pleomorphic adenoma (SDLP, 128 of 177 [72%]; total parotidectomy, 62 of 96 [65%]). An abdominal dermal fat graft was less commonly performed for patients who underwent SDLP than those who underwent total parotidectomy (2 of 177 [1%] vs 20 of 96 [21%]; difference, -20% [95% CI, -28% to -11%]). The rate of great auricular nerve preservation was higher in the SDLP group than in the total parotidectomy group (84 of 102 [82%] vs 20 of 34 [59%]; difference, 24% [95% CI, 5%-42%]). No meaningful difference in length of hospital stay was found. The percentage of patients with House-Brackmann grade I immediately after surgery was 48% (85 of 177) in the SDLP group and 21% (20 of 96) in the total parotidectomy group (difference, 28% [95% CI, 16%-40%]). There were no clinically meaningful differences in rates of hematoma, sialocele, seroma, ear numbness, wound infection, or unplanned return to emergency department or operating room. The SDLP group reported a lower rate of Frey syndrome than the total parotidectomy group (1 of 137 [1%] vs 12 of 78 [15%]; difference, -15% [95% CI, -23% to -7%]), as well as a lower rate of facial contour defect (28 of 162 [17%] vs 25 of 84 [30%]; difference, -13% [95% CI, -24% to -1%]) and a higher rate of first bite syndrome (34 of 148 [23%] vs 7 of 78 [9%]; difference, 14% [95% CI, 5%-23%]). The percentage of patients with House-Brackmann grade I at their first follow-up visit was 67% (118 of 177) in the SDLP group compared with 49% (47 of 96) in the total parotidectomy group (difference, 17% [95% CI, 4%-30%]). There was no clinically meaningful difference in House-Brackmann grade after 1 year. Conclusions and Relevance Findings of this case series study suggest that SDLP can be considered an effective and even superior technique for management of benign tumors in the deep parotid lobe. Advantages associated with SDLP include reduction in need for reconstruction for facial contour defect and reduction in complications, such as immediate facial nerve weakness and Frey syndrome. The incidence of first bite syndrome was higher in the SDLP group. Tumor control was not compromised by SLDP.
Collapse
Affiliation(s)
| | - Katherine Z. Xie
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lauren Y. Lu
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christine M. Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Linda X. Yin
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel L. Price
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kathryn M. Van Abel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
12
|
Roh JL. Frey syndrome after conservative parotidectomy: Importance of closing the remnant parotid parenchyma. J Plast Reconstr Aesthet Surg 2023; 85:149-154. [PMID: 37494848 DOI: 10.1016/j.bjps.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Frey syndrome (FS) is a typical late complication following parotidectomy. Parotid surgery without proper coverage or reconstruction of exposed parotid parenchyma may contribute to the development of FS. Therefore, this study compared the closure versus the non-closure of exposed parotid parenchyma in the occurrence of FS. METHODS This study included 195 patients with parotid lesions who underwent partial or superficial parotidectomy plus closure or non-closure of exposed parotid parenchyma, both with the application of fibrin glue. Two surgical methods of closure and non-closure were allocated to patients without randomization and blinding processes. The primary outcome was FS, and the second outcome was other complication rates. RESULTS The closure and non-closure of exposed parotid parenchyma were performed in 102 and 93 patients, respectively. Early postoperative complications occurred with temporary events: transient facial weakness, 32 (16.4%); hematoma, 13 (6.7%); and wound infection, 2 (1.0%), without statistical difference between the two groups (P > 0.1). However, sialocele occurred in the non-closure group (n = 19) more than in the closure group (n = 7) (P = 0.005). In the first postoperative year, decreased sensation and local pain were found in 16 patients (8.2%) and 9 patients (4.6%), respectively, with no statistical difference between the two groups (P > 0.1). FS was found more in the non-closure group (n = 19, 20.4%) than in the closure group (n = 4, 3.9%) (P < 0.001). CONCLUSION The closure of exposed parotid parenchyma and covering fascia is preferred over the non-closure to prevent FS.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| |
Collapse
|
13
|
Liu AQ, Butskiy O, Cheung VWF, Anderson DW. The timing of drain removal in parotidectomies: outcomes of removal at 4 h post-operatively and a Canadian survey of practice patterns. J Otolaryngol Head Neck Surg 2023; 52:60. [PMID: 37705038 PMCID: PMC10500887 DOI: 10.1186/s40463-023-00665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The post-operative management of parotidectomies is highly provider dependent. No guidelines are currently available for timing of parotid drain removal. This study aimed to assess: (1) outcomes and complications after early drain removal (< 4 h, post-operative day [POD] 0) versus late drain removal (POD ≥ 1); (2) current Canadian provider practices. METHODS A single surgeons ten-year parotidectomy practice was reviewed, spanning his practice change from routine POD ≥ 1 drain removal to POD 0 removal, with extraction of patient demographic, disease, and complication variables. An anonymous, cross-sectional survey on parotid drain practices was distributed to Canadian Society of Otolaryngology-Head and Neck Surgery members. Descriptive statistics, Wilcoxon Rank Sum, and unpaired student's t-tests were calculated. RESULTS In total, 526 patients were included and 44.7% (235/526) had drains removed POD 0. There was no significant difference in hematoma or seroma rates between the POD 0 and POD ≥ 1 drain removal cohorts. The national survey on parotid drain management had 176 responses. The majority (67.9%) reported routinely using drains after parotidectomy and 62.8% reported using a drain output based criteria for removal. The most common cut-off output was 30 ml in 24 h (range 5-70 ml). CONCLUSION There was no difference in hematoma or seroma rates for patients with parotid drains removed on POD 0 versus POD ≥ 1. Our national survey found significant variation in Canadian parotidectomy drain removal practices, which may be an area that can be further assessed to minimize hospital resources and improve patient care.
Collapse
Affiliation(s)
- Alice Q Liu
- Division of Otolaryngology-Head and Neck Surgery, Diamond Health Care Centre, University of British Columbia, 2775 Laurel St, 4th Floor ENT Clinic, Vancouver, BC, V5Z 1M9, Canada.
| | - Oleksandr Butskiy
- Division of Otolaryngology-Head and Neck Surgery, Diamond Health Care Centre, University of British Columbia, 2775 Laurel St, 4th Floor ENT Clinic, Vancouver, BC, V5Z 1M9, Canada
| | | | - Donald W Anderson
- Division of Otolaryngology-Head and Neck Surgery, Diamond Health Care Centre, University of British Columbia, 2775 Laurel St, 4th Floor ENT Clinic, Vancouver, BC, V5Z 1M9, Canada
| |
Collapse
|
14
|
Yang X, Ge S, Tao Y, Li J, Shang W, Song K. Assessment of the observation management of sialocele after partial superficial parotidectomy. Oral Dis 2023; 29:996-1004. [PMID: 34773330 DOI: 10.1111/odi.14079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Xiaochen Yang
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
- School of Stomatology, Qingdao University, Shandong, China
| | - Shengyou Ge
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
- School of Stomatology, Qingdao University, Shandong, China
| | - Yueqin Tao
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Jieying Li
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
- School of Stomatology, Qingdao University, Shandong, China
| | - Wei Shang
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
- School of Stomatology, Qingdao University, Shandong, China
| | - Kai Song
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
- School of Stomatology, Qingdao University, Shandong, China
| |
Collapse
|
15
|
Roh JL. Sialocele formation after partial parotidectomy: Dependent on remnant parotid exposure. Head Neck 2023; 45:1299-1304. [PMID: 36939294 DOI: 10.1002/hed.27348] [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: 12/04/2022] [Revised: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND This study compared the complete closure versus the exposure of remnant parotid parenchyma in sialocele formation. METHODS This study included 151 patients with benign parotid lesions who underwent partial parotidectomy plus the complete closure or exposure of remnant parotid parenchyma. Two surgical methods of closed or exposed parenchyma were alternatively allocated to consecutive patients without randomization and blinding processes. RESULTS Complete closure and exposure of the remnant parotid parenchyma were performed in 81 and 70 patients. Early postoperative complications occurred with temporary events: transient facial weakness, 24 (16%); hematoma, 9 (6%); wound infection, 1 (0.7%) without statistical difference between the two groups (p > 0.1). Postoperative sialocele was more frequently found in the exposure group (n = 15) than the closure group (n = 4; p = 0.003). CONCLUSIONS The complete closure of remnant parotid parenchyma is preferred over the exposure of injured parenchymal parenchyma to prevent postparotidectomy sialocele.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.,Department of Biomedical Science, General Graduate School, CHA University, Seongnam, Republic of Korea
| |
Collapse
|
16
|
Massimilla EA, Motta G, Magaldi M, Montella M, Messina G, Testa D, Cantone E, Motta G. Minimal Margin Surgery and Intraoperative Neuromonitoring in Benign Parotid Gland Tumors: Retrospective Clinical Study. J Pers Med 2022; 12:jpm12101641. [PMID: 36294780 PMCID: PMC9604631 DOI: 10.3390/jpm12101641] [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] [Received: 08/16/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
Extracapsular dissection (ECD) was introduced for the removal of superficial and small benign parotid tumors. According to a recent proposal, ECD is reserved for tumors that are 3 cm or less, mobile, and close to the parotid borders in cases of pleomorphic adenoma. The aim of the study is to evaluate the effectiveness of ECD for treatment of benign parotid tumors also in cases of tumors that were larger than 3 cm and deeper. All ECD for benign parotid neoplasms conducted between 2007 and 2017 were reviewed. The lesions included were limited to primary parotid tumors and categorized by Quer proposal. Facial nerve monitoring was used in all cases. Facial nerve palsy and local recurrences were assessed. The 88 ECD performed met inclusion criteria. The mean lesion size was 4.26 cm. Of the tumors, 68 were less than 3 cm in diameter and 20 were larger, 64 were superficial, and 24 were deep. The most common lesion types were pleomorphic adenoma (88.6%). There was no significant difference in complication rates between the size of tumor (p = 0.9) and location (p = 0.91). Our results suggest that extracapsular dissection could be considered an option for first-time diagnosed benign parotid tumors, even in cases of large dimensions and deep lobe involvement.
Collapse
Affiliation(s)
- Eva Aurora Massimilla
- Department of Mental, Physical Health and Preventive Medicine-ENT Unit, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
- Correspondence:
| | - Giovanni Motta
- Department of Mental, Physical Health and Preventive Medicine-ENT Unit, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
| | - Michelangelo Magaldi
- Department of Mental, Physical Health and Preventive Medicine-ENT Unit, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
| | - Marco Montella
- Department of Mental, Physical Health and Preventive Medicine-Pathology Unit, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Gaetana Messina
- Department of Cardio-Thoracic and Respiratory Sciences-Thoracic Surgery Unit, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
| | - Domenico Testa
- Department of Mental, Physical Health and Preventive Medicine-ENT Unit, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology-Head and Neck Surgery Unit, University of Naples Federico II, 80131 Naples, Italy
| | - Gaetano Motta
- Department of Mental, Physical Health and Preventive Medicine-ENT Unit, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
| |
Collapse
|
17
|
Roh JL. Function-preserving surgery via single transverse cervical incision for Warthin's tumor in the parotid gland. Head Neck 2022; 44:1335-1341. [PMID: 35243713 DOI: 10.1002/hed.27027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND This study evaluated functional and disease control outcomes after gland-preserving surgery via a single transverse cervical incision for Warthin's tumor of the parotid gland. METHODS One-hundred eleven patients with Warthin's tumor underwent the preservation of most normal parotid tissues and the facial nerve combined with the en-bloc resection of tumors. Postoperative complications, subjective satisfaction, salivary function, and metachronous tumor were assessed in each patient. RESULTS No patients had an extension to modified Blair or periauricular incision with the median operation time of 32 min. Temporary and permanent paralysis of the facial nerve was 5 (4.0%) and none of 125 tumor resection sides, respectively. Postoperative complications were minimal. The secretory functions between the affected and unaffected glands did not differ. One patient had metachronous tumor for a median follow-up of 72 months. CONCLUSION Functional gland-preserving surgery via single transverse cervical incision can safely treat Warthin's tumor in the parotid gland.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
18
|
Roh JL. Gland-preserving surgery of benign parotid tumours via postauricular sulcus incision: Is it safe and effective with the scarless incision? Oral Oncol 2022; 127:105808. [PMID: 35263678 DOI: 10.1016/j.oraloncology.2022.105808] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| |
Collapse
|
19
|
Sagalow ES, Christopher V, Banoub RG, Gill KS, Xu V, Jain N, Malkani K, Elmer N, Zhan T, Stanek JJ, Hwang M, Krein HD, Heffelfinger RN. Rate of Fat Graft Volume Loss After Parotidectomy. J Craniofac Surg 2022; 33:2082-2086. [DOI: 10.1097/scs.0000000000008615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
20
|
Roh JL. Transoral Complete vs Partial Excision of the Sublingual Gland for Plunging Ranula. Otolaryngol Head Neck Surg 2021; 167:479-483. [PMID: 34932413 DOI: 10.1177/01945998211067500] [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]
Abstract
OBJECTIVES Plunging ranula is a pseudocyst of saliva extravasated from the sublingual gland (SLG) to the submandibular space. This is treated by transoral excision of the SLG or transcervical cyst excision that might differently affect surgical morbidity and recurrence. This study compared the clinical outcomes of complete vs partial excision of the SLG for plunging ranula. STUDY DESIGN A nonrandomized comparative study. SETTING Academic medical center. METHODS This study included 42 patients with plunging ranula who underwent complete or partial excision of the SLG with the evacuation of cystic content. Two surgical methods of complete or partial SLG resection were alternatively allocated to consecutive patients without randomization. The primary outcome was a postoperative recurrence. Secondary outcomes were operation time and complications. RESULTS Complete and partial excision of the SLG was performed in 22 and 20 patients, respectively, without injury to the Wharton's duct or the lingual nerve. Postoperative complications in 42 patients were minor with temporary events: hematoma, 1 (5%); tongue numbness, 2 (5%); dysgeusia, 4 (9%); and dysphagia, 2 (5%), which did not differ between patients with complete and partial excision of the SLG (P > .1). However, recurrence occurred in only 5 of 20 patients with partial SLG excision but none of 22 patients with complete SLG excision for a median follow-up of 36 months. CONCLUSIONS Complete SLG excision is preferred over partial SLG excision to treat plunging ranula for reducing postsurgical risks of complications and recurrence.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
21
|
Chen S, Zhao M, Wang D, Zhao Y, Qiu J, Liu Y. Endoscopic and Robotic Parotidectomy for the Treatment of Parotid Tumors: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:748885. [PMID: 34900694 PMCID: PMC8660082 DOI: 10.3389/fonc.2021.748885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background The goal of this review was to introduce endoscopic/robotic parotidectomy (EP/RP) and compare EP/RP against conventional parotidectomy (CP) regarding the intraoperative and postoperative parameters in the treatment of parotid tumors. Methods A systematic literature search of medical databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed from inception to November 2020 to generate relevant studies. Results A total of 13 eligible studies (572 patients) were included for systematic review, and 7 out of 13 comparable studies for the quantitative synthesis of outcomes. Patients who underwent EP were characterized by less intraoperative bleeding volume, shorter incision length, and higher satisfaction postoperatively (WMD, 95% CI, -42.80; - 58.23 to -27.37; p < 0.01; WMD, 95% CI, -5.64; -7.88 to -3.39; p < 0.01; SMD, 95% CI, 1.88; 1.46 to 2.31; p < 0.01, respectively). However, operative time and risk of facial palsy exhibited no significant differences (WMD, 95% CI, -11.17; -26.71 to 4.34; p = 0.16; OR, 95% CI,0.71; 0.39 to 1.32; p = 0.28, respectively). Conclusions Our findings suggest that the current evidence does not adequately support EP is equally safe and effective as CP. In certain selected cases, endoscopic technology has its unique advantages. For patients with strong cosmetic needs, endoscopic or robotic techniques may be an alternative through adequate preoperative evaluations. Systematic Review Registration International Prospective Register of Systematic Reviews, identifier CRD42020210299.
Collapse
Affiliation(s)
- Shanwen Chen
- Department of Otorhinolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mei Zhao
- Oncology Department of Integrated Traditional Chinese and Western Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dong Wang
- Department of Otorhinolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yi Zhao
- Department of Otorhinolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jianxin Qiu
- Department of Otorhinolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yehai Liu
- Department of Otorhinolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
22
|
Roh JL. Selective deep lobe parotidectomy via retroauricular hairline (Roh's) incision for deep lobe parotid pleomorphic adenoma. Oral Dis 2021; 29:188-194. [PMID: 34739166 DOI: 10.1111/odi.14069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/08/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Deep lobe parotid tumour is commonly removed with the covering superficial lobe of parotid gland. Total or subtotal parotidectomy leads to an increase in surgical morbidity. This study evaluated recurrence and function after selective deep lobe parotidectomy via retroauricular hairline (Roh's) incision for pleomorphic adenoma. MATERIALS AND METHODS Twenty-eight patients with deep lobe parotid pleomorphic adenomas underwent selective deep lobe parotidectomy with preservation of the superficial lobe and the facial lobe via Roh's incision. Each patient was evaluated with any complications, cosmetic and salivary functions and local recurrence. RESULTS Superficial lobe-preserving surgery via Roh's incision was successfully applied to all patients without injury to the facial nerve and the Stensen's duct for a median operation time of 65 min. Facial nerve paralysis was found only temporarily in 9 (32%) patients, and other complications were minimal. None of the patients had postoperative Frey's syndrome. Salivary secretory function in the operated side was well preserved. No recurrence was found in the patients for a median follow-up of 94 months. CONCLUSIONS Selective deep lobe parotidectomy via Roh's incision is a reliable option of treatment for deep lobe parotid pleomorphic adenoma.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
23
|
Roh JL. Functional gland-preserving surgery for submandibular gland pleomorphic adenoma. J Cancer Res Clin Oncol 2021; 148:2623-2629. [PMID: 34705103 DOI: 10.1007/s00432-021-03844-8] [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: 08/10/2021] [Accepted: 10/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Conventional surgery for submandibular gland tumour is total excision of the gland affected by the tumour. Gland-preserving surgery is commonly used for benign tumours arising in the parotid gland but not in the submandibular gland. This study evaluated long-term oncological and functional outcomes after gland-preserving surgery in patients with pleomorphic adenoma of the submandibular gland via the submental approach. METHODS This longitudinal study included 105 consecutive patients with submandibular gland pleomorphic adenoma who underwent the gland-preserving surgery combined with the en-bloc resection of tumours via the submental approach. Salivary scintigraphy was performed 6 months after surgery, and ultrasonography was regularly followed. Intraoperative findings, postoperative complications, cosmetic and salivary functions, and tumour recurrence were assessed in these patients. RESULTS Median tumour size and submental incision length were 2.0 and 3.3 cm, respectively. Median operation time and amount of blood loss were 25 min and 18.5 mL, respectively. None had marginal or lingual nerve paralysis and most patients were satisfied with incision scar and facial contour. The salivary function of the affected gland was equal to that of the unaffected gland. One patient (0.9%) had single nodular recurrence 54 months after surgery and others had no recurrence for follow-up of median 96 months. CONCLUSIONS Pleomorphic adenoma of the submandibular gland can be safely removed by the gland-preserving surgery via the submental approach which has operation time, cosmetic and functional benefits with compromising oncological outcomes.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Gyeonggi, 13496, Republic of Korea.
| |
Collapse
|
24
|
Predictors of Sialocele or Salivary Fistula After Partial Superficial Parotidectomy for Benign Parotid Tumor: A Retrospective Study. J Oral Maxillofac Surg 2021; 80:327-332. [PMID: 34662554 DOI: 10.1016/j.joms.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Partial superficial parotid (PSP) resection is the mainstay of treatment for benign parotid tumor. Unfortunately, the post-surgical formation of sialocele or salivary fistula is a well-recognized complication of parotid surgery. The aim of this study was to determine the predictors of sialocele or salivary fistula after PSP resection for parotid benign tumor. METHODS This retrospective cohort study includes patients who underwent PSP resection for benign parotid tumors from January 1, 2015 to December 31, 2019. The predictor variables were demographic data, systemic disease, smoking history, tumor size and type, surgical approach, and area. The outcome variables were the occurrence of sialocele or salivary fistula after PSP resection. Each possible risk factor was then examined using univariate analysis. Variables associated with sialocele or salivary fistula in the univariate analysis were then included in a multiple logistic regression model, and analyzed for possible factors related to the occurrence of sialocele or salivary fistula after partial superficial parotid resection. RESULTS The sample was composed of 872 subjects with a mean age of 51.0 ± 8.3, and 59.5% were male. The frequency of sialocele or salivary fistula after partial superficial parotid resection was 10.4% (n = 92). Based on the multiple logistic regression model, hypertension and location of the lesion were associated with sialocoele formation. Hypertension was associated with a decreased risk for the formation of sialocele or salivary fistula (ORs = 0.6, 95% CI = [0.4,1.003], P = .051). When compared the superior lesions, anterior lesions were associated with a decreased risk for the formation of sialocele or salivary fistula (ORs = 0.32, 95% CI = [0.111,0.92], P = .034) and lesions in the middle were associated with an increased risk for sialocele or salivary fistula development (ORs = 2.315,95% CI = [1.199,4.469], P = .012). CONCLUSIONS The incidence of sialocele or salivary fistula development was 10.4% in patients undergoing partial superficial parotidectomy in this study. Moreover, middle and anterior tumor location was shown to increase sialocele or salivary fistula risk.
Collapse
|
25
|
Roch M, Mauvais O, Vergez S, Brenet E, Lindas P, Toussaint B, Nguyen DT, Gauchotte G, Rumeau C, Gallet P. Is Revision Surgery Necessary for Patients With High Risk of Recurrence After Parotidectomy? A Multicenter Retrospective Study. Ann Otol Rhinol Laryngol 2021; 131:782-790. [PMID: 34496666 DOI: 10.1177/00034894211045269] [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: 11/17/2022]
Abstract
OBJECTIVES Close margin is a frequent situation after parotidectomy. The need for systematic prophylactic revision surgery is a question that arises regularly for malignant tumors, as it exposes to a high risk of facial palsy, while oncological benefits are unclear. STUDY DESIGN retrospective study. SETTING Multicentric. SUBJECTS AND METHODS We included all patients operated for systematic revision surgery in case of close margins after parotidectomy for a malignant tumor and analyzed the rate of tumor residue and its risk factors. RESULTS A tumor residue was identified in 43.5% of 23 cases, but none in case of initial complete excision with supra-millimetric margins. Invaded lymph nodes were identified in 6 cases, but none in case of low-grade tumors. CONCLUSIONS Systematic revision seems mandatory in case of infra-millimetric margins and high-grade tumors or positive lymph node; further studies are needed to confirm whether it can be spared for T1-T2/N0 low-grade tumors, with close margins but complete initial excision.
Collapse
Affiliation(s)
- Médarine Roch
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | - Olivier Mauvais
- ENT Department, Regional University Hospital of Besancon, Besancon, France
| | - Sebastien Vergez
- ENT Department, Regional University Hospital of Toulouse, Toulouse, France
| | - Esteban Brenet
- ENT Department, Regional University Hospital of Reims, Reims, France
| | - Pierre Lindas
- ENT Department, Robert Schuman Hospital, Metz, France
| | - Bruno Toussaint
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | - Duc Trung Nguyen
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | | | - Cécile Rumeau
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| | - Patrice Gallet
- ENT Department, Regional University Hospital of Nancy, Nancy, France
| |
Collapse
|
26
|
Roh JL. Functional gland-preserving surgery via periauricular incision for pleomorphic adenoma of the parotid gland. Eur J Surg Oncol 2021; 48:21-26. [PMID: 34465486 DOI: 10.1016/j.ejso.2021.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Gland-preserving surgery is often used for benign tumours in the parotid gland. Partial superficial parotidectomy via a periauricular incision may bring satisfactory cosmetic outcomes but the disease control outcome remains unrevealed. This study evaluated functional and disease control outcomes after gland-preserving surgery via periauricular incision for pleomorphic adenoma of the parotid gland. METHODS This longitudinal study included 248 consecutive patients with parotid pleomorphic adenoma who underwent the preservation of most normal parotid tissues and the facial nerve combined with the en-bloc resection of tumours via periauricular incision. Postoperative complications, subjective satisfaction, salivary function, and tumour recurrence were assessed in each patient. The secretory function of the salivary gland was measured using salivary scintigraphy at 6 months after surgery, and ultrasonography was regularly followed. RESULTS Median tumour size was 2.5 cm (range, 0.8-5.2 cm) and median operation time was 55 min (range, 39-88 min). All tumours were safely removed by gland-preserving surgery via periauricular incision without extension to Blair or hairline incision and tumour spillage. Temporary and permanent paralysis of the facial nerve was 14 (5.6%) and none of the study patients, respectively. Postoperative complications were minor and Frey's syndrome was found in 6 (2.4%) patients. The Secretary function of the affected gland was equal to that of the unaffected gland. No patients had a recurrence for a median follow-up of 78 months (range, 24-126 months). CONCLUSIONS Functional gland-preserving surgery via periauricular incision can treat pleomorphic adenoma in the parotid gland with satisfactory functional, cosmetic, and disease control outcomes.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-do, Seongnam, Republic of Korea.
| |
Collapse
|
27
|
Brodie KD, Zebolsky AL, Ochoa E, Ha PK, Heaton CM, El‐Sayed IH, Ryan WR. A prospective study of patient-reported xerostomia-related outcomes after parotidectomy. Laryngoscope Investig Otolaryngol 2021; 6:683-689. [PMID: 34401492 PMCID: PMC8356866 DOI: 10.1002/lio2.568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE There is a paucity of data on patient-reported outcome measures regarding xerostomia after parotidectomy surgery. Although salivary flow rates after parotidectomy have been previously studied, they do not correlate with subjective xerostomia. This study was designed to evaluate if unilateral parotidectomy increases patient-reported xerostomia. METHODS A prospective cohort of patients undergoing unilateral partial, superficial, or total parotidectomy for benign or low-grade malignant pathology without postoperative radiation at a tertiary care academic center was studied. We analyzed patient-reported outcome measures of xerostomia using the Xerostomia Questionnaire (XQ) preoperatively and postoperatively. We compared pre- and postoperative cumulative and individual XQ scores using Wilcoxon signed-rank tests. We stratified patients by the weight in grams (g) of the parotid tissue excised, pathology, smoking status, and xerostomia-related medication use. RESULTS Twenty-two adults with benign or low grade malignant unilateral parotid tumors were included. Postoperative questionnaires were completed at a median of 10.2 months (interquartile range [IQR] 8.6-11.9) after unilateral parotidectomy. Mean preoperative and postoperative cumulative XQ scores, on a 100-point scale, with higher scores representing worse symptoms, were 10.33 (95% CI: 4.46-16.20) and 10.54 (95% CI: 5.10-15.98), respectively, with a mean change of +0.21 (p = 0.472). There were no statistically significant changes in individual XQ symptom scores. Neither type of parotidectomy, resection specimens weighing over 10 g, smoking habits, xerostomia-related medication use, nor malignant pathology were associated with worse symptom scores. CONCLUSION Based on these data, unilateral parotidectomy does not appear to definitely, or at least consistently, increase xerostomia per patient reporting. More extensive parotid resections are not associated with worse symptom scores. These data can help guide preoperative counseling and postoperative expectations for parotidectomy. LEVEL OF EVIDENCE 2b.
Collapse
Affiliation(s)
- Kara D. Brodie
- Department of Otolaryngology – Head and Neck SurgeryUniversity of California – San FranciscoSan FranciscoCaliforniaUSA
| | - Aaron L. Zebolsky
- Department of Otolaryngology – Head and Neck SurgeryUniversity of California – San FranciscoSan FranciscoCaliforniaUSA
| | - Edgar Ochoa
- University of California – San Francisco School of MedicineSan FranciscoCaliforniaUSA
| | - Patrick K. Ha
- Division of Head and Neck Oncologic and Endocrine Surgery, University of California – San Francisco, Department of Otolaryngology – Head and Neck Surgery, Helen Diller Comprehensive Cancer CenterUCSF Mission Bay Medical CenterSan FranciscoCaliforniaUSA
| | - Chase M. Heaton
- Division of Head and Neck Oncologic and Endocrine Surgery, University of California – San Francisco, Department of Otolaryngology – Head and Neck Surgery, Helen Diller Comprehensive Cancer CenterUCSF Mission Bay Medical CenterSan FranciscoCaliforniaUSA
| | - Ivan H. El‐Sayed
- Division of Head and Neck Oncologic and Endocrine Surgery, University of California – San Francisco, Department of Otolaryngology – Head and Neck Surgery, Helen Diller Comprehensive Cancer CenterUCSF Mission Bay Medical CenterSan FranciscoCaliforniaUSA
| | - William R. Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, University of California – San Francisco, Department of Otolaryngology – Head and Neck Surgery, Helen Diller Comprehensive Cancer CenterUCSF Mission Bay Medical CenterSan FranciscoCaliforniaUSA
| |
Collapse
|
28
|
Yamamoto H, Kojima T, Okanoue Y, Otsuki S, Hasebe K, Yuki R, Hori R. Impact of Changing Surgical Strategies on Clinical Outcomes in Patients with Parotid Carcinoma: A 53-Year Single-Institution Experience. MEDICINA-LITHUANIA 2021; 57:medicina57080745. [PMID: 34440951 PMCID: PMC8399018 DOI: 10.3390/medicina57080745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: We investigated the clinical outcomes of patients who underwent surgery for parotid carcinoma in a single institution during a 53-year period. This study aimed to estimate the impact of changing the surgical approach to parotid carcinoma on clinical outcomes including the incidence rate of the facial nerve palsy. Materials and Methods: Sixty-seven patients with parotid carcinoma who underwent surgery between 1966 and 2018 were retrospectively reviewed. Group A consisted of 29 patients who underwent surgery from 1966 to 2002, and Group B consisted of 38 patients from 2002 to 2018. Treatment outcomes were estimated. Additionally, candidate prognostic factors of Group B, the current surgical approach group, were evaluated. Results: Partial parotidectomy and total parotidectomy were performed in 35 and 32 patients, respectively. Partial parotidectomy was performed in 4 patients in Group A and 31 patients in Group B, with a predominant increase in Group B. The facial nerve was preserved in 43 patients, among whom 8 in Group A (8/17; 47.1%) and 7 in Group B (7/26; 26.9%) had temporary postoperative facial nerve palsy. Postoperative radiotherapy was performed on 35 patients. The 5-year OS, DSS, and DFS rates for Group A were 77.1%, 79.9%, and 71.5%, respectively. The 5-year OS, DSS, and DFS rates for Group B were 77.1%, 77.1%, and 72.4%, respectively. Clinical T4 stage, clinical N+ stage, stage IV disease, and tumor invasion of the facial nerve were independent prognostic factors in Group B. Conclusions: The incidence of facial nerve palsy in the current surgical approach group decreased compared with that in the previous surgical approach group. The current surgical management and treatment policies for parotid carcinoma have led to improved outcomes.
Collapse
Affiliation(s)
- Hirotaka Yamamoto
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
- Department of Otolaryngology, Shizuoka City Hospital, 10-93 Otte-cho, Aoi-ku, Shizuoka 420-8630, Japan
| | - Tsuyoshi Kojima
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Yusuke Okanoue
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Shuya Otsuki
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Koki Hasebe
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Ryohei Yuki
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Ryusuke Hori
- Department of Otolaryngology—Head and Neck Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
- Correspondence: ; Tel.: +81-562-93-9291
| |
Collapse
|
29
|
Mashrah MA, Al-Sharani HM, Al-Aroomi MA, Abdelrehem A, Aldhohrah T, Wang L. Surgical interventions for management of benign parotid tumors: A systematic review and network meta-analysis. Head Neck 2021; 43:3631-3645. [PMID: 34288212 DOI: 10.1002/hed.26813] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 12/16/2022] Open
Abstract
The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis (NMA) is to answer the following questions: (1) Does the extent of surgical resection of benign parotid tumors increase the risk of postoperative complications? (2) What is the best surgical intervention for treatment of benign parotid tumors that can provide an acceptable balance between tumor recurrence rate and other postoperative complications? A comprehensive search on PubMed, Embase, Scopus, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of tumor recurrence, facial nerve weakness (temporary [TFW] or permanent [PFP]), Frey's syndrome (FS), sialocele, and salivary fistula. The Bayesian network meta-analysis (NMA) accompanied by a random effect model and 95% credible intervals (CrI) were calculated using the GeMTC R package. Forty-four studies with a total of 7841 participants were included in the current NMA comparing five surgical interventions, namely enucleation, extracapsular dissection (ECD), partial superficial parotidectomy (PSP), superficial parotidectomy (SP), and total parotidectomy (TP). Enucleation showed the highest recurrence rate compared to ECD, SPS, SP, and TP. No statistical differences were observed concerning the recurrence rate when ECD, PSP, SP, and TP were compared together. There was an increased incidence of TFW and FS with the increase in the extent of parotid resection, while no significant difference was found when comparing enucleation with ECD and PSP. SP showed the highest incidence of PFP, and salivary fistula compared to ECD, PSP, and TP. The tumor recurrence rates in enucleation, ECD, PSP, SP, and TP were 14.3%, 3.6%, 3.7%, 2.8%, and 1.4%, respectively. The current NMA demonstrated that the risk of TFW and FS increases with the increase in the extent of parotid resection and that ECD and PSP can be considered the treatment of choice for benign parotid tumors, as both provide an acceptable balance between the incidence of tumor recurrence and facial nerve dysfunction.
Collapse
Affiliation(s)
- Mubarak Ahmed Mashrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Maxillofacial Surgery, Motherhood and Childhood Hospital, Ministry of Health, Ibb, Yemen
| | - Hesham Mohammed Al-Sharani
- Department of Maxillofacial Surgery, School of Stomatology, Harbin Medical University, Harbin, China.,Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Maged Ali Al-Aroomi
- Department of Oromaxillofacial - Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Ahmed Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Taghrid Aldhohrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liping Wang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
30
|
Abstract
The parotid gland is located in a cosmetically sensitive area. Given cultural emphasis on cosmesis, using minimally invasive or hidden incisions, when appropriate, can significantly improve patient satisfaction and quality of life following surgery. Facelift-style incisions have been used since the late 1960s to approach parotid pathology. Several alternative incisions, including technology-assisted approaches, also have been described in the literature. To that end, this article explore the existing data regarding several historical and emerging cosmetic approaches to the parotid gland comparing relative advantages and disadvantages of each.
Collapse
|
31
|
Auger SR, Kramer DE, Hardy B, Jandali D, Stenson K, Kocak M, Al-Khudari S. Functional outcomes after extracapsular dissection with partial facial nerve dissection for small and large parotid neoplasms. Am J Otolaryngol 2021; 42:102770. [PMID: 33188987 DOI: 10.1016/j.amjoto.2020.102770] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/27/2020] [Accepted: 10/13/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE Multiple surgical options exist for benign parotid tumors without agreement upon a single, best approach. We evaluated the short-term outcomes and rate of complications using the ECD-FND technique for small and large parotid neoplasms involving the superficial and deep lobes of the parotid gland using a categorical approach. MATERIAL AND METHODS A single surgeon retrospective cohort study with analysis of patient demographics, outcomes, and complication rates was conducted of patients undergoing the ECD-FND for benign parotid neoplasm. Cases from May 2014 to May 2020 with at least 6 months follow up were considered. Complications were assessed by chart review and tumors were categorized by size and by European Salivary Gland Society (ESGS) classification assigned by a neuroradiologist. RESULTS Fifty-one patients who underwent ECD-FND of suspected benign parotid mass met inclusion criteria. The most common histology was pleomorphic adenoma (56.9%) followed by Warthin's tumor (19.6%). Overall rate of complications was 31.4% with no major complications. Most patients (88.2%) had normal facial nerve function immediately after surgery and all recovered completely in the post operative period. Sialocele occurred in 15.7% of patients with 87.5% resolved within one month and seromas occurred in four patients (7.8%). There was no significant difference in complication rates between the size of tumor (p = 0.889), depth (p = 0.770), or ESGS classification (p = 0.846). CONCLUSIONS The ECD-FND technique achieved excellent facial nerve outcomes among our cohort, which included a - proportion of large (>3 cm) and deep lobe tumors. Complications rates and outcomes were similar for larger and deep lobe tumors that underwent a ECD-FND approach. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Samuel R Auger
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Dallas E Kramer
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Brendan Hardy
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Danny Jandali
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Kerstin Stenson
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mehmet Kocak
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Samer Al-Khudari
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
32
|
Colaianni CA, Feng AL, Richmon JD. Partial parotidectomy via periauricular incision: Retrospective cohort study and comparative analysis to alternative incisional approaches. Head Neck 2020; 43:825-832. [PMID: 33191533 DOI: 10.1002/hed.26542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/14/2020] [Accepted: 10/30/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We investigated a periauricular approach to the parotid and compared outcomes to alternative parotidectomy incisions. METHODS Retrospective chart review of patients (n = 97) undergoing partial parotidectomy for benign or malignant pathology by a single surgeon. After October 2017, most patients were approached via a periauricular incision (n = 59). RESULTS There was no significant difference in patient age, tumor location, length of hospital stay, postoperative complication, or pathology. Mean tumor diameter was significantly smaller in the periauricular group (2.1 cm) than in the traditional incision group (2.6 cm). No permanent injuries to facial nerve branches occurred in either group. Patients were followed for a median of 44 days after surgery. CONCLUSIONS This is the largest study to date that demonstrates the periauricular incision is a safe and feasible approach for most parotid neoplasms. The cosmetic advantage of this approach is that the resulting scar is smaller and does not extend into the neck.
Collapse
Affiliation(s)
- C Alessandra Colaianni
- Harvard Medical School Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Allen L Feng
- Harvard Medical School Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Harvard Medical School Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| |
Collapse
|
33
|
Patel SG. Editorial on superficial or partial superficial parotidectomy for the treatment of primary benign parotid tumors. J Surg Oncol 2020; 122:1296-1297. [PMID: 33043449 DOI: 10.1002/jso.26220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/05/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Snehal G Patel
- Department of Surgery Head, Neck Service Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
34
|
Mlees MA, Elbarbary AH. Superficial or partial superficial parotidectomy for the treatment of primary benign parotid tumors. J Surg Oncol 2020; 122:1315-1322. [DOI: 10.1002/jso.25970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Mohamed Ali Mlees
- Surgical Oncology Unit, General Surgery Department Tanta University Hospitals Tanta Egypt
| | | |
Collapse
|
35
|
Al-Aroomi MA, Mashrah MA, Abotaleb BM, Sun J, Al-Worafi NA, Huang Y, Xie F. Comparison of postoperative complications and facial nerve recovery rates after conventional and partial superficial parotidectomy of benign parotid tumours: a prospective study. Int J Oral Maxillofac Surg 2020; 50:335-340. [PMID: 32814655 DOI: 10.1016/j.ijom.2020.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/16/2020] [Accepted: 07/31/2020] [Indexed: 02/05/2023]
Abstract
The aim of this study was to compare postoperative complications and facial nerve (FN) recovery rates between conventional superficial parotidectomy (CSP) and partial superficial parotidectomy (PSP) as surgical treatment for benign parotid tumours. A prospective study was conducted on 55 consecutive patients who underwent either CSP (n=35) or PSP (n=20) for benign parotid tumours. The primary outcomes were FN injury, FN recovery rates, and Frey syndrome. Secondary outcomes were operative time, hospital stay, sialocele, haematoma, and auricular numbness. The degree of FN injury was evaluated at 1 week, 1, 3, 6, and 12 months postoperative using the House-Brackmann grading system. Frey syndrome was assessed using a subjective clinical questionnaire and objective Minor starch-iodine test. No patient in either group experienced permanent FN paralysis. There was a significantly higher incidence of temporary FN weakness in the CSP group (P=0.007). The respective FN recovery rates at 1, 3, 6, and 12 months were 60%, 88.6%, 94.3%, and 100% in the CSP group and 90%, 95%, 100%, and 100% in the PSP group. No significant difference was observed between the groups regarding the incidence of Frey syndrome, sialocele, and haematoma. The operative time and hospital stay were both shorter in the PSP group. Although the PSP is a more conservative procedure with significantly reduced FN injury, operative time, and hospital stay compared to CSP, the CSP procedure shows a comparable FN recovery rate to the PSP.
Collapse
Affiliation(s)
- M A Al-Aroomi
- Department of Oral and Maxillofacial Surgery, Lanzhou University Second Hospital, School of Stomatology, Lanzhou University, Lanzhou, China.
| | - M A Mashrah
- Department of Oral and Maxillofacial Surgery, Mother and Childhood Hospital, Ministry of Health, Ibb, Yemen
| | - B M Abotaleb
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - J Sun
- Department of Oral and Maxillofacial Surgery, Lanzhou University Second Hospital, School of Stomatology, Lanzhou University, Lanzhou, China
| | - N A Al-Worafi
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China
| | - Y Huang
- Department of Oral and Maxillofacial Surgery, Lanzhou University Second Hospital, School of Stomatology, Lanzhou University, Lanzhou, China
| | - F Xie
- Department of Oral and Maxillofacial Surgery, Lanzhou University Second Hospital, School of Stomatology, Lanzhou University, Lanzhou, China.
| |
Collapse
|
36
|
Psychogios G, Bohr C, Constantinidis J, Canis M, Vander Poorten V, Plzak J, Knopf A, Betz C, Guntinas-Lichius O, Zenk J. Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors. Eur Arch Otorhinolaryngol 2020; 278:15-29. [DOI: 10.1007/s00405-020-06250-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Yibulayin F, Feng L, Wang M, Lu MM, Luo Y, Liu H, Yang ZC, Wushou A. Head & neck acinar cell carcinoma: a population-based study using the seer registry. BMC Cancer 2020; 20:631. [PMID: 32641007 PMCID: PMC7346396 DOI: 10.1186/s12885-020-07066-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/12/2020] [Indexed: 12/17/2022] Open
Abstract
Background To explore the clinicopathologic characteristics, treatment and prognostic factors of head and neck acinar cell carcinoma (HNACC) comprehensively. Methods A population-based study was conducted using data from the Surveillance, Epidemiology, and End Results database (1975–2016). Overall survival (OS) and HNACC-specific survival of patients with different clinicopathologic variables were compared using the Kaplan-Meier method and Cox multivariate regression. Results A total of 2624 primary HNACC cases (1052 males, 1572 females) were identified. There was a significant difference in gender distribution. Among the total cohort, 2416 cases originated from salivary glands, including 2325 parotid gland ACC cases. Regardless of confounding factors, the 10-year and 20-year disease-specific survival (DSS) was 93.6 and 90%, respectively. Surgery was favourably associated with better DSS and OS [HR = 0.13, P = 0.0092 and HR = 0.23, P = 0.0203]. Gender was the only demographic independent prognostic factor for both DSS and OS [Male vs female, HR = 3.3, P = 0.0028 for DSS; HR = 2.44, P = 0.0376 for OS]. Higher pathological grade was adversely associated with DSS and OS [Grade II, HR = 4.03, P = 0.0444; Grade III + IV, HR = 35.64, P = 0.0000 for DSS; Grade III + IV, HR = 4.49, P = 0.0000 for OS, Grade I as reference]. In addition, TNM/AJCC stage was commonly associated with prognosis. Conclusion Surgery was the only favourable prognostic indicator for both DSS and OS. Gender, age, pathological differentiation and TNM/AJCC stage were independent prognostic factors for survival.
Collapse
Affiliation(s)
- Feiluore Yibulayin
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital, Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China.,Department of Preventive Medicine, School of Public Health, Shanghai Medical College, Fudan University, 138 Yi xue yuan Road, Shanghai, 200001, People's Republic of China
| | - Lei Feng
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital, Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China
| | - Meng Wang
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital, Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China
| | - Meng-Meng Lu
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital, Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China
| | - Yuan Luo
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital, Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China
| | - Hui Liu
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital, Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China
| | - Zhi-Cheng Yang
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital, Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China.
| | - Alimujiang Wushou
- Department of Oral & Maxillofacial Surgery and Oral Biomedical Engineering Laboratory Shanghai Stomatological Hospital, Fudan University, 356 Beijing East Road, Shanghai, 200001, People's Republic of China.
| |
Collapse
|
39
|
Li C, Matthies L, Hou X, Knipfer C, Gosau M, Friedrich RE. A meta-analysis of the pros and cons of partial superficial parotidectomy versus superficial parotidectomy for the treatment of benign parotid neoplasms. J Craniomaxillofac Surg 2020; 48:590-598. [DOI: 10.1016/j.jcms.2020.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/10/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022] Open
|
40
|
Zhang Q, Yang Y, Yang P, Tan Y, Liu X, Xiong B, Qiu J. Cosmetic approach selection in parotidectomy for benign parotid gland tumour according to its location. J Plast Reconstr Aesthet Surg 2020; 73:921-926. [PMID: 32165143 DOI: 10.1016/j.bjps.2019.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/07/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the feasibility and aesthetic results when comparing two cosmetic approaches that were employed in parotidectomy according to the tumour location with the traditional Blair approach. DESIGN Retrospective study. SETTING Tertiary Referral Centre. PATIENTS Seventy-six patients were included in the study. RESULTS The degree of satisfaction with the cosmetic incision approach was significantly higher than that with the traditional Blair approach. The incidence of transient facial paralysis and salivary fistula were not statistically significant when compared with those in the traditional incision in 6-month follow-up post-operatively. DISCUSSION Conventional parotidectomy using the traditional Blair incision (or its modification) usually leaves a visible scar in this region, which can have major adverse impacts on the social or psychological well-being of an individual. To achieve better aesthetic results, according to the location of the benign parotid tumour, two formal cosmetic approach incisions could be performed in parotidectomy, which was superior to the traditional Blair incision. The authors propose that these two cosmetic approaches for parotidectomy can be both technically feasible and safe.
Collapse
Affiliation(s)
- Q Zhang
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital of Nanchang University, Jiangxi Province, China.
| | - Y Yang
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - P Yang
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Y Tan
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - X Liu
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - B Xiong
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - J Qiu
- Department of Oral & Maxillofacial Surgery, First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| |
Collapse
|
41
|
Shoukair FL, Maly A, Haran TK, Hirshoren N, Abu Tair J. Maxillofacial diagnostic features of the enigmatic metastasizing pleomorphic adenoma. Int J Oral Maxillofac Surg 2020; 49:841-847. [PMID: 32005572 DOI: 10.1016/j.ijom.2020.01.002] [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: 02/24/2019] [Revised: 12/26/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
Considering the confusion in the literature regarding local recurrence, spread, or metastases of pleomorphic adenoma (PA) in the head and neck region, the aim of this study was to enhance understanding of the characteristics of metastasizing pleomorphic adenoma (MPA) by reviewing the literature and presenting a case. English language articles with proof of metastases were included in the literature review. Of the 80 cases in the literature with MPA, 46 were female and 33 were male (sex missing for one case). Thirty-five percent of the neoplasms affected the bones; the maxilla was affected in five cases and the mandible in three. The parotid was the primary site in 72.5% of cases and the submandibular gland in 16.2% of cases. The local recurrence rate was 70%. The mean interval between primary PA and MPA was 15.52 years. The total mortality rate was 8.7%. A case of PA of the submandibular gland that recurred after surgical excision and metastasized (confirmed by the presence of intact cortical borders) to the ipsilateral mandibular body, upper lip, and neck is described. The high mortality rate in a histologically defined benign disease that metastasizes demands that management include careful primary excision and long-term clinical follow-up.
Collapse
Affiliation(s)
- F L Shoukair
- Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah, Jerusalem, Israel.
| | - A Maly
- Department of Pathology, Faculty of Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | - T K Haran
- Department of Pathology, Faculty of Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | - N Hirshoren
- Department of ENT, Faculty of Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | - J Abu Tair
- Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah, Jerusalem, Israel; Arab American University-AAUP, Palestinian Authority
| |
Collapse
|
42
|
Ozturk K, Ozturk A, Turhal G, Kaya I, Akyildiz S, Uluoz U. Comparative outcomes of extracapsular dissection and superficial parotidectomy. Acta Otolaryngol 2019; 139:1128-1132. [PMID: 31560243 DOI: 10.1080/00016489.2019.1669821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Retrospective analysis of extracapsular dissection (ECD) and superficial parotidectomy (SP).Aims/objectives: Comparing the outcomes of ECD and SP in surgery of benign parotid masses.Material and methods: Total of 136 patients included in the study. The inclusion criteria were pathologically proven benign FNA biopsy, lack of deep lobe invasion and single tumour diameter lower than 4 cm, absence of radiologically and clinically malignant lesion and facial paralysis at the time of diagnosis.Objectives: Drain volumes and seroma presence, clinical evaluation of face nerve function; signs of infective complications were collected from patients' clinic chart. Complications and recurrence rates were obtained from follow-up forms.Results: The mean follow-up period was 42.53 ± 14.88 months. In SP group, three patients with disease recurrence were found, 8 (10.2%) had early facial nerve paralysis (grade 2 and 3) and 11 (14.1%) had Frey's syndrome. No postoperative complication, early facial paralysis and recurrence were observed in ECD group.Conclusion and significance: ECD procedure was found to be as successful as SP in the selected patient group in approach to the pathologically proven and single benign parotid masses with similar recurrence and lower complication rates compared to the SP.
Collapse
Affiliation(s)
- Kerem Ozturk
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Arin Ozturk
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Goksel Turhal
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Isa Kaya
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Serdar Akyildiz
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Umit Uluoz
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| |
Collapse
|
43
|
Mutlu V, Kaya Z. Which Surgical Method is Superior for the Treatment of Parotid Tumor? Is it Classical? Is it New? Eurasian J Med 2019; 51:273-276. [PMID: 31692615 DOI: 10.5152/eurasianjmed.2019.19108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective We aimed to compare the incidence of parotid tumors seen in our region in the last ten years with the literature values and to compare the recently proposed new parotidectomy methods with classical parotidectomy methods which we applied for ten years. Materials and Methods 37 females and 36 males total 73 patients who made parotidectomy between 2008 and 2018 were included in the study. The patients age, sex, histopathological diagnosis, surgical methods applied to malignant or benign tumors and side of the disease were recorded. Histopathological results and the results of surgical methods applied were compared with literature. Results The mean age of the 73 patients underwent parotidectomy was 54±34. Of the cases, 57 (78%) cases were benign and 16 (22%) were malignant. Histopathologically benign masses were found 3.5 time more common than malignant masses. The sides of diseases were observed at the near rates (right, left; 52%, 48%, respectively). The most often detected benign neoplasm was pleomorphic adenoma with 42 (74%) cases. The most often detected malignant neoplasm was mucoepidermoid carcinoma with 6 (43%) cases. As surgical method, superficial parotidectomy was applied to 64 (88%) patients, total parotidectomy to 9 (12%) patients and the neck dissection to 7 (10%) patients. Conclusion We recommend that to be applied the superficial parotidectomy as the smallest procedure to be performed in the surgery of parotid tumors and to be avoided from partial superficial parotidectomies. In short, we advocate to classical methods for the parotid tumor surgery.
Collapse
Affiliation(s)
- Vahit Mutlu
- Department of Otorhinolaryngology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Zulkuf Kaya
- Department of Otorhinolaryngology, Atatürk University School of Medicine, Erzurum, Turkey
| |
Collapse
|
44
|
Park GC, Roh JL, Cho KJ, Jin MH, Jung YG, Lee HW, Kim TG, Choi SH, Nam SY, Kim SY. Clinically Node-Negative Parotid Gland Cancers: Prognostic Factors of Survival and Surgical Extent. Oncology 2019; 98:102-110. [PMID: 31645043 DOI: 10.1159/000503580] [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: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Conservative parotidectomy is known to reduce morbidity, but has been rarely examined in patients with clinically node-negative (cN0) parotid cancers. We evaluated the clinicopathological variables influencing the outcomes of these patients and the efficacy of conservative parotidectomy. METHODS We reviewed the clinical and pathological data of 256 patients with cN0 parotid carcinomas who underwent curative surgery at our institution. Of these, 110 and 146 underwent conservative and total parotidectomy, respectively, with 83 undergoing elective neck dissection and 135 receiving postoperative radiotherapy. Univariate and multivariate analyses of variables predicting recurrence-free survival (RFS) and overall survival (OS) were performed. Morbidity, survival, and recurrence rates were compared between the conservative and total parotidectomy groups. RESULTS The 5-year RFS and OS rates in all patients were 85.7 and 91.4%, respectively. Multivariate analysis showed that advanced T classification, positive resection margin, and high-histologic grade were independent prognostic factors for both RFS and OS. Among the 201 patients with low- or intermediate-grade parotid cancers, those who underwent total parotidectomy had a greater chance of facial nerve paralysis than those who underwent conservative parotidectomy (p < 0.001). The 5-year RFS and OS after conservative parotidectomy (93.7 and 100%, respectively) were not worse than those after total parotidectomy (85.5 and 90.9%, respectively). CONCLUSION Patients with cN0 parotid cancers may be stratified by histological grade and T classification. Conservative parotidectomy may be suitable for early T1-2 low- or intermediate-grade tumors if a resection margin is secured.
Collapse
Affiliation(s)
- Gi Cheol Park
- Department of Otolaryngology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi Hyeon Jin
- Department of Biostatistics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Yong Gi Jung
- Department of Otolaryngology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hyoun Wook Lee
- Department of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
45
|
Martin H, Jayasinghe J, Lowe T. Superficial parotidectomy versus extracapsular dissection: literature review and search for a gold standard technique. Int J Oral Maxillofac Surg 2019; 49:192-199. [PMID: 31301925 DOI: 10.1016/j.ijom.2019.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/24/2019] [Accepted: 06/05/2019] [Indexed: 11/17/2022]
Abstract
Benign parotid tumours usually present as a slow-growing, asymptomatic mass in the pre-auricular region. Although they are uncommon, surgical excision is the mainstay of treatment due to the risk of malignant transformation in some benign tumours. Surgical techniques have evolved over the years, with superficial parotidectomy and extracapsular dissection being the current procedures of choice. There is currently no gold standard, and it remains unclear which surgical modality is the superior option. A literature review was performed in relation to the relative merits of each technique and to evaluate the reasons underpinning the ongoing debate. A total of 16 papers comparing the main clinical outcomes of the procedures were critically reviewed using the PRISMA protocol. Overall, extracapsular dissection indicated a reduced recurrence rate, facial nerve paralysis, Frey syndrome, and operation time. The superior outcomes following extracapsular dissection could be attributed to the less radical nature of the procedure. However, there were various limitations identified within the review that may have affected the results. Selection bias was the most significant, with patients assigned to the different procedures depending on the tumour size and location. Consequently, the debate continues as to what constitutes the gold standard of care for benign parotid tumours.
Collapse
Affiliation(s)
- H Martin
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK.
| | - J Jayasinghe
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - T Lowe
- University of Aberdeen Dental Institute, Aberdeen, UK; Oral and Maxillofacial Department, Aberdeen Royal Infirmary, Aberdeen, UK
| |
Collapse
|
46
|
Zheng C, Cao R, Gao M, Huang Z, Sheng M, Hu Y. Comparison of surgical techniques for benign parotid tumours: a multicentre retrospective study. Int J Oral Maxillofac Surg 2019; 48:187-192. [DOI: 10.1016/j.ijom.2018.07.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/12/2018] [Accepted: 07/27/2018] [Indexed: 11/25/2022]
|
47
|
Grosheva M, Pick C, Granitzka T, Sommer B, Wittekindt C, Klussmann JP, Guntinas‐Lichius O, Beutner D. Impact of extent of parotidectomy on early and long‐term complications: A prospective multicenter cohort trial. Head Neck 2019; 41:1943-1951. [DOI: 10.1002/hed.25651] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 08/21/2018] [Accepted: 12/21/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Maria Grosheva
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of Cologne Cologne Germany
| | - Carina Pick
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of Cologne Cologne Germany
| | - Thordis Granitzka
- Department of Otolaryngology, Head and Neck SurgeryJena University Hospital Jena Germany
| | - Barbara Sommer
- Department of Otolaryngology, Head and Neck SurgeryUniversity of Giessen Giessen Germany
| | - Claus Wittekindt
- Department of Otolaryngology, Head and Neck SurgeryUniversity of Giessen Giessen Germany
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of Cologne Cologne Germany
- Department of Otolaryngology, Head and Neck SurgeryUniversity of Giessen Giessen Germany
| | | | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of Cologne Cologne Germany
- Department of Otolaryngology, Head and Neck SurgeryUniversity of Goettingen Goettingen Germany
| |
Collapse
|
48
|
Burghartz M, Hackenberg S, Sittel C, Hagen R. Surgery of the major salivary glands and its impact on salivary flow-A review. Laryngoscope 2018; 129:2053-2058. [PMID: 30478835 DOI: 10.1002/lary.27587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to bring attention to a rather unnoted side effect of salivary gland surgery-reduced salivary flow. METHODS A systematic PubMed, Cochrane Library, LIVIVO, and Embase databases search was performed to identify relevant articles. RESULTS Eight studies matched the inclusion criteria. All studies described an association between salivary gland surgery and reduced salivary flow. In five of the eight studies, patients reported on xerostomia after salivary gland surgery. CONCLUSIONS Head and neck surgeons should inform their patients more accurately about reduced salivary flow and possible xerostomia after salivary gland surgery, and focus more on conservative strategies and minimally invasive techniques. Laryngoscope, 129:2053-2058, 2019.
Collapse
Affiliation(s)
- Marc Burghartz
- Department of Otorhinolaryngology-Head and Neck Surgery , Stuttgart Hospital, Stuttgart, Germany
| | - Stephan Hackenberg
- the Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery , University Hospital Würzburg, Würzburg, Germany
| | - Christian Sittel
- Department of Otorhinolaryngology-Head and Neck Surgery , Stuttgart Hospital, Stuttgart, Germany
| | - Rudolf Hagen
- the Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery , University Hospital Würzburg, Würzburg, Germany
| |
Collapse
|
49
|
Park SJ, Han S, Lee HJ, Ahn SH, Jeong WJ. Preservation of Salivary Function Following Extracapsular Dissection for Tumors of the Parotid Gland. J Oral Maxillofac Surg 2018; 76:2004-2010. [DOI: 10.1016/j.joms.2018.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 12/22/2022]
|
50
|
Kilavuz AE, Songu M, Pinar E, Ozkul Y, Ozturkcan S, Aladag I. Superficial Parotidectomy Versus Partial Superficial Parotidectomy: A Comparison of Complication Rates, Operative Time, and Hospital Stay. J Oral Maxillofac Surg 2018; 76:2027-2032. [DOI: 10.1016/j.joms.2018.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
|