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Song MS, Woo SH. Endoscope-Assisted Hairline Approach for Head and Neck Masses: A Review. Clin Exp Otorhinolaryngol 2023; 16:317-325. [PMID: 37536749 DOI: 10.21053/ceo.2022.01634] [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: 11/19/2022] [Accepted: 07/29/2023] [Indexed: 08/05/2023] Open
Abstract
Conventional surgery through a transcervical incision is indicated for the treatment of certain tumors in the head and neck. However, this method can cause multiple problems, including scarring and cosmetic concerns. The endoscope-assisted hairline approach, which serves as an alternative to conventional surgical procedures, is gaining popularity due to its excellent cosmetic and functional outcomes. However, given the anatomical complexity involved, the endoscope-assisted hairline technique is not frequently employed in head and neck surgery. The evolution of the hairline surgical approach has been influenced by changes in disease conditions and recent advances in surgical tools. This review article discusses the use of endoscope-assisted hairline approaches in the resection of head and neck masses, focusing on the surgical procedure and postoperative clinical outcomes.
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Affiliation(s)
- Min Seok Song
- Department of Otolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Seung Hoon Woo
- Department of Otolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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Yin S, Han Y, Liu Y, Chen B, Fu Z, Sheng S, Wang J, Shen C, Wang X, Jia Y. Comparison of various surgical incisions in parotidectomy: A systematic review and network meta-analysis. Front Oncol 2022; 12:972498. [PMID: 35992792 PMCID: PMC9389557 DOI: 10.3389/fonc.2022.972498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background This network meta-analysis aimed to comprehensively compare the operative and postoperative outcomes of different parotidectomy incisions. Methods Embase, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials were searched up to April 2022. A complete Bayesian network meta-analysis was performed using the Markov Monte Carlo method in OpenBUGS. Results Seventeen studies with 1609 patients were included. Thirteen were retrospective cohort studies, three were prospective cohort studies, and one was a randomized controlled study. The quality of evidence was rated as very low in most comparisons. The incision satisfaction score of the modified facelift incision (MFI), retroauricular hairline incision (RAHI), V-shaped incision (VI) were higher than that of the modified Blair incision (MBI) (MBI vs. MFI: mean difference [MD] -1.39; 95% credible interval [CrI] -2.23, -0.57) (MBI vs. RAHI: MD -2.25; 95% CrI -3.40, -1.12) (MBI vs. VI: MD -2.58; 95% CrI -3.71, -1.46); the tumor size treated by VI was smaller than that by MBI (MD 5.15; 95% CrI 0.76, 9.38) and MFI (MD 5.16; 95% CrI 0.34, 9.86); and the risk of transient facial palsy in the MFI was lower than that in the MBI (OR 2.13; 95% CrI 1.28, 3.64). There were no differences in operation time, drainage volume, wound infection, hematoma, salivary complications, Frey syndrome, or permanent facial palsy between incision types. Conclusion The traditional MBI is frequently used for large tumor volumes, but the incision satisfaction score is low and postoperative complication control is poor. However, emerging incisions performed well in terms of incision satisfaction scores and control of complications. More randomized controlled trials are needed to compare the different parotidectomy incisions. Patients should be fully informed about the characteristics of each incision to make the most informed decision, along with the physician’s advice. Systematic Review Registration PROSPERO, identifier CRD42022331756
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Affiliation(s)
- Siyue Yin
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Medical University, Hefei, China
| | - Yanxun Han
- Anhui Medical University, Hefei, China
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuchen Liu
- Anhui Medical University, Hefei, China
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bangjie Chen
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Medical University, Hefei, China
| | - Ziyue Fu
- Anhui Medical University, Hefei, China
| | | | | | | | | | - Yiwen Jia
- Department of Gastroenterology, The Third Affiliated Hospital of Anhui Medical University (Hefei first people’s Hospital), Hefei, China
- *Correspondence: Yiwen Jia,
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Matsumoto F, Ohba S, Fujimaki M, Kojima T, Sakyo A, Kojima M, Ikeda K. Efficacy of modified face lift incision for the resection of benign parotid gland tumor located anteriorly or superiorly. Auris Nasus Larynx 2021; 48:978-982. [PMID: 33468349 DOI: 10.1016/j.anl.2021.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The goals of resection of benign parotid gland tumor are complete resection of lesion and preservation of the facial nerve function. Traditionally, the bayonet-shaped incision (Blair incision: BI) and the modified face lift incision (mFLI) are commonly used for parotidectomy. However, concerns exist about the adequacy of exposure and identification of the facial nerve in anterior or superior parotid lesions. The aim of this study was to compare the surgical outcomes between BI and mFLI and to evaluate the adequacy, possible indications, and limitations of mFLI for the resection of benign parotid gland tumors located anteriorly or superiorly. METHODS This retrospective study analyzed the medical records of 175 patients with various types of benign parotid tumor who underwent partial parotidectomy via BI (97 patients) or mFLI (78 patients). Tumors were divided into five categories depending on their location: anterior, superior, inferior, middle, and deep lobe tumors. The outcomes of operation were analyzed according to tumor location between the incision types. RESULTS Tumor locations were not significantly different between the two groups. Transient facial palsy occurred in 23 out of 152 patients (15.1%); permanent palsy was not observed in either group. The incidence rates of facial palsy were higher among patients with superior and deep lobe tumors; in the mFLI and BI groups, proportions of superior tumors were 22.2% and 27.2%, respectively, and those of deep lobe tumors were 35.7% and 23.5%, respectively. With regard to superior and anterior tumors, the incidence rate of postoperative facial palsy was insignificantly lower in the mFLI group (10.5%) than in the BI group (18.2%). CONCLUSIONS There were no differences in the incidence rates of postoperative facial palsy between mFLI and BI for any tumor location. Use of the mFLI is feasible for the resection of most benign parotid tumors located anteriorly or superiorly.
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Affiliation(s)
- Fumihiko Matsumoto
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Japan.
| | - Shinichi Ohba
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Japan
| | - Mitsuhisa Fujimaki
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Japan
| | - Takashi Kojima
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Japan
| | - Airi Sakyo
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Japan
| | - Masataka Kojima
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Japan
| | - Katsuhisa Ikeda
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Japan
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Ahn D, Lee GJ, Sohn JH. Individualized Use of Facelift, Retroauricular Hairline, and V-Shaped Incisions for Parotidectomy. J Oral Maxillofac Surg 2020; 78:2339.e1-2339.e8. [PMID: 32949504 DOI: 10.1016/j.joms.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/23/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Despite the increased need for better cosmetic outcomes following parotidectomy, there is no study on the individualized use of esthetic approaches for parotidectomy. We aimed to evaluate the feasibility of individualzsed esthetic approaches for parotidectomy using facelift (FL), retroauricular hairline (RAH), and V-shaped incisions, and compare their surgical and cosmetic outcomes. METHODS This was a retrospective cohort study. Between 2015 and 2019, we included patients who underwent parotidectomy using FL, RAH, and V-shaped incisions for the treatment of benign parotid tumors. The surgical approach for parotidectomy was determined based on tumor location and each patient's cosmetic demand, following a comprehensive discussion of available esthetic approaches. Surgical and cosmetic outcomes were assessed as primary outcome variables, which were compared among the 3 incision groups. One-way analysis of variance/Kruskal-Wallis test and the chi-squared test were used to inspect differences in continuous and categorical variables, respectively, among the groups. RESULTS A total of 213 patients, consisting of 122, 50, and 41 patients in the FL, RAH, and V-shaped groups, respectively, were included in the present study. In the FL, RAH, and V-shaped groups, the patient age was 53.5, 51.8, and 42.1 years, respectively (P < .001), and the tumor size was 2.8, 2.7, and 1.9 cm, respectively (P < .001). All parotidectomies were successfully completed with no incision extension or major complications. The subjective scar satisfaction scores assessed at 3 months postoperatively were 8.5, 9.1, 9.2 in the FL, RAH, and V-shaped groups, respectively (P < .001). However, the Vancouver scar scale was consistent across all groups. CONCLUSIONS Individualized use of esthetic approaches for parotidectomy is feasible and yields improved cosmetic results, leading to high patient satisfaction. Although FL incision is still the standard approach for esthetic parotidectomy, both RAH and the V-shaped incisions could further enhance the cosmetic outcomes of parotidectomy.
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Affiliation(s)
- Dongbin Ahn
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Daegu, Korea.
| | - Gil Joon Lee
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Daegu, Korea
| | - Jin Ho Sohn
- Professor & Department Head, Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Daegu, Korea
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Gao L, Liang QL, Ren WH, Li SM, Xue LF, Zhi Y, Song JZ, Wang QB, Dou ZC, Yue J, Zhi KQ. Comparison of endoscope-assisted versus conventional resection of parotid tumors. Br J Oral Maxillofac Surg 2019; 57:1003-1008. [DOI: 10.1016/j.bjoms.2019.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
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Movassaghi K, Lewis M, Shahzad F, May JW. Optimizing the Aesthetic Result of Parotidectomy with a Facelift Incision and Temporoparietal Fascia Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2067. [PMID: 30881826 PMCID: PMC6416109 DOI: 10.1097/gox.0000000000002067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/19/2018] [Indexed: 11/27/2022]
Abstract
The 3 most common problems after a parotidectomy are cheek contour deformity, Frey syndrome (gustatory sweating), and a visible scar on the neck. These problems can potentially be prevented by (1) facelift type incisions, which eliminate the neck incision and (2) interposition of temporoparietal fascia at the parotidectomy site that fills the defect and provides a barrier to aberrant neuronal regeneration. We followed 11 patients who underwent parotidectomy (9 superficial and 2 total parotidectomies) for a variety of parotid tumors between December 2001 and January 2018. Facelift type incisions were used in all patients, and temporoparietal fascia flaps were used to fill the parotidectomy defects. The last 6 patients were tested for objective evidence of Frey syndrome with the Minor Starch Iodine test. Patients were then followed for up to 7 years (11 months to 7 years, average 3 years). All patients had well-hidden scars and good contour of the cheeks. None of the patients developed subjective or objective evidence of Frey syndrome. This small series suggests that the aesthetic result after parotidectomy can be improved by using a facelift incision and placement of a temporoparietal fascia flap into the parotidectomy defect. Additionally, the tissue barrier thus provided may also help to prevent Frey syndrome.
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Affiliation(s)
- Kiya Movassaghi
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Matthew Lewis
- From the Department of Surgery, Division of Plastic Surgery, Oregon Health & Science University, Portland, Ore
| | - Farooq Shahzad
- From the Department of Surgery, Division of Plastic Surgery, Oregon Health & Science University, Portland, Ore
- Department of Surgery, Division of Plastic Surgery, Northwestern University, Chicago, Ill
| | - James W. May
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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The Effectiveness of Sternocleidomastoid Flap Versus Superficial Musculoaponeurotic System Flap for the Prevention of Frey Syndrome and Facial Depressed Deformity in Parotid Surgery for Pleomorphic Adenoma. Ann Plast Surg 2018; 80:125-129. [DOI: 10.1097/sap.0000000000001233] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dell'Aversana Orabona G, Salzano G, Abbate V, Piombino P, Astarita F, Iaconetta G, Califano L. Use of the SMAS flap for reconstruction of the parotid lodge. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 35:406-11. [PMID: 26900246 PMCID: PMC4755052 DOI: 10.14639/0392-100x-395] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The purpose of our study was to evaluate the benefits of the SMAS flap in patients with benign tumours of the parotid gland treated by superficial parotidectomy. We carried out a retrospective chart review on 123 patients suffering from benign tumours of the parotid gland admitted to our Institution between March 1997 and March 2010. A superficial parotidectomy was performed in all the cases reported. Our sample was divided in two groups basing SMAS flap reconstruction done (Group 2) or not (Group 1) after superficial parotidectomy. Reconstruction using SMAS flap was accomplished in 64 patients. Chi-square test was used to assess statistical difference between the two groups. The level of statistical significance was P < 0.05. No significant differences concerning hematoma, wound infection and facial paralysis were observed between the first and second group (3.38 vs 1.56% [P > 0.05], 8.47% vs 4.68% [P > 0.05], 5.08% vs 0.00% [P > 0.05]). Transient facial nerve weakness, fistula, dip skin and Frey's syndrome were significantly more frequent without SMAS flap reconstruction (10.16% vs 3.125% [P < 0.05], 13.55% vs 3.125% [P < 0.05], 13.55% vs 3.125% [P < 0.05], 20.33% vs 0% [P < 0.05] respectively). The use of the SMAS flap is able to reduce the cosmetic and functional complications that occur after the removal of a benign tumour of the parotid through the superficial parotidectomy technique, above all, it reduces the occurrence of Frey's syndrome.
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Affiliation(s)
- G Dell'Aversana Orabona
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
| | - G Salzano
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
| | - V Abbate
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
| | - P Piombino
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
| | - F Astarita
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
| | - G Iaconetta
- Neurosurgery Department, University of Salerno, Salerno, Italy
| | - L Califano
- Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Science, Federico II University
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Gao L, Ren W, Li S, Yan X, Li F, Yuan R, Shang W, Zhi K. Comparing Modified with Conventional Parotidectomy for Benign Parotid Tumors. ORL J Otorhinolaryngol Relat Spec 2017; 79:264-273. [DOI: 10.1159/000479742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
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10
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Woo SH, Park JJ, Kwon M, Pyeong Kim J. “Hidden scar” submandibular gland excision using an endoscope-assisted hairline approach. Oral Oncol 2017; 65:83-88. [DOI: 10.1016/j.oraloncology.2016.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/16/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
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Pham M, Eviston TJ, Clark JR. Reconstruction of limited parotidectomy defects using the dermofat graft. ANZ J Surg 2016; 87:E256-E260. [DOI: 10.1111/ans.13608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 02/20/2016] [Accepted: 03/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- My Pham
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse at RPA; Sydney New South Wales Australia
| | - Timothy J. Eviston
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse at RPA; Sydney New South Wales Australia
| | - Jonathan R. Clark
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse at RPA; Sydney New South Wales Australia
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
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Free abdominal fat transfer for partial and total parotidectomy defect reconstruction. Laryngoscope 2016; 126:2694-2698. [DOI: 10.1002/lary.26025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 03/06/2016] [Accepted: 03/16/2016] [Indexed: 11/07/2022]
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Modification of Blair Approach With a Modified Endaural Component to Access the Parotid Region. J Craniofac Surg 2016; 26:1972-4. [PMID: 26192031 DOI: 10.1097/scs.0000000000001917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study is to present our experience with a modification of the Blair approach to the parotid area, by means of a modified endaural component, which provides both excellent exposure and optimal functional and esthetic results, mainly over the preauricular area. PATIENTS AND METHODS A retrospective case series study was performed. It included surgical cases of patients who were operated on the parotid region in which the mentioned approach was indicated. The information was collected from the database available at the Universidad El Bosque Oral and Maxillofacial Surgery Department in Bogota, Colombia from 2008 to 2013. RESULTS The sample consisted of 12 patients, with ages ranging from 23 to 56 years and a mean age of 38 years. A total of 8 patients were women and 4 patients were men. Parotid pathologies included salivary gland tumor (10 patients) and cranial base tumor (2 patients). Procedures executed were: superficial lobe and total parotidectomy resection, pharynx extended and cranial base tumor resections. CONCLUSIONS This investigation presents our experience with a modified approach to the parotid region. This approach gives an extended and safe exposure to the region with excellent cosmetic outcomes.
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Modified facelift incision for partial parotidectomy versus bayonet-shaped incision: a comparison using visual analog scale. Eur Arch Otorhinolaryngol 2016; 273:3269-75. [DOI: 10.1007/s00405-015-3878-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
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Eleven Years of Parotid Gland Surgery in a Plastic and Reconstructive Department. J Craniofac Surg 2016; 27:e26-33. [DOI: 10.1097/scs.0000000000002299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Woo SH, Kim JP, Baek CH. Endoscope-assisted extracapsular dissection of benign parotid tumors using hairline incision. Head Neck 2015; 38:375-9. [DOI: 10.1002/hed.23901] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 07/22/2014] [Accepted: 10/24/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Seung Hoon Woo
- Department of Otolaryngology; Gyeongsang National University; Jinju Korea
- Institute of Health Sciences; Gyeongsang National University; Jinju Korea
| | - Jin Pyeong Kim
- Department of Otolaryngology; Gyeongsang National University; Jinju Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology - Head and Neck Surgery; Sungkyunkwan University School of Medicine, Samsung Medical Center; Seoul South Korea
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Ghassemi A, Shamsinejad M, Gerressen M, Talebzadeh M, Rüben A, Modabber A. Esthetic outcome after soft tissue reconstruction of the face using deep dissection and composite facelift technique. J Oral Maxillofac Surg 2013; 71:1415-23. [PMID: 23540429 DOI: 10.1016/j.joms.2013.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/28/2013] [Accepted: 02/01/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Large defects in the face resulting from the excision of malignant tumors, trauma, and congenital malformation pose a significant challenge to reconstructive surgeons. Achieving good esthetic and functional outcomes is often very demanding. PATIENTS AND METHODS A facelift technique was used in 47 patients (25 female, 22 male; age range, 17.5 to 82.3 years; mean age, 49.3 years) to replace lost tissue of the face from 2009 through 2012. The minimum defect size was 2 cm in diameter and the maximum was 8 cm. To achieve tension-free coverage with a reliable blood supply, a deep-plane dissection, including the skin and superficial musculoaponeurotic system (SMAS), was performed. The deep sub-SMAS dissection was extended into the neck and the contralateral part, as needed. A thick flap was created and composite lifting was performed. RESULTS No significant deformity concerning the lower eyelids, nose, and lip was registered. Most scars could be placed in hidden regions and became undetectable after a year. The facial nerve function remained intact in all patients. CONCLUSION Using these facelift techniques, including the incision, sub-SMAS dissection for volumetric positioning of the skin, and the SMAS flap, the closure of extensive facial defects with excellent functional and esthetic results is conceivable.
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Affiliation(s)
- Alireza Ghassemi
- Department of Oral, Maxillofacial, and Plastic Facial Surgery, University Hospital RWTH-Aachen, Aachen, Germany.
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Grover N, D'Souza A. Facelift approach for parotidectomy: an evolving aesthetic technique. Otolaryngol Head Neck Surg 2013; 148:548-56. [PMID: 23380762 DOI: 10.1177/0194599812475221] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To systematically review the literature on the modified facelift incision for parotidectomy and to identify the scope and safety of this approach, along with cosmetic outcomes. Where available, a direct comparison was made with Blair's incision (BI). DATA SOURCES Medline, PubMed, Cochrane, and CINHAL databases for English-language studies published between 1960 and 2011 on the facelift approach for parotidectomy. REVIEW METHODS Exclusion criteria were studies reporting on concurrent facelift, studies that used synthetic material for reconstruction of the surgical bed, descriptive studies, and studies with duplicate patient data. Outcome measures were candidacy for surgery, variations in incision, cosmetic outcomes, surgical time, complication rates, and limitations. RESULTS Of the initial 139 studies, 11 studies encompassing 628 patients were included. Male-to-female ratio was 0.49:1, and average age was 47.1 years. In total, 582 surgeries were performed for benign lesions. Only 10 studies specified the extent of surgery: 8 authors used it for performing superficial/partial parotidectomy, and 2 described 17 cases of total parotidectomy. Tumors up to 8 cm have been excised, with a median value of 4 cm. Operative time, formally analyzed in 3 studies, was not significantly different when compared with BI. Complication rates were not increased with this approach. Aesthetic outcomes pertaining to postoperative scar were good, as reported by the patients. CONCLUSION The facelift approach is a cosmetically superior approach to parotid tumors as proven by objective data. Most publications in the literature pertaining to the modified facelift incision for parotidectomy have been in the past decade, lending credence to its rising popularity.
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Affiliation(s)
- Nancy Grover
- Department of Otolaryngology Head and Neck Surgery, University Hospital Lewisham, London, UK.
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Borumandi F, George KS, Cascarini L. Parotid surgery for benign tumours. Oral Maxillofac Surg 2012; 16:285-290. [PMID: 22847039 DOI: 10.1007/s10006-012-0352-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 07/25/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE The majority of parotid tumours are benign, making parotid surgery a compromise between adequate tumour excision and preservation of function and facial harmony. Besides the traditional superficial or total parotidectomy, less invasive techniques have been described with similar recurrent rates. The aim of this review is to assess the evidence in the published literature and to summarise the advantages and disadvantages of the available techniques. METHODS A systematic search in Pubmed for studies on surgery of benign parotid tumours (BPTs) published between January 2000 and January 2012 was conducted. Case series with a clear description of the surgical technique and a minimum number of 10 patients were included. RESULTS Four hundred sixty-three articles were found, 49 abstracts reviewed and 37 case series were selected for this review. The surgical techniques for benign parotid tumours can largely be grouped into facial nerve dissecting (superficial parotidectomy, partial superficial parotidectomy and total parotidectomy) and non-nerve dissecting techniques (extracapsular dissection). With all of the currently used techniques, a low recurrence (<3 %) with a low incidence of permanent facial nerve morbidity (0.2-4 %) can be achieved. The tumour-facial nerve interface and pseudopodia are areas at risk for positive margins. CONCLUSION There is currently no agreement in the literature about the extent of surgery for BPTs to obtain an adequate margin. The tumour nerve interface is the predetermined area at risk for tumour spillage and positive margin. A prolonged follow-up is recommended. Further long-term randomised clinical trials are required to address the question of the extent of the excision in benign parotid surgery.
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Affiliation(s)
- Farzad Borumandi
- Department of Oral and Maxillofacial Surgery, Northwick Park Hospital, North West London Hospitals NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK.
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