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Fawzy A, Balbaa MA, Hagag M. Evaluation of functional and aesthetic outcomes of free dermal fat graft versus superficial musculoaponeurotic system flap after superficial parotidectomy: randomized clinical trial. BJS Open 2023; 7:7156603. [PMID: 37151084 PMCID: PMC10165060 DOI: 10.1093/bjsopen/zrac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/12/2022] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Parotidectomy is the standard procedure for treatment of many parotid lesions; however, it has several drawbacks. Facial asymmetry and Frey's syndrome are the most annoying complications to patients. Insertion of interpositioning grafts into the parotidectomy bed can decrease these complications significantly. Free dermal fat graft (FDFG) and superficial musculoaponeurotic system (SMAS) flap have very promising results. This RCT aimed to compare these two techniques regarding functional and aesthetic outcomes. METHODS Between February 2016 and October 2021, adult patients undergoing superficial conservative parotidectomy in a single centre for a benign indication were randomized into two equal groups using a closed envelope method. In one group, FDFG was inserted at the parotidectomy bed, whereas, in the other group, SMAS flap was performed. Preoperative, operative, and postoperative data were recorded and analysed. The primary outcome was the development of Frey's syndrome. RESULTS Seventy-eight patients were randomized into two equal groups of 39 patients. There was no significant difference between the two groups regarding development of Frey's syndrome. There was no significant statistical difference between study groups regarding demographic data, co-morbidities, parotid pathologies, specimen volumes, total operating time, and postoperative complications. A tendency for over correction was observed in FDFG and under correction in SMAS flap. There was no statistically significant difference between the study groups regarding the patients' aesthetic satisfaction with the majority displaying excellent satisfaction with no poor results. CONCLUSION FDFG and SMAS flap are simple, rapid, and reliable procedures and are effective in improving both functional and aesthetic outcomes post-parotidectomy. They have comparable results; however, selection of either procedure can be determined according to patient and tumour characteristics. Registration number: NCT05452837 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Ahmed Fawzy
- Department of General Surgery, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, Egypt
| | - M Ashraf Balbaa
- Department of General Surgery, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, Egypt
| | - Mahmoud Hagag
- Department of General Surgery, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, Egypt
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Effectiveness of the Fibrinogen-Thrombin-Impregnated Collagen Patch in the Prevention of Postoperative Complications after Parotidectomy: A Single-Blinded, Randomized Controlled Study. J Clin Med 2022; 11:jcm11030746. [PMID: 35160200 PMCID: PMC8836986 DOI: 10.3390/jcm11030746] [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: 01/17/2022] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/10/2022] Open
Abstract
We investigated whether a fibrinogen-thrombin collagen sponge patch reduces postoperative complications of parotid gland surgery. This single-blinded, randomized controlled study included 165 patients who underwent parotid surgery for benign tumors (2018–2019) at a tertiary center. Primary outcomes were postoperative drain amount, days until drain removal, and discharge. Patients were scheduled for follow-up at 1 and 4 weeks, and 3 months after surgery. Complications including surgical site infection, pain, seroma, sialocele, salivary fistula, facial nerve palsy, Frey’s syndrome with subjective symptoms, and facial asymmetry were analyzed. After identifying confounding variables, multivariate approaches were used. Histologic analysis was performed in a mouse model of salivary gland surgery. In total, 162 patients (77, fibrinogen-thrombin collagen patch group; 85, controls) were included, with no significant between-group differences other than resected tissue. Among postoperative total drain amount and days until drain removal and discharge, the only postoperative total drain was significantly lower in the patch group than in the control group in the adjusted model. Additionally, although validation through robust trials with longer follow-up is needed, we found the potential benefit of the fibrinogen patch on Frey’s syndrome and facial asymmetry. In conclusion, fibrinogen-thrombin-impregnated collagen patches in parotidectomy can reduce postoperative drainage and improve outcomes.
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Kim JH, Kim DH, Lim JY, Won HR, Shin YS, Kim CH, Ban MJ, Park JH, Byeon HK, Hong HJ, Choi EC, Koh WY. Effect of human acellular dermal matrix (Megaderm™) on infra-auricular depressed deformities, Frey's syndrome, and first bite syndrome following parotidectomy: a multi-center prospective study. Gland Surg 2021; 10:670-677. [PMID: 33708549 DOI: 10.21037/gs-20-703] [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] [Indexed: 11/06/2022]
Abstract
Background Parotidectomy is the primary treatment for parotid gland tumors. However, complications may include a prominent facial scar or infra-auricular depressed deformity, Frey's syndrome, first bite syndrome, or other facial pain, numbness, and paralysis. Acellular dermal matrix (ADM) has been widely used to prevent these complications in parotid surgery, but there have been no prospective, multi-center trials documenting its efficacy. This study evaluates the effectiveness of ADM implantation in preventing infra-auricular depressed deformity, Frey's syndrome and first bite syndrome after parotidectomy. Methods We analyzed 51 cases of standard parotidectomy and 58 cases of parotidectomy with implantation of Megaderm™ ADM through prospective multicenter trial. Acute complications including infection, seroma, hematoma, skin necrosis, and acute parotid area pain were evaluated 1 week postoperatively. Clinician grading of Frey's syndrome and blinded clinician evaluation of infra-auricular depressed deformities were conducted at 3, 6, and 12 months. Patients evaluated subjective satisfaction with neck appearance, Frey's syndrome quality, and acute parotid area pain at 3, 6, and 12 months. Results There was a higher incidence of seroma in the Megaderm™ group than in the control group at week 1. The incidence and total clinician-evaluated Frey's syndrome scores were significantly lower in the Megaderm™ group than in the control group at 3, 6, and 12 months. Both the objective and subjective evaluations of the facial contour showed a better outcome in the Megaderm™ group compared to the control group at 3, 6, and 12 months. There were no significant differences between the groups in the patient-reported Frey's syndrome quality scores at 3, 6, and 12 months, but the Megaderm™ group reported significantly less acute pain than the control group. Conclusions ADM implantation can effectively reduce the occurrence of Frey's syndrome, infra-auricular depressed deformity, and first bite syndrome after parotidectomy. ADM may be especially advantageous in complex parotidectomy cases when significant complications are expected.
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Affiliation(s)
- Joo Hyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Da Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho-Ryun Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Yoo Seob Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Ajou University College of Medicine, Kungki-do, Republic of Korea
| | - Chul-Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ajou University College of Medicine, Kungki-do, Republic of Korea
| | - Myung Jin Ban
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Jae Hong Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hyung Kwon Byeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woon Yoo Koh
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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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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Mashrah MA, Aldhohrah T, Abdelrehem A, Koraitim M, Wang L. What is the best method for prevention of postparotidectomy Frey syndrome? Network meta-analysis. Head Neck 2021; 43:1345-1358. [PMID: 33439485 DOI: 10.1002/hed.26597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/22/2020] [Accepted: 12/17/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Prevention of Frey syndrome (FS) after parotidectomy using an interposition barrier has long been gaining a wide popularity; however, there is no clear evidence regarding which preventive technique is more effective. The aim of this network meta-analysis (NMA) is to answer the question: What is the best method for prevention of FS after parotidectomy? METHODS A comprehensive search of the PubMed, Embase, SCOPUS, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of subjective Frey syndrome (SFS) and objective Frey syndrome (OFS). The Bayesian NMA accompanied with a random effects model and 95% credible intervals (CrIs) were calculated using GeMTC R package. RESULTS Thirty-four studies (n = 2987 patients) with five interventions, namely Alloderm (ADM), temporoparietal fascia (TPF), sternocleidomastoid muscle (SCM), superficial musculoaponeurotic system (SMAS), and free fat graft (FFG), were compared together and with no interposition barrier (NB). The results of NMA showed a statistically significant reduction in both SFS and OFS when ADM, TPF, SMAS, FFG, and SCM were compared with NB. No statistical differences were observed when comparing ADM, SCM, SMAS, FFG, and TPF. TPF ranked the best of all treatments (59.4%) and was associated with the least incidence of SFS; whereas ADM ranked the best of all treatments (61.1%) and was associated with the least incidence of OFS. CONCLUSIONS All interventions (TPF flap, ADM, FFG, SMAS, and SCM) were associated with a significant reduction in the incidence of FS when compared with NB. TPF and ADM showed the best outcome with the least incidence of SFS and OFS, respectively.
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Affiliation(s)
- Mubarak Ahmed Mashrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Taghrid Aldhohrah
- Guanghua Stomatology Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ahmed Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Koraitim
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Liping Wang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Reconstruction using sternocleidomastoid muscle flap versus posterior belly of digastric muscle flap compared with no reconstruction following superficial parotidectomy. Oral Maxillofac Surg 2020; 25:81-87. [PMID: 32827113 DOI: 10.1007/s10006-020-00892-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The most common complications following superficial parotidectomy are formation of contour deformity and development of Frey's syndrome. Multiple modalities are being used to prevent these complications. We hereby intend to compare the reconstruction modalities (sternocleidomastoid (SCM) muscle flap, posterior belly of digastric (PBD) muscle flap) with) No reconstruction (NR) following superficial parotidectomy. MATERIALS AND METHODS A comparative study was designed which included 15 patients requiring parotidectomy. These patients were divided into three groups viz. SCM, PBD, and NR. The functional outcome (facial nerve involvement, Frey syndrome, ear lobule sensation, neck movements) and the esthetic results were evaluated subjectively and objectively. The outcomes were statistically evaluated using chi-square test and ANOVA test. RESULTS Facial nerve palsy occurred in 2 cases in each group, and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 1 patient in the SCM group, in 2 patients in the PBD group, and in 4 patients in the NR group; only 1 patient of PBD group and 3 patients of NR group complained of gustatory sweating. Neck movements were unaffected in the PBD and NR groups; however, 1 patient complained of mild discomfort and pain during neck movements in the SCM group. CONCLUSION Primary closure showed the worst results regarding cosmetic deformity. Hence, it is recommended to mandatorily reconstruct the defect. However, the sternocleidomastoid muscle flap is a better cosmetic option compared with posterior belly of digastric muscle flap. In cases with larger defects, a combination of both the flaps can be used. SCM flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve and mildly affected neck movements.
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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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Moore MG, Yueh B, Lin DT, Bradford CR, Smith RV, Khariwala SS. Controversies in the Workup and Surgical Management of Parotid Neoplasms. Otolaryngol Head Neck Surg 2020; 164:27-36. [PMID: 32571148 DOI: 10.1177/0194599820932512] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Parotid neoplasms are a rare heterogeneous group of tumors with varied clinical presentation and behavior. Here we provide an evidence-based review of the contemporary approach to evaluation and surgical management of parotid tumors. DATA SOURCE PubMed and Web of Science Databases. REVIEW METHODS Searches of the PubMed and Web of Science databases were performed on subjects related to the diagnosis and surgical management of parotid neoplasms. Particular emphasis was placed on the following areas: evaluation of parotid tumors, including imaging workup and the utility of fine-needle aspiration; extent of surgery of the primary lesion, including the extent of parotidectomy as well as oncologic management of the facial nerve; the extent of surgery of involved and at-risk cervical lymphatics; and parotid bed reconstruction. Articles published from 2014 to the present were prioritized, supplementing with information from prior studies in areas where data are lacking. CONCLUSION A summary of the literature in these areas is outlined to provide an evidence-based approach to evaluation and management of parotid neoplasms. IMPLICATIONS FOR PRACTICE While data are available to help guide many aspects of workup and management of parotid neoplasms, further research is needed to refine protocols for this heterogeneous group of diseases.
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Affiliation(s)
- Michael G Moore
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bevan Yueh
- The University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Derrick T Lin
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | | | | | - Samir S Khariwala
- The University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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Petrides GA, Subramaniam N, Pham M, Clark JR. Reducing the morbidity of parotidectomy for benign pathology. ANZ J Surg 2020; 90:2315-2321. [PMID: 32483863 DOI: 10.1111/ans.16008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Conservative surgical approaches, reconstructive techniques and technology are increasingly used in parotid surgery. The aim of this study was to determine the surgeon-modifiable factors which impact the rates of post-operative complications following parotidectomy for benign pathology. METHODS A retrospective cohort study of patients undergoing parotidectomy for benign pathology by or under the supervision of the senior author between 2006 and 2019 was performed. Clinicopathological variables, operative techniques and post-operative complications were recorded using standardized templates. Multivariable logistic regression models were used to obtain odds ratios (ORs) whilst adjusting for the effect of other clinically relevant covariates. RESULTS In total, 357 parotidectomies were performed. Independent factors associated with post-operative facial paresis were re-operative surgery (OR 3.51, 95% CI 1.19-10.33, P = 0.023), nerve integrity monitoring (OR 0.50, 95% CI 0.26-0.99, P = 0.046) and operation type, with focused tumour dissection (FTD) having the lowest rate of paresis (OR 0.19, 95% CI 0.040-0.92, P = 0.038) compared to limited parotidectomy. Factors associated with reduced wound complications on adjusted analysis were dermofat grafting (OR 0.10, 95% CI 0.01-0.72, P = 0.023), lesion size (OR 0.68, 95% CI 0.50-0.92, P = 0.01) and FTD (OR 0.16, 95% CI 0.05-0.59, P = 0.005) compared to limited parotidectomy. CONCLUSION FTD, nerve integrity monitoring and dermofat grafting are surgeon-modifiable variables associated with lower rates of post-operative complications following parotidectomy for benign pathology. However, the benefit of these operative techniques relies on their appropriate utilization by performing surgeons.
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Affiliation(s)
- George A Petrides
- Department of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Narayana Subramaniam
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - My Pham
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Issa SAA, Jameel ME. Free Dermal Fat Graft for Reconstruction of Soft Tissue Defects in the Maxillofacial Region. Craniomaxillofac Trauma Reconstr 2020; 13:260-266. [PMID: 33456697 DOI: 10.1177/1943387520910678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Study Design Facial contour deformities are a very challenging issue for aesthetic and reconstructive surgeons. Free dermal fat graft is a composite graft used for the reconstruction of soft tissue defects in the maxillofacial region. The free dermal fat graft is easily adapted and contoured intraoperatively and provides a soft, natural, and favorable appearance after augmentation of the soft tissue defects. Objective To assess the use of free dermal fat graft for reconstruction of soft tissue defects in the maxillofacial region in regard to graft success, percentage of overcorrection, any associated complications, and cone beam computed tomography scan linear measurements for defect's depth. Methods This is a prospective study that included a patients were grafted with free dermal fat graft for correction of facial soft tissue defects from November 2017 to July 2019. All patients possess a depression defect and facial asymmetry due to congenital facial deformities, post-traumatic deformities, and post-ablative surgical deformities. Results Eleven patients (8 males and 3 females) with a mean age of 33.7 years were enrolled in this study. Five regions in the maxillofacial area were grafted in 11 patients. The mean of the postoperative follow-up was 6 months. The percentage of graft overcorrection was 15%. The mean for graft survival was 94.4% with no serious complications reported. Conclusions The autologous FDFG is a versatile and less invasive method in the reconstruction of facial soft tissue defects with a very good survival rate.
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Affiliation(s)
- Sabah Abdul-Aziz Issa
- Iraqi Board For Medical Specializations, Department of Oral and Maxillofacial Surgery, Medical City Complex, Baghdad, Iraq
| | - Mustafa Emaduldeen Jameel
- Iraqi Board For Medical Specializations, Department of Oral and Maxillofacial Surgery, Medical City Complex, Baghdad, Iraq
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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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Wang C, Wu D, Mao C, Lu M, Cai Z, Lai Y, Chen W. The preventive effect of decellularized pericardial patch against Frey's syndrome following the superficial parotidectomy. J Craniomaxillofac Surg 2019; 47:832-836. [PMID: 30738637 DOI: 10.1016/j.jcms.2019.01.022] [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] [Received: 08/28/2018] [Revised: 11/19/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE This study aimed to investigate the feasibility of adopting the ThormalGEN surgical patch (a porcine decellularized pericardial patch) in the superficial parotidectomy to prevent postoperative Frey's syndrome in patients with benign parotid tumor. MATERIALS AND METHODS A total of 59 patients with benign parotid tumor undergoing superficial parotidectomy between April 2016 and January 2017 were enrolled, and divided into the ThormalGEN group (n = 37) and the control group (n = 22) based on their willingness to have the ThormalGEN surgical patch used in the superficial parotidectomy. At 6 months postoperation, the incidences of postoperative complications and Frey's syndrome were assessed by subjective assessment (patient self-assessment) and objective assessment (starch-iodine test), respectively. The risk factor of Frey's syndrome was analyzed by the multivariate logistic regression model. RESULTS The starch-iodine test, for objective assessment, showed that the ThormalGEN group had a significantly lower incidence of Frey's syndrome than the control group (8.11% vs. 40.91%, p = 006). However, in the patient self-assessment, there was no significant difference in the incidence of Frey's syndrome between groups (8.11% [3/37] vs. 13.64% [3/22], p = 0.4968). The incidences of postoperative complications were not significantly different between group (all p > 0.05). Two patients (5.41%) in the ThormalGEN group had salivary fistula. Multivariate logistic regression analysis showed that the ThormalGEN group had a significantly lower risk of Frey's syndrome than the control group (odds ratio = 0.11, 95% confidence interval = 0.02-0.51, p < 0.01). CONCLUSION These results suggest that the ThormalGEN surgical patch can effectively reduce the incidence of Frey's syndrome following superficial parotidectomy in patients with benign parotid tumor, and that this patch has a good safety and biocompatibility profile.
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Affiliation(s)
- Chengyong Wang
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Dong Wu
- The Affiliated Stomatological Hospital of Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Chuanqing Mao
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Meng Lu
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Zhiyu Cai
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Yongzhen Lai
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Weihui Chen
- Department of Oral Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China.
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Reconstruction of parotidectomy and lateral skull base defects. Curr Opin Otolaryngol Head Neck Surg 2017; 25:431-438. [DOI: 10.1097/moo.0000000000000391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tamplen M, Knott PD, Fritz MA, Seth R. Controversies in Parotid Defect Reconstruction. Facial Plast Surg Clin North Am 2016; 24:235-43. [DOI: 10.1016/j.fsc.2016.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Baum SH, Pförtner R, Ladwein F, Schmeling C, Rieger G, Mohr C. Use of dermis-fat grafts in the prevention of Frey's syndrome after parotidectomy. J Craniomaxillofac Surg 2016; 44:301-8. [DOI: 10.1016/j.jcms.2015.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/12/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022] Open
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Autologous fat transfer: an aesthetic and functional refinement for parotidectomy. Surg Res Pract 2014; 2014:873453. [PMID: 25379564 PMCID: PMC4208499 DOI: 10.1155/2014/873453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 12/02/2013] [Accepted: 12/05/2013] [Indexed: 11/28/2022] Open
Abstract
Parotidectomy is a surgical procedure associated to functional (Frey's syndrome) as well as aesthetic (facial asymmetry) complications that can be very disturbing for the patient. Several procedures have been described to primarily avoid or secondarily reconstruct the facial defect and treat the neurological iatrogenic syndrome.
Autologous fat transfer was primarily used in 10 cases to avoid such complications. It is an easy technique widely used in cosmetic and reconstructive surgery. This technique gives very satisfying long-term results on the cosmetic as well as on the physiological point of view.
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