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

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

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

Comparison of different methods for evaluating the relationship between facial nerve and benign parotid tumors

Objectives

The goals of benign parotid gland tumor resection are complete resection of the lesion and preservation of the facial nerve function. As the facial nerve cannot be directly visualized via imaging modalities, several methods, including the facial nerve line, Utrecht line, retromandibular vein, Stenon duct, and minimum fascia-tumor distance techniques, have been developed to estimate its location. However, there are no reports on their accuracy in determining tumor location. In the present study, we aimed to assess the diagnostic accuracy of these methods based on tumor location.

Methods

This retrospective study analyzed medical records and histological reports of 359 patients with various types of benign parotid gland tumors who underwent a parotidectomy between April 2014 and March 2020. The tumor location was subdivided into the following sections: anterior, superior, inferior, and middle. The tumor location was estimated using five methods: facial nerve line, Utrecht line, retromandibular vein, Stenon duct, and minimum fascia-tumor distance. The final diagnosis of superficial or deep lobe tumor was made based on surgical findings.

Results

Each method showed a higher accuracy for superficial tumors (was more than 90%) than for deep lobe tumors. In contrast, for deep lobe tumors, the accuracy of diagnosis with the facial nerve line, Utrecht line, and retromandibular vein methods was low, in the 30% range. Among all methods, the Stenon duct method had the highest accuracy in the diagnosis of deep lobe tumors. The SD method was most useful in cases where both the duct and tumors were detected. The minimum fascia-tumor distance method had the second highest diagnostic accuracy (63%); however, for anterior tumors, it tended to provide false negatives.

Conclusions

All tested methods were useful in diagnosing superficial lobe tumors; however, they were not helpful in diagnosing deep lobe tumors, especially anterior tumors.

Comparison of various surgical incisions in parotidectomy: A systematic review and network meta-analysis

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