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Srivastava P, Kumar S, Singh AB, Chandra M, Singh HP. Extended cervicomastoid approach with sternocleidomastoid flap reconstruction for parotid surgery: A better esthetic technique. Natl J Maxillofac Surg 2022; 13:384-389. [PMID: 36683934 PMCID: PMC9851352 DOI: 10.4103/njms.njms_421_21] [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: 06/16/2021] [Revised: 08/30/2021] [Accepted: 09/15/2021] [Indexed: 01/25/2023] Open
Abstract
Aim of the Study The aim of the study is to compare the esthetic outcome of extended cervicomastoid approach with reconstruction with conventional approach (modified Blair's incision) for parotid surgery. Materials and Methods 48 patients were enrolled and grouped into A: surgery through extended cervicomastoid incision with sternocleidomastoid reconstruction and B: surgery through modified Blair's incision. After parotid surgery, patients were followed up to 6 months on the basis of flap ischemia, patient satisfaction, and cosmesis (visual analog scale [VAS]). Results In our study, preauricular depression over the face was present in 4.2% and 95.8% patients Group A and B at 6 months, respectively (P < 0.001) and retromandibular depression (70.8%) in Group B (P < 0.001). Subjective Frey's syndrome was present in 8.3% of patients of Group B (P > 0.05). The mean value of VAS between the two groups was 1.08 ± 0.28 and 3.29 ± 0.62 at 6 months (P = 0.001) while mean change was significantly (P = 0.03) higher in Group A (1.00 ± 0.00) as compared to Group B (0.20 ± 0.72) from postoperative to 6 months, respectively. Patient of Group A had good satisfaction level (62.5% and 91.7%) at 6 weeks and 6 months while Group B patients had fair satisfaction level (87.5%) at 6 weeks and poor satisfaction level 79.2% at 6 months. Conclusion Parotidectomy through extended cervicomastoid incision with sternocleidomastoid flap reconstruction experienced lower rates of postoperative complications, flap necrosis, and gustatory sweating in comparison to cervicomastoid facial approach, and thus, the previous incision is esthetically superior that allows cheek contour reconstruction with no increase in operative time or postoperative complications.
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Affiliation(s)
- Priyanka Srivastava
- Department of Otorhinolaryngology and Head Neck Surgery, Super Speciality Cancer Institute and Hospital, Lucknow, Uttar Pradesh, India
| | - Sunil Kumar
- Department of Otorhinolaryngology and Head Neck Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Abhishek Bahadur Singh
- Department of Otorhinolaryngology and Head Neck Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Manish Chandra
- Department of Otorhinolaryngology and Head Neck Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Hitendra Prakash Singh
- Department of Otorhinolaryngology and Head Neck Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
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Cameron N, Balsiger R, Prueter J, Kadakia S. Transfacial transmandibular approach to the masticator space: Excision of odontogenic myxoma arising from the mandibular condyle. Am J Otolaryngol 2021; 42:102944. [PMID: 33592553 DOI: 10.1016/j.amjoto.2021.102944] [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: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
Odontogenic myxomas are an uncommon benign odontogenic tumor that can present with a wide variety of symptomatology depending on location and potentially be locally destructive. The present case describes a 66-year-old female who presented with left lower facial paresthesia, left aural fullness and hearing loss. She was found to have an odontogenic myxoma that involved the condylar head and extended into the masticator space. In this report we detail our surgical approach utilizing a preauricular transfacial transmandibular approach to the masticator space. In addition, we will discuss various approaches to the masticator space and infratemporal fossa along with considerations on how to manage facial nerve paralysis, facial contour deformities, and post-operative rehabilitation for permanent unilateral condylar head disarticulation.
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Affiliation(s)
- Nicholas Cameron
- Department of Otolaryngology-Head and Neck Surgery, Kettering Health Network, Dayton, OH, United States of America.
| | - Robert Balsiger
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, United States of America.
| | - James Prueter
- Department of Otolaryngology-Head and Neck Surgery, Southwest Ohio ENT, Dayton, OH, United States of America
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Boonshoft School of Medicine at Wright State University, Premier Health Comprehensive Head and Neck Oncology and Reconstruction Program, 30 E Apple St, Suite 2200, Dayton, OH 45409, United States of America.
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3
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De Virgilio A, Costantino A, Russo E, Ferreli F, Pellini R, Petruzzi G, Zocchi J, Spriano G, Mercante G. Different Surgical Strategies in the Prevention of Frey Syndrome: A Systematic Review and Meta-analysis. Laryngoscope 2021; 131:1761-1768. [PMID: 33502015 DOI: 10.1002/lary.29414] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/17/2020] [Accepted: 01/12/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS To define the best surgical technique able to reduce Frey syndrome (FS) incidence after parotidectomy. STUDY DESIGN Systematic review and network meta-analysis. METHODS An arm-based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were the incidence of subjective (clinical) and objective (positive starch-iodine test result) FS, respectively. RESULTS A total of 3830 patients with a median age of 50.35 years (n = 2323; IQR 44.25-54.18) were included for six interventions [temporoparietal fascia (TPFF), free fat graft (FFG), acellular dermal matrix (ADM), sternocleidomastoid muscle (SCM) flap, and superficial musculoaponeurotic system (SMAS) flap]. If compared to no treatment, the greatest reduction of subjective (clinical) FS incidence was measured for the TPFF (OR: 0.07, CI: 0.004-0.57), the ADM (OR: 0.09, CI: 0.02-0.35), and the FFG (OR: 0.11, CI: 0.03-0.42) techniques. However, a significant difference was measured also for the SCM flap (OR: 0.38, CI: 0.18-0.73) and for the SMAS flap (OR: 0.42, CI: 0.19-0.97). All treatments showed a significant reduction of the objective FS incidence if compared to no treatment (FFG, OR: 0.06, CI: 0.002-0.62; TPFF, OR: 0.07, CI: 0.01-0.33; ADM, OR: 0.11, CI: 0.03-0.44; SMAS, OR: 0.36, CI: 0.17-0.71; SCM, OR: 0.40, CI: 0.19-0.74). CONCLUSIONS TPFF, ADM, and FFG seem to be the best treatment strategies to prevent FS after parotidectomy. Further randomized controlled trials comparing these techniques should be conducted to define specific indications. Laryngoscope, 131:1761-1768, 2021.
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Affiliation(s)
- Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, Italy
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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.
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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
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Giotakis EI, Giotakis AI. Modified facelift incision and superficial musculoaponeurotic system flap in parotid malignancy: a retrospective study and review of the literature. World J Surg Oncol 2020; 18:8. [PMID: 31918725 PMCID: PMC6953144 DOI: 10.1186/s12957-020-1785-3] [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: 11/11/2019] [Accepted: 01/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background Data reporting the use of modified facelift incision (MFI) approach with or without superficial musculoaponeurotic system (SMAS) reconstruction in parotid malignancy are limited. To enhance the limited knowledge in this subject, the authors of the current study report quality data of MFI in patients with parotid malignancy with or without SMAS reconstruction. Methods We performed a retrospective review of parotid malignancy patients treated with the MFI over a 5-year period (2015–2019) in the 1st ENT University Department, University of Athens, Greece. Results We identified five patients with parotid malignancy. We performed MFI parotidectomy in 5/5 patients and SMAS reconstruction in 2/5 patients. All tumors were classified as T1N0M0. After a mean follow-up of 43.6 months (minimum, 36; maximum, 55), we noted no recurrence. The patients reported no Frey’s syndrome. Conclusions The authors of the current study suggest consideration of the MFI approach in parotid malignancy. A MFI approach should at least favor small parotid tumors without neck metastatic disease (T1cN0). Surgeons could also address larger tumors with a MFI approach. Surgeons should reconstruct the parotid lodge with a SMAS advancement flap in tumors not in proximity with the SMAS.
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Affiliation(s)
- Evangelos I Giotakis
- First Department of Otorhinolaryngology, Hippocration Hospital, Medical University of Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
| | - Aris I Giotakis
- First Department of Otorhinolaryngology, Hippocration Hospital, Medical University of Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece.
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Cosmetic outcome of implantation of cross-linked human acellular dermal matrix after parotidectomy. Br J Oral Maxillofac Surg 2019; 57:301-305. [DOI: 10.1016/j.bjoms.2019.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/25/2019] [Indexed: 11/21/2022]
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Jo MG, Lee DJ, Cha W. A modified V-shaped incision combined with superficial musculo-aponeurotic system flap for parotidectomy. Acta Otolaryngol 2019; 139:178-183. [PMID: 30870057 DOI: 10.1080/00016489.2018.1562216] [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] [Indexed: 10/27/2022]
Abstract
BACKGROUND V-shaped incision (VSI) for parotidectomy had been introduced for cosmetic purpose. Despite having aesthetic superiority, it required excessive retraction or an additional hairline incision for adequate surgical exposure. To overcome these problems, we conceptualized a modified VSI approach combined with a separate superficial musculo-aponeurotic system flap. AIMS This study aimed to propose this approach and evaluate its technical feasibility and efficacy for excision of parotid tumors. MATERIALS AND METHODS This is a prospective, nonrandomized study involving 74 patients with small-to-medium (<4 cm), benign parotid tumors located superficially. The patients were divided into two groups based on the incision techniques used: modified VSI and modified Blair incision (MBI). The clinical outcomes of both approaches for parotidectomy were analyzed. RESULTS Thirty-four patients underwent modified VSI approach, while 40 underwent MBI. All parotidectomies with modified VSI were successfully completed without any further incision, and no facial nerve injury or intraoperative tumor rupture complication was reported. There were no significant differences in the complications between both approaches, such as hematoma, infection, wound dehiscence, skin necrosis, sialocele, or sensory disturbance. The modified VSI group showed better cosmetic satisfaction results than did the MBI group (9.2 and 7.8, respectively; p < .001). CONCLUSIONS AND SIGNIFICANCE The modified VSI approach is safe and feasible for small-to-medium benign parotid tumors. This approach could be a possible option for patients with a high cosmetic demand. LEVEL OF EVIDENCE 4. STUDY DESIGN Prospective pilot study.
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Affiliation(s)
- Min-Gyu Jo
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan, Republic of Korea
| | - Dong-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan, Republic of Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University College of Medicine, Busan, Republic of Korea
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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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10
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Irvine LE, Larian B, Azizzadeh B. Locoregional Parotid Reconstruction. Otolaryngol Clin North Am 2016; 49:435-46. [DOI: 10.1016/j.otc.2015.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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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12
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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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Nofal AAF, Mohamed M. Sternocleidomastoid Muscle Flap after Parotidectomy. Int Arch Otorhinolaryngol 2015; 19:319-24. [PMID: 26491478 PMCID: PMC4593913 DOI: 10.1055/s-0035-1549155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/23/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Most patients after either superficial or total parotidectomy develop facial deformity and Frey syndrome, which leads to a significant degree of patient dissatisfaction. Objective Assess the functional outcome and esthetic results of the superiorly based sternocleidomastoid muscle (SCM) flap after superficial or total parotidectomy. Methods A prospective cohort study for 11 patients subjected to parotidectomy using a partial-thickness superiorly based SCM flap. The functional outcome (Frey syndrome, facial nerve involvement, and ear lobule sensation) and the esthetic results were evaluated subjectively and objectively. Results Facial nerve palsy occurred in 5 cases (45%), and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 3 patients (27%), although only 1 (9%) subjectively complained of gustatory sweating. The designed visual analog score completed by the patients themselves ranged from 0 to 3 with a mean of 1.55 ± 0.93; the scores from the blinded evaluators ranged from 1 to 3 with a mean 1.64 ± 0.67. Conclusion The partial-thickness superiorly based SCM flap offers a reasonable cosmetic option for reconstruction following either superficial or total parotidectomy by improving the facial deformity. The flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve.
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Affiliation(s)
| | - Morsi Mohamed
- Department of General Surgery, Zagazig University, Zagazig, Egypt
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García-Díez EM, Cho-Lee GY, Raigosa-García JM, Sieira-Gil R, Pagès CM. Rhytidectomy Approach for Mandibular Reconstruction With Microvascular Free Flaps After Resection of Mandibular Benign Tumors. J Oral Maxillofac Surg 2013; 71:2156-68. [DOI: 10.1016/j.joms.2013.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 05/05/2013] [Accepted: 05/06/2013] [Indexed: 11/25/2022]
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Dermofat Graft After Superficial Parotidectomy to Prevent Frey Syndrome and Depressed Deformity. J Craniofac Surg 2013; 24:1260-2. [DOI: 10.1097/scs.0b013e31828025e2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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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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Liu H, Li Y, Dai X. Modified face-lift approach combined with a superficially anterior and superior-based sternocleidomastoid muscle flap in total parotidectomy. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:593-9. [DOI: 10.1016/j.tripleo.2011.04.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 04/18/2011] [Indexed: 11/25/2022]
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Arden RL, Miguel GS. Aesthetic parotid surgery: Evolution of a Technique. Laryngoscope 2011; 121:2581-5. [DOI: 10.1002/lary.22154] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/06/2011] [Accepted: 06/14/2011] [Indexed: 11/09/2022]
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Kyrgidis A, Triaridis S. Facelift Approach in Benign Parotid Surgery, Frey Syndrome, and Total Superficial Parotidectomy. J Oral Maxillofac Surg 2011; 69:2486-7. [DOI: 10.1016/j.joms.2011.06.223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 06/03/2011] [Accepted: 06/17/2011] [Indexed: 10/17/2022]
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Lin TC, Chen PR, Wen YH, Chou YF. Intra-auricular modification of facelift incision with sternocleidomastoid flap - a cosmetic approach for parotidectomy: how we do it. Clin Otolaryngol 2011; 36:375-9. [DOI: 10.1111/j.1749-4486.2011.02314.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zhi K, Ren W, Gao L, Zhao L, Huang S, Li J, Guo F. Face-lift incision combined with sternomastoid muscular flap in parotidectomy. Aesthetic Plast Surg 2011; 35:558-62. [PMID: 21403992 DOI: 10.1007/s00266-011-9663-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 01/06/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND To improve the aesthetic outcome of a traditional parotidectomy, this study used a face-lift incision combined with a sternomastoid muscular (SCM) flap and compared the classical method with these techniques from the patient's perspective. METHODS Between 2005 and 2007, 38 patients with benign parotid disease underwent surgery. The patients were retrospectively assigned to two groups according to the surgical technique used. Parotidectomy was performed using a combined face-lift incision and SCM flap for 18 patients (modified group). Another 20 patients received classical parotidectomy (Blair incision without reconstruction) (classical group). The patients were followed up every 3 months for 3 years. During the follow-up period, the patients were specifically asked about their satisfaction with their postoperative appearance. RESULTS During the follow-up period, all the patients in the group that had the face-lift incision and SCM flap were satisfied with the aesthetic outcome, and the depression deformity was considerably less. Nine patients in the classical group were not satisfied with the aesthetic outcome. CONCLUSION The face-lift incision and SCM flap technique can be performed safely with satisfactory cosmetic and functional results. It results in improved patient satisfaction without additional risk of complications.
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Affiliation(s)
- Keqian Zhi
- Department of Oral and Maxillofacial Surgery/Oncological Head and Neck Surgery, Stomatological Hospital, Xi'an Jiaotong University, Number 98, Xiwu Road, Xi'an, ShaanXi 710004, China.
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Amin A, Mostafa A, Rifaat M, Nabawi A, Shallan M, Rabie A, Elzohairy M. Parotidectomy for benign parotid tumors: An aesthetic approach. J Egypt Natl Canc Inst 2011; 23:67-72. [DOI: 10.1016/j.jnci.2011.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 05/20/2011] [Indexed: 11/29/2022] Open
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Dermofat Graft After Superficial Parotidectomy Via a Modified Face-Lift Incision to Prevent Frey Syndrome and Depressed Deformity. J Craniofac Surg 2011; 22:1021-3. [DOI: 10.1097/scs.0b013e3182101655] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Improving Esthetic Results in Benign Parotid Surgery: Statistical Evaluation of Facelift Approach, Sternocleidomastoid Flap, and Superficial Musculoaponeurotic System Flap Application. J Oral Maxillofac Surg 2011; 69:1235-41. [DOI: 10.1016/j.joms.2010.03.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 01/23/2010] [Accepted: 03/04/2010] [Indexed: 11/21/2022]
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Bianchi B, Ferri A, Ferrari S, Copelli C, Blasio CD, Sesenna E. Reply to “Comments on Improving Aesthetic Results in Benign Parotid Surgery: Statistical Evaluation of the Facelift Approach, Sternocleidomastoid Flap, and Superficial Musculoaponeurotic System Flap Application”. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2010.10.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shekar K, Singh M, Godden D, Puxeddu R, Brennan PA. Recent advances in the management of salivary gland disease. Br J Oral Maxillofac Surg 2009; 47:594-7. [DOI: 10.1016/j.bjoms.2009.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2009] [Indexed: 11/28/2022]
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Curry JM, King N, Reiter D, Fisher K, Heffelfinger RN, Pribitkin EA. Meta-analysis of Surgical Techniques for Preventing Parotidectomy
Sequelae. ACTA ACUST UNITED AC 2009. [DOI: 10.1001/archfaci.2009.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joseph M. Curry
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nancy King
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David Reiter
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kyle Fisher
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ryan N. Heffelfinger
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Edmund A. Pribitkin
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Curry JM, King N, Reiter D, Fisher K, Heffelfinger RN, Pribitkin EA. Meta-analysis of Surgical Techniques for Preventing Parotidectomy Sequelae. ACTA ACUST UNITED AC 2009; 11:327-31. [DOI: 10.1001/archfacial.2009.62] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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