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Surgical Innovation Apr 2023The mainstay of first-line treatment of parotid tumors is adequate surgical removal. The present study was conducted to compare the differences between parotidectomy... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The mainstay of first-line treatment of parotid tumors is adequate surgical removal. The present study was conducted to compare the differences between parotidectomy with postauricular incision (PI) and modified Blair incision (MBI).
DATA SOURCES
A systematic search of PubMed, Embase and the Cochrane Library was performed.
METHODS
The data of interest and study characteristics were extracted from the included studies. Statistical analysis was performed with Comprehensive Meta-Analysis software (version 3; BioStat, Englewood, NJ). Dichotomous data and continuous data were analyzed by calculating the risk difference and the mean difference with the 95% confidence interval respectively.
RESULTS
Four retrospective studies were included in the present meta-analysis. The pooled results revealed that the cosmetic satisfaction score was higher in the PI group (MD = 2.67; 95% CI, 2.12 to 3.23) and that intraoperative blood loss was lower in the PI group (MD = -55.35; 95% CI, -100.33 to -10.36). The operative duration (MD = -5.15; 95% CI, -24.06 to 13.75), tumor size (MD = -.07; 95% CI, -.27 to .13) and incidences of common postoperative complications were comparable between the two groups.
CONCLUSIONS
According to these findings, the use of PI in parotidectomies may be one of the options for improving cosmetic outcomes. This technique may be considered if oncological safety can be secured.
Topics: Humans; Retrospective Studies; Parotid Neoplasms; Postoperative Complications; Blood Loss, Surgical; Surgical Wound
PubMed: 36128913
DOI: 10.1177/15533506221120484 -
Clinical Otolaryngology : Official... Dec 2017Fibrin sealants (FS) are commercially available products used in surgical wounds as adjuncts to haemostasis and closure of dead space. The role of FS in soft tissue head... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fibrin sealants (FS) are commercially available products used in surgical wounds as adjuncts to haemostasis and closure of dead space. The role of FS in soft tissue head and neck surgery has not been established.
OBJECTIVES
To assess whether FS improves wound-related outcomes in patients undergoing soft tissue surgery of the head and neck anatomical region that would commonly require a drain.
TYPE OF REVIEW
Systematic review and meta-analysis of randomised controlled trials (RCTs).
SEARCH STRATEGY
MEDLINE (1946-2016), EMBASE (1974-2016), PubMed (2016), CENTRAL (2016), ClinicalTrials.gov (2016), WHO International Clinical Trials Registry and Platform (2016), Research Gate (2016).
EVALUATION METHOD
Two independent reviewers screened and selected studies. Included studies were assessed for risk of bias and data extracted using a predetermined data collection form.
RESULTS
Of the 421 studies that were screened, 11 RCTs met the inclusion criteria. There were two RCTs on thyroidectomy, three on "surgery involving neck dissection" (central or lateral), five on rhytidectomy and one on parotidectomy. There was a tendency for FS to reduce "mean total drainage volume" (mean difference -26.86 mL, 95% CI -43.41 to -10.31, I =97%, P=.001). Subgroup analysis of thyroidectomy (mean difference -36.36 mL, 95% CI -72.82 to 0.10, I =79%, P=.05), "surgery involving neck dissection" (mean difference -33.21 mL, 95% CI -70.01 to 3.59, I =94%, P=.08) and rhytidectomy (mean difference -13.79 mL, 95% CI -17.57 to -10.01, I =0%, P < .00001) concurred with the overall analysis. There was a suggestion that FS may reduce "mean retention time of drains" by 1.24 days (95% CI -3.32 to 0.85, I =99%, P=.25) and "hospital length of stay" by 2.09 days (95% CI -5.18 to 0.99, I =97%, P=.18), but this was not statistically significant. There was also a suggestion that FS may protect against adverse events (RR 0.69, 95% CI 0.35 to 1.38, I =0%, P=.29) and haematoma/seroma formation (RR 0.49, 95% CI 0.22 to 1.07, I =0%, P=0.07).
CONCLUSIONS
There was considerable heterogeneity within the RCTs included in this study, thus restricting definitive conclusions. FS has however shown a definite benefit in rhytidectomy and potential benefit in other soft tissue head and neck surgical procedures. Further pragmatic trials are required particularly in the field of lateral neck dissection.
Topics: Drainage; Fibrin Tissue Adhesive; Humans; Neck Dissection; Parotid Gland; Postoperative Complications; Randomized Controlled Trials as Topic; Rhytidoplasty; Thyroidectomy
PubMed: 28130927
DOI: 10.1111/coa.12837 -
Otolaryngology--head and Neck Surgery :... Jan 2022We performed a systematic review and meta-analysis of deep lobe parotid tumors to evaluate their unique characteristics. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We performed a systematic review and meta-analysis of deep lobe parotid tumors to evaluate their unique characteristics.
DATA SOURCES
PubMed/Medline, Embase, Web of Sciences, and Cochrane Library databases were queried for relevant literature.
REVIEW METHODS
Studies were individually assessed by 2 independent reviewers. Risk of bias was assessed with the Cochrane bias tool, GRADE criteria, and MINORS criteria. Results were reported according to the PRISMA guidelines. Statistical analysis was performed by comparing rates of malignancy between deep and superficial lobe tumors.
RESULTS
In total, 8 studies including 379 deep lobe parotid tumors met inclusion criteria. Mean age at diagnosis was 44.9 years. Computed tomography scan was the most common imaging modality. Preoperative diagnostic fine-needle aspiration was utilized in 39.4% of patients and demonstrated high sensitivity for malignant disease. The most common approach was subtotal parotidectomy with facial nerve preservation (58.9%). The rate of malignancy was 26.6%, which was significantly higher than that of the superficial lobe tumors in this study (risk ratio, 1.25; 95% CI, 1.01-1.56). The rate of temporary postoperative facial nerve weakness between deep and superficial lobe tumors was 32.5% and 11.7%, respectively.
CONCLUSION
Deep lobe parotid tumors had a 26.6% rate of malignancy. On meta-analysis, deep lobe tumors appeared to have higher rates of malignancy than superficial lobe tumors. Surgical excision of deep lobe tumors showed increased rates of temporary facial nerve paresis as compared with superficial lobe tumors. Computed tomography scan was the most common imaging modality. There were limited data regarding the utility of fine-needle aspiration.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Parotid Neoplasms; Young Adult
PubMed: 33878987
DOI: 10.1177/01945998211009235 -
Frontiers in Oncology 2022This network meta-analysis aimed to comprehensively compare the operative and postoperative outcomes of different parotidectomy incisions.
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.
PubMed: 35992792
DOI: 10.3389/fonc.2022.972498 -
American Journal of Otolaryngology 2020To evaluate surgical approaches and outcomes associated with accessory parotid gland neoplasms.
OBJECTIVE
To evaluate surgical approaches and outcomes associated with accessory parotid gland neoplasms.
DATA SOURCES
MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials.
REVIEW METHODS
A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed. Studies were included if they reported surgical management and outcomes of patients with accessory parotid gland neoplasms.
RESULTS
After screening 3532 records, 15 studies were included with a total of 187 patients. Benign tumors consisted of 61.5% of cases. External open, transoral, and preauricular endoscopic approaches were used for 82.3%, 11.3%, and 6.5% of cases, respectively. Accessory lobe resection alone, concurrent with partial parotidectomy, and concurrent with total parotidectomy were used in 54.8%, 43.0%, and 2.2% of cases, respectively. Complication rates were similar between histology groups (7.8% benign vs. 8.3% malignant, p = 0.82). Accessory lobe resection with concurrent partial parotidectomy had the lowest overall complication rate (6.3%). Resections limited to the accessory lobe were found to have an overall complication rate of 8.7%.
CONCLUSION
The results offer an overview of the surgical management and complications for accessory parotid gland tumors. Overall surgical complication rates found in these case series may be lower for management of accessory gland tumors than rates available in the literature for tumors within the main parotid gland.
Topics: Adult; Aged; Aged, 80 and over; Endoscopy; Humans; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Treatment Outcome; Young Adult
PubMed: 32580067
DOI: 10.1016/j.amjoto.2020.102610 -
Journal of Cranio-maxillo-facial... Jul 2015Different types of surgical management of pleomorphic adenoma of the parotid gland are associated with different recurrence rates. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Different types of surgical management of pleomorphic adenoma of the parotid gland are associated with different recurrence rates.
MATERIAL AND METHODS
A systematic review of literature until 2014 with meta-analysis was conducted. Inclusion criteria were original studies of patients with surgical management for pleomorphic adenoma of the parotid gland and recurrence rates, with a median follow-up period of 5 years. The Newcastle-Ottawa Quality Assessment Scale (NOQAS) was used to assess the quality.
RESULTS
Sixteen studies were included. Four studies show a low recurrence rate (0.01, 95% confidence interval [CI] = 0.00-0.02) after total parotidectomy. Twelve studies show a low recurrence rate (0.02, 95% CI = 0.01-0.03) after superficial parotidectomy. Six studies show a low recurrence rate (0.02, 95% CI = 0.01-0.04) after limited parotidectomy. Six studies demonstrate a low recurrence rate (0.01, 95% CI = 0.00-0.04) after extracapsular dissection. Five studies report a low-to-medium recurrence rate (0.08, 95% CI = 0.03-0.14) after extracapsular enucleation.
CONCLUSION
Information about recurrence rates, times of recurrence in relation to type of surgical treatment, and significance of capsule rupture is very poor. With regard to recurrence rates and surgical approaches, the types of operations that show the lowest recurrence rate are total parotidectomy and extracapsular dissection. Controversies over surgical treatment of PA of parotid gland remain, and the safest surgical method for the removal of this tumors has not been identified.
Topics: Adenoma, Pleomorphic; Dissection; Follow-Up Studies; Humans; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms
PubMed: 25982213
DOI: 10.1016/j.jcms.2015.03.017 -
Head & Neck Nov 2021The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis... (Meta-Analysis)
Meta-Analysis Review
The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis (NMA) is to answer the following questions: (1) Does the extent of surgical resection of benign parotid tumors increase the risk of postoperative complications? (2) What is the best surgical intervention for treatment of benign parotid tumors that can provide an acceptable balance between tumor recurrence rate and other postoperative complications? A comprehensive search on PubMed, Embase, Scopus, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of tumor recurrence, facial nerve weakness (temporary [TFW] or permanent [PFP]), Frey's syndrome (FS), sialocele, and salivary fistula. The Bayesian network meta-analysis (NMA) accompanied by a random effect model and 95% credible intervals (CrI) were calculated using the GeMTC R package. Forty-four studies with a total of 7841 participants were included in the current NMA comparing five surgical interventions, namely enucleation, extracapsular dissection (ECD), partial superficial parotidectomy (PSP), superficial parotidectomy (SP), and total parotidectomy (TP). Enucleation showed the highest recurrence rate compared to ECD, SPS, SP, and TP. No statistical differences were observed concerning the recurrence rate when ECD, PSP, SP, and TP were compared together. There was an increased incidence of TFW and FS with the increase in the extent of parotid resection, while no significant difference was found when comparing enucleation with ECD and PSP. SP showed the highest incidence of PFP, and salivary fistula compared to ECD, PSP, and TP. The tumor recurrence rates in enucleation, ECD, PSP, SP, and TP were 14.3%, 3.6%, 3.7%, 2.8%, and 1.4%, respectively. The current NMA demonstrated that the risk of TFW and FS increases with the increase in the extent of parotid resection and that ECD and PSP can be considered the treatment of choice for benign parotid tumors, as both provide an acceptable balance between the incidence of tumor recurrence and facial nerve dysfunction.
Topics: Bayes Theorem; Humans; Neoplasm Recurrence, Local; Network Meta-Analysis; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies
PubMed: 34288212
DOI: 10.1002/hed.26813 -
The Journal of Laryngology and Otology May 2022
PubMed: 35535752
DOI: 10.1017/S0022215122001141 -
Otolaryngology--head and Neck Surgery :... Jun 2023To compare outcomes of facial nerve repair or grafting following facial nerve-sacrificing procedures among patients treated with and without postoperative radiotherapy... (Review)
Review
OBJECTIVE
To compare outcomes of facial nerve repair or grafting following facial nerve-sacrificing procedures among patients treated with and without postoperative radiotherapy (RT).
DATA SOURCES
PubMed, OVID, Conference Papers Index, Cochrane Library, ClinicalTrials.gov.
REVIEW METHODS
Databases were searched using terms including "facial nerve," "graft," "repair," and "radiotherapy." Abstracts mentioning facial nerve repair and evaluation of facial nerve function were included for full-text review. Studies that utilized the House-Brackmann or similar validated scale for evaluation of postoperative facial nerve function were selected for review. All identified studies were included in a pooled t test analysis.
RESULTS
Twelve studies with 142 patients were included in the systematic review. All 12 studies individually demonstrated no significant difference in facial nerve outcomes between patients who received postoperative radiation and patients who did not. A pooled t test of data from all studies also demonstrated no significant difference in postoperative facial nerve function between the postoperative RT and non-RT groups (t stat = 0.92, p = .36).
CONCLUSION
This analysis, including 12 studies, demonstrated that among patients undergoing facial nerve grafting or repair, there was no significant difference in postoperative facial nerve function between postoperative RT and non-RT patients. Due to the small sample size and variability in study methods, further studies directly comparing outcomes between patients with and without postoperative RT would be beneficial.
Topics: Humans; Facial Nerve; Treatment Outcome; Facial Nerve Injuries; Face; Neurosurgical Procedures
PubMed: 36939391
DOI: 10.1002/ohn.224 -
Journal of Otolaryngology - Head & Neck... Dec 2023To quantify the results of superficial parotidectomy (SP) and partial SP (PSP) for benign parotid tumours using a systematic evaluation method. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To quantify the results of superficial parotidectomy (SP) and partial SP (PSP) for benign parotid tumours using a systematic evaluation method.
METHODS
A systematic search of English and Chinese databases (PubMed, Web of Science, Cochrane Library, China Knowledge Network, Wanfang and Vipshop) was conducted to include studies comparing the treatment outcomes of SP with PSP.
RESULTS
Twenty-three qualified, high-quality studies involving 2844 patients were included in this study. The results of this study showed that compared to the SP surgical approach, the PSP surgical approach reduced the occurrence of temporary facial palsy (OR = 0.33; 95% confidence interval [CI] 0.26-0.41), permanent facial palsy (OR = 0.28; 95% CI 0.16-0.52) and Frey syndrome (OR = 0.36; 95% CI 0.23-0.56) in patients after surgery, and the surgery operative time was reduced by approximately 27.35 min (95% CI - 39.66, - 15.04). However, the effects of PSP versus SP on salivary fistula (OR = 0.70; 95% CI 0.40-1.24), sialocele (OR = 1.48; 95% CI 0.78-2.83), haematoma (OR = 0.34; 95% CI 0.11-1.01) and tumour recurrence rate (OR = 1.41; 95% CI 0.48-4.20) were not statistically significant.
CONCLUSION
Compared with SP, PSP has a lower postoperative complication rate and significantly shorter operative time, suggesting that it could be used as an alternative to SP in the treatment of benign parotid tumours with the right indications.
Topics: Humans; Facial Paralysis; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 38135871
DOI: 10.1186/s40463-023-00679-w