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Chai XD, Jiang H, Tang LL, Zhang J, Yue LF. Factors influencing Frey syndrome after parotidectomy with acellular dermal matrix. World J Clin Cases 2024; 12:1578-1584. [PMID: 38576730 PMCID: PMC10989425 DOI: 10.12998/wjcc.v12.i9.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/22/2024] [Accepted: 02/25/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Frey syndrome, also known as ototemporal nerve syndrome or gustatory sweating syndrome, is one of the most common complications of parotid gland surgery. This condition is characterized by abnormal sensations in the facial skin accompanied by episodes of flushing and sweating triggered by cognitive processes, visual stimuli, or eating. AIM To investigate the preventive effect of acellular dermal matrix (ADM) on Frey syndrome after parotid tumor resection and analyzed the effects of Frey syndrome across various surgical methods and other factors involved in parotid tumor resection. METHODS Retrospective data from 82 patients were analyzed to assess the correlation between sex, age, resection sample size, operation time, operation mode, ADM usage, and occurrence of postoperative Frey syndrome. RESULTS Among the 82 patients, the incidence of Frey syndrome was 56.1%. There were no significant differences in sex, age, or operation time between the two groups (P > 0.05). However, there was a significant difference between ADM implantation and occurrence of Frey syndrome (P < 0.05). ADM application could reduce the variation in the incidence of Frey syndrome across different operation modes. CONCLUSION ADM can effectively prevent Frey syndrome and delay its onset.
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Affiliation(s)
- Xian-Da Chai
- Department of Oral and Maxillofacial Surgery, People’s Hospital of Anshun, Anshun 561000, Guizhou Province, China
| | - Huan Jiang
- Department of Oral and Maxillofacial Surgery, People’s Hospital of Anshun, Anshun 561000, Guizhou Province, China
| | - Ling-Ling Tang
- Department of Oral and Maxillofacial Surgery, People’s Hospital of Anshun, Anshun 561000, Guizhou Province, China
| | - Jing Zhang
- Department of Oral and Maxillofacial Surgery, People’s Hospital of Anshun, Anshun 561000, Guizhou Province, China
| | - Long-Fei Yue
- Department of General Practice, People’s Hospital of Anshun, Anshun 561000, Guizhou Province, China
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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.
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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.
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Ho CF, Hsin LJ, Yang SW, Tsai YT, Tsai MS, Lee YC. Postauricular incision versus conventional transcervical incision in submandibular gland excision: A systematic review and meta-analysis. Asian J Surg 2023; 46:18-23. [PMID: 35382969 DOI: 10.1016/j.asjsur.2022.03.072] [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: 01/06/2022] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 12/16/2022] Open
Abstract
Surgical removal of the submandibular gland is indicated for different conditions affecting the gland, such as neoplasm, sialadenitis, and sialolithiasis, and different types of surgical approaches have been reported. The purpose of this meta-analysis was to evaluate the differences between the postauricular approach and conventional transcervical approach in submandibular gland excision. A systematic review was performed using PubMed, Embase and the Cochrane Library to identify studies comparing outcomes of submandibular gland surgery via the postauricular approach and conventional transcervical approach. The data of interest were analyzed with Comprehensive Meta-Analysis software (version 3; Biostat, Englewood, NJ). Dichotomous data and continuous data were analyzed by calculating the risk difference (RD) and the mean difference (MD) with the 95% confidence interval (CI), respectively. The results show that the postauricular incision is a feasible approach to access the submandibular gland, and compared with the conventional transcervical approach, it requires a longer operative duration but has a similar complication rate and yields better cosmetic outcomes.
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Affiliation(s)
- Che-Fang Ho
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Li-Jen Hsin
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Shih-Wei Yang
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Yi-Chan Lee
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan.
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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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Apparent Diffusion Coefficient (ADC) Histogram Analysis in Parotid Gland Tumors: Evaluating a Novel Approach for Differentiation between Benign and Malignant Parotid Lesions Based on Full Histogram Distributions. Diagnostics (Basel) 2022; 12:diagnostics12081860. [PMID: 36010211 PMCID: PMC9406314 DOI: 10.3390/diagnostics12081860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess the diagnostic value of ADC distribution curves for differentiation between benign and malignant parotid gland tumors and to compare with mean ADC values. 73 patients with parotid gland tumors underwent head-and-neck MRI on a 1.5 Tesla scanner prior to surgery and histograms of ADC values were extracted. Histopathological results served as a reference standard for further analysis. ADC histograms were evaluated by comparing their similarity to a reference distribution using Chi2-test-statistics. The assumed reference distribution for benign and malignant parotid gland lesions was calculated after pooling the entire ADC data. In addition, mean ADC values were determined. For both methods, we calculated and compared the sensitivity and specificity between benign and malignant parotid gland tumors and three subgroups (pleomorphic adenoma, Warthin tumor, and malignant lesions), respectively. Moreover, we performed cross-validation (CV) techniques to estimate the predictive performance between ADC distributions and mean values. Histopathological results revealed 30 pleomorphic adenomas, 22 Warthin tumors, and 21 malignant tumors. ADC histogram distribution yielded a better specificity for detection of benign parotid gland lesions (ADChistogram: 75.0% vs. ADCmean: 71.2%), but mean ADC values provided a higher sensitivity (ADCmean: 71.4% vs. ADChistogram: 61.9%). The discrepancies are most pronounced in the differentiation between malignant and Warthin tumors (sensitivity ADCmean: 76.2% vs. ADChistogram: 61.9%; specificity ADChistogram: 81.8% vs. ADCmean: 68.2%). Using CV techniques, ADC distribution revealed consistently better accuracy to differentiate benign from malignant lesions (“leave-one-out CV” accuracy ADChistogram: 71.2% vs. ADCmean: 67.1%). ADC histogram analysis using full distribution curves is a promising new approach for differentiation between primary benign and malignant parotid gland tumors, especially with respect to the advantage in predictive performance based on CV techniques.
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Postauricular Incision Versus Conventional Transcervical Incision in Second Branchial Cleft Cyst Excision: A Systematic Review and Meta-Analysis. J Craniofac Surg 2022; 33:2365-2371. [PMID: 35882056 PMCID: PMC9612730 DOI: 10.1097/scs.0000000000008741] [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: 11/03/2021] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
Surgical removal is the treatment of choice for second branchial cleft cysts (SBCCs), which are congenital anomalies. The conventional procedure is performed through a transcervical approach, which would lead to a visible scar in the anterior neck. Conversely, the postauricular approach could keep the scar in the hairline or retroauricular sulcus, rendering it almost invisible after the surgery. The purpose of this meta-analysis was to evaluate the differences between the postauricular and conventional transcervical approaches to SBCC excision. A systematic review was performed using PubMed, Embase, and the Cochrane Library to identify studies comparing outcomes of SBCC surgery via postauricular and conventional transcervical approaches. The data of interest were analyzed with Comprehensive Meta-Analysis software (version 3). The data of interest were analyzed by calculating the risk difference (RD), the standardized mean difference, and the mean difference (MD) with the 95% confidence interval (CI). Three studies were eligible for the final analysis. The pooled analysis demonstrated that the cosmetic satisfaction score was significantly higher with the postauricular approach (standardized mean difference, 2.12; 95% CI, 0.68–3.56). The operative duration was significantly longer with the postauricular approach than with the conventional transcervical approach (MD, 12.81; 95% CI, 2.39–23.23). The incidences of postoperative marginal mandibular nerve palsy (RD, 0.00; 95% CI, −0.09 to 0.09), bleeding complications (RD, −0.02; 95% CI, −0.09 to 0.05), salivary complications (RD, −0.00; 95% CI, −0.07 to 0.06), cyst size (MD, 0.02; 95% CI, −0.96–0.99), and length of hospital stay (MD, −2.50; CI, −7.30 to 2.30) were comparable between the 2 groups. The postauricular approach is feasible for use in SBCC excision and yields better cosmetic outcomes, a longer operative duration, and a similar rate of complications.
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Chen SWT, Hsin LJ, Lin WN, Tsai YT, Tsai MS, Lee YC. LigaSure versus Conventional Parotidectomy: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10040706. [PMID: 35455883 PMCID: PMC9027715 DOI: 10.3390/healthcare10040706] [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: 03/02/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Surgery with parotidectomy is the preferable treatment for most parotid tumors. Our meta-analysis compared the differences between the use of the LigaSure (LS) device and the conventional suture ligation technique (CT) in parotidectomies. A literature search in databases including EMBASE, MEDLINE, and the Cochrane Library was carried out. Studies including parotidectomy using LS and CT were included with the intraoperative and postoperative parameters collected. Continuous operative time data were measured by mean differences (MDs). Discrete data on postoperative complications, including facial palsy, postoperative bleeding, and salivary complications, were evaluated with risk differences (RDs). All values were reported with 95% confidence intervals (CIs). Five studies were included in our meta-analysis. The pooled analysis demonstrated a significant reduction in operative time in the LS group (MD: −21.92; 95% CI, −30.18 to −13.66). In addition, the analysis indicated that the incidence of postoperative complications, including permanent facial palsy (RD, −0.01; 95% CI, −0.06 to 0.05), temporary facial palsy (RD, 0.00; 95% CI, −0.03 to 0.04), salivary complications (RD, −0.01; 95% CI, −0.08 to 0.06), and postoperative bleeding (RD, −0.02; 95% CI, −0.07 to 0.04), were all similar between the LS group and the CT group. According to the results, the LS device appears to be a safe and useful tool and could shorten the operative time in patients needing parotidectomy.
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Affiliation(s)
- Sonia Wei-Ting Chen
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
| | - Li-Jen Hsin
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Wan-Ni Lin
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Yao-Te Tsai
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Ming-Shao Tsai
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Yi-Chan Lee
- Department of Otolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (L.-J.H.); (W.-N.L.); (Y.-T.T.); (M.-S.T.)
- Correspondence: ; Tel.: +886-2-2431-3131 (ext. 6255); Fax: +886-2-2431-1190
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