Modification of Blair Approach With a Modified Endaural Component to Access the Parotid Region

A Review of Surgical Incisions Used for the Excision of Benign Parotid Tumors

OBJECTIVE

To provide surgical references for selecting appropriate parotidectomy incisions, reviewing modified approaches, incision designs, and associated complications.

METHODS

We have systematically searched 5 medical literature databases examining parotidectomy incision designs and postoperative complications from 2008 to 2021.

RESULTS

There are a total of 9 novel incision designs: 1) posterior auricular hairline incision (PAHI); 2) combined preauricular and retroauricular incision (CPRI); 3) V-shaped incision (VI); 4) N-shaped incision (NI); 5) postaural incision (PI); 6) preauricular crutch incision (PCI); and 7) endaural incision (EI). Simultaneously, there are a total of 8 postoperative complications: 1) infection; 2) salivary fistula; 3) facial nerve palsy/paresis; 4) ear lobule numbness; 5) Frey syndrome; 6) facial deformity; 7) hematoma; and 8) tumor reoccurrence.

CONCLUSIONS

Over the last decade, a surge in modified parotidectomy incisions has been witnessed in clinical practice. This expansion is attributed to rapid technical advancements and a deeper understanding of anatomy and histopathology. These modified approaches contribute significantly to improving cosmetic outcomes, minimizing associated complications, and enhancing patient satisfaction.

Incisions for Parotidectomy: A Narrative Review

ABSTRACT

In the last 2 decades, authors have gained considerable interest in modifying the age-old classical parotidectomy incisions to address cosmetic concerns of their patients. The article reviews all the incisions that have been introduced over time after modified facelift and Blair incision for performing parotidectomy. These include retroauricular hairline approach, Arden technique, trichophytic incision, periauricular incision, intraauricular modification of facelift approach, endaural approach, postaural approach, Panda technique, preauricular crutch approach, and mini Blair incision. Although these have been reported to be safe, feasible, and cosmetically better approaches, at present, the absence of well-designed prospective observational and interventional studies do not warrant them to be widely used in clinical practice. This will guide surgeons in making patient curated parotidectomy incisions under special circumstances. Currently, these remain limited to the hands of experienced surgeons in high volume centers.

Availability of secondary healthcare data for conducting pharmacoepidemiology studies in Colombia: A systematic review

Real-world evidence (RWE) is emerging as a fundamental component of the post-marketing evaluation of medicinal products. Even though the focus on RWE studies has increased in Colombia, the availability of secondary data sources to perform this type of research is not well documented. Thus, we aimed at identifying and characterizing secondary data sources available in Colombia. We performed a systematic literature review on PubMed, EMBASE, and VHL using a combination of controlled vocabulary and keywords for the concepts of electronic health records, epidemiologic studies and Colombia. A total of 323 publications were included. These comprised 123 identified secondary data sources including pharmacy dispensing databases, government datasets, disease registries, insurance databases, and electronic heath records, among others. These data sources were mostly used for cross-sectional studies focused on disease epidemiology in a specific population. Almost all databases (95%) contained demographic information, followed by pharmacological treatment (44%) and diagnostic tests (39%). Even though the database owner was identifiable in 94%, access information was only available in 44% of the articles. Only a pharmacy-dispensing database, local cancer registries, and government databases included a description regarding the quality of the information available. The diversity of databases identified shows that Colombia has a high potential to continue enhancing its RWE strategy. Greater efforts are required to improve data quality and accessibility. The linkage between databases will expand data pooling and integration to boost the translational potential of RWE.

Feasibility and advantages of endoscope-assisted parotidectomy: a systematic review and meta-analysis

The object of this paper was to explore the feasibility and advantages of endoscope-assisted parotid tumour resection. Three databases (PubMed, Web of Science, and Cochrane) were used to search for all related randomised controlled trials or controlled trials (up to November 2019). The key parameters for assessment included 'Endoscope', 'Endoscopes', 'Cancer of Parotid', and 'Parotid Cancer'. To evaluate the feasibility and advantages of endoscope-assisted resection of parotid tumours, the data for each parameter were pooled, based on patients who received endoscope-assisted surgery and those who received conventional surgery. This meta-analysis included seven studies, involving 170 patients in the endoscopy group and 270 patients in the control group. The analysis using the pooled data showed that there were no significant differences in the operating times between the two groups; however, the endoscopy group had significantly shorter incisions and less intraoperative bleeding. In addition, the patients who received endoscope-assisted surgery had lower incidences of temporary facial paralysis and Frey's syndrome after surgery. Patients in the endoscopy group had greater postoperative satisfaction. Endoscope-assisted parotid tumour resection results in only a small, concealed incision wound and fewer postoperative complications. Therefore, it is promising for the surgical treatment of parotid tumours.

Previously Reported Approach Now Used for Temporomandibular Joint Replacement

Over time, different techniques have been described to obtain broad access to the temporomandibular joint (TMJ), in order to allow good visibility, minimizing post-operative complications at the same time. Most of these techniques have been very useful to perform joint replacement using custom made prostheses, varying in its extension, aesthetics and functional results. The aim of this study was to present the authors' experience using the Blair approach modified by Fernández in 2015, to replace failed TMJ prostheses, when distortion of the surgical reference points has occurred.

Cosmetic approach selection in parotidectomy for benign parotid gland tumour according to its location

OBJECTIVE

The aim of this study is to evaluate the feasibility and aesthetic results when comparing two cosmetic approaches that were employed in parotidectomy according to the tumour location with the traditional Blair approach.

DESIGN

Retrospective study.

SETTING

Tertiary Referral Centre.

PATIENTS

Seventy-six patients were included in the study.

RESULTS

The degree of satisfaction with the cosmetic incision approach was significantly higher than that with the traditional Blair approach. The incidence of transient facial paralysis and salivary fistula were not statistically significant when compared with those in the traditional incision in 6-month follow-up post-operatively.

DISCUSSION

Conventional parotidectomy using the traditional Blair incision (or its modification) usually leaves a visible scar in this region, which can have major adverse impacts on the social or psychological well-being of an individual. To achieve better aesthetic results, according to the location of the benign parotid tumour, two formal cosmetic approach incisions could be performed in parotidectomy, which was superior to the traditional Blair incision. The authors propose that these two cosmetic approaches for parotidectomy can be both technically feasible and safe.