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European Archives of... Oct 2021To establish if day case superficial parotidectomy is feasible, safe and does not result in excess readmissions.
PURPOSE
To establish if day case superficial parotidectomy is feasible, safe and does not result in excess readmissions.
METHOD
A retrospective review was carried out of all patients listed for superficial parotidectomy with day case intent by a single surgeon between January 2016 and December 2019 inclusively. The reasons for failure of same day discharge were established. Postoperative complications and readmissions were recorded. Our approach for a superficial parotidectomy typically includes the use of a 10Fr suction drain which is removed at 4 h postoperatively if the output is less than 30 ml.
RESULTS
Ninety-one consecutive superficial parotidectomies listed for day case surgery were eligible for inclusion. Seventeen patients failed to be discharged on the same day and were admitted giving a day case success rate of 81%. Most of these (n = 9) occurred in the first year of adopting day case surgery. The most common reason to admit patients was a late finish (n = 8, 47%). Six patients (25%) were admitted due to anaesthetic complications. One patient had a surgical complication requiring admission.
CONCLUSION
Our series demonstrates that day case superficial parotidectomy using a surgical drain is feasible, safe and does not result in an unacceptable readmission rate. In our experience, surgical complications are an uncommon cause for day case failure. The most common cause for day case failure was a late finish. Postoperative complications including bleeding, seroma/salivary collection and facial nerve palsy were in keeping with or better than those quoted in the literature.
Topics: Ambulatory Surgical Procedures; Facial Paralysis; Humans; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Seroma
PubMed: 33555439
DOI: 10.1007/s00405-021-06642-7 -
The Journal of Laryngology and Otology Oct 2021To report the clinical outcomes of patients with chronic parotid sialadenitis treated with superficial parotidectomy, and to review the literature. (Comparative Study)
Comparative Study Review
OBJECTIVES
To report the clinical outcomes of patients with chronic parotid sialadenitis treated with superficial parotidectomy, and to review the literature.
METHODS
A retrospective case series was conducted of all patients undergoing parotidectomy for chronic parotid sialadenitis at our institution between 2009 and 2018.
RESULTS
Eighteen superficial parotidectomies were performed, resulting in complete symptom resolution in 17 patients. There was only one recurrence, of a milder form of the disease, requiring no specific treatment. Eight temporary post-operative facial nerve palsies and one permanent palsy occurred. Further complications included post-operative wound haematoma, seroma, Frey's syndrome, neuropathic pain and wound infection.
CONCLUSION
Superficial parotidectomy is sufficient to control patient symptoms, avoiding the increased morbidity associated with near-total parotidectomy. The literature does not point to a clear difference in either the incidence of recurrence or the risk of a facial nerve palsy between the two procedures. Furthermore, the symptoms attributed to recurrence are often not severe enough to warrant salvage near-total parotidectomy.
Topics: Adult; Aged; Facial Nerve Diseases; Facial Paralysis; Female; Hematoma; Humans; Incidence; Male; Middle Aged; Neuralgia; Parotid Diseases; Postoperative Complications; Recurrence; Retrospective Studies; Seroma; Sialadenitis; Surgical Wound Infection; Sweating, Gustatory; Treatment Outcome; Wounds and Injuries
PubMed: 34353395
DOI: 10.1017/S0022215121002115 -
Otolaryngology--head and Neck Surgery :... Jan 2021Parotid neoplasms are a rare heterogeneous group of tumors with varied clinical presentation and behavior. Here we provide an evidence-based review of the contemporary... (Review)
Review
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.
Topics: Biopsy, Fine-Needle; Diagnosis, Differential; Diagnostic Imaging; Facial Nerve; Facial Paralysis; Humans; Neck Dissection; Parotid Neoplasms; Postoperative Complications; Plastic Surgery Procedures
PubMed: 32571148
DOI: 10.1177/0194599820932512 -
Head & Neck Jul 2019Superficial parotidectomy has traditionally been completed with a drain and overnight hospital stay. We report perioperative and postoperative outcomes for patients... (Comparative Study)
Comparative Study
BACKGROUND
Superficial parotidectomy has traditionally been completed with a drain and overnight hospital stay. We report perioperative and postoperative outcomes for patients undergoing drainless outpatient parotidectomy vs traditional drained extended stay parotidectomy.
METHODS
Retrospective chart review from a single surgeon from 2009 to 2017 of patients undergoing parotidectomy, including demographic data, surgical approach, tumor pathology and size, blood loss, drain placement, postoperative pain control, and complications, was done. A comparison was performed between patients undergoing drain placement and those treated with "drainless" technique.
RESULTS
Ninety-one patients underwent parotidectomy (42 drainless; 49 drained). Intraoperative blood loss was lower in the "drainless" group (16.0 mL vs 34.9 mL, P < .001). There was a lower rate of facial nerve paresis in the "drainless" group compared with the "drained" cohort (7% vs 16.3%, P = .18). Seroma formation and infection rate was similar.
CONCLUSION
In the properly selected patient, outpatient drainless parotidectomy is a viable procedure with comparable outcomes to traditional extended stay drained parotidectomy.
Topics: Adenolymphoma; Adenoma, Pleomorphic; Ambulatory Surgical Procedures; Blood Loss, Surgical; Drainage; Facial Paralysis; Female; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Seroma
PubMed: 30706566
DOI: 10.1002/hed.25671 -
STAR Protocols Mar 2022The murine parotid salivary glands develop postnatally, shaping oral mucosal immunity in early and adult life. This protocol details the surgical removal of the parotid...
The murine parotid salivary glands develop postnatally, shaping oral mucosal immunity in early and adult life. This protocol details the surgical removal of the parotid glands (parotidectomy) of mice. We also describe a protocol for saliva collection to enable manipulation and measurement of physiological and immunological salivary functions. Our saliva collection approach has been modified from published protocols to enable saliva collection from young mice, which can be challenging. For complete details on the use and execution of this protocol, please refer to Koren et al. (2020).
Topics: Animals; Mice; Parotid Gland; Saliva; Salivary Glands
PubMed: 34977687
DOI: 10.1016/j.xpro.2021.101048 -
Medical Archives (Sarajevo, Bosnia and... Jun 2022While salivary gland tumors constitute 5-6% of all head and neck tumors, they constitute 2-3% of all trunk tumors. About 3.8 per 100,000 of parotid tumors are diagnosed...
BACKGROUND
While salivary gland tumors constitute 5-6% of all head and neck tumors, they constitute 2-3% of all trunk tumors. About 3.8 per 100,000 of parotid tumors are diagnosed in the US each year, about 1300 to 1600 cases. The salivary gland cancer rate is 0.9 per 10000. The frequency of salivary gland tumors varies according to localization.
OBJECTIVE
In our study, we aimed to evaluate retrospectively the histopathological results, incidence, surgical treatment modalities and complications of parotid tumors operated in our clinic.
METHODS
We examined the patients who were operated for parotid gland tumor. The files of 136 patients who were admitted to the Otorhinolaryngology department of Dicle University Medical Faculty Hospital between January 2010 and April 2020 due to a parotid mass and underwent parotidectomy and whose pathology results were reported as benign or malignant parotid tumors were retrospectively scanned and included in the study. Patients' age, gender, FNAB cytology result, type of surgery, histopathological results after surgery and complications after surgical treatment were recorded.
RESULTS
A total of 136 patients, 73 (53.7%) male and 63 (46.3%) female, were included in the study. The mean age of the patients was 48.26±17.37 (min=14, max=83) years. Superficial parotidectomy was performed in 108 (79.4%) patients and total parotidectomy was performed in 28 (20.6%) patients. According to the histopathological results after surgery, 108 (79.4%) benign tumors and 28 (20.6%) malignant tumors were diagnosed. Accordingly, pleomorphic adenoma (47.8%) was the second most common with 65 patients, followed by Whartin tumor (25.7%) with 35 patients. The sensitivity (sensitivity) of FNAB was 85.2%, and the specificity (specificity) was 96.2%. The accuracy of FNAB was found to be 94.0%.
CONCLUSION
Good identification of the parotid mass preoperatively, together with both FNAB and radiological imaging methods, gains much more value in differentiating malignant and benign pathologies. While superficial parotidectomy is mostly sufficient in benign tumors, total parotidectomy-radical parotidectomy in malignant tumors and neck dissection should be considered in high-grade tumors even if there is no neck metastasis. Patients should be evaluated for RT and CT according to the tumor type after surgery.
Topics: Adenoma, Pleomorphic; Aged, 80 and over; Female; Humans; Male; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Salivary Gland Neoplasms
PubMed: 36200113
DOI: 10.5455/medarh.2022.76.170-174 -
The Surgeon : Journal of the Royal... Aug 2022Sialocele and salivary fistula are recognised complications of parotid surgery and have been reported to be more common with less extensive parotidectomy. We...
PURPOSE
Sialocele and salivary fistula are recognised complications of parotid surgery and have been reported to be more common with less extensive parotidectomy. We investigated the efficacy of tissue sealant(Cunniffe et al., 2019) as an alternative to surgical drainage in terms of length of hospital stay (LOS), cost, and incidence of wound complications.
METHODS
The study comprised a retrospective review of a prospectively maintained parotidectomy database at a single tertiary Head and Neck referral centre between 2009 and 2020. Cases undergoing concomitant neck dissection or major skin resection were excluded. Patients were divided into Group 1 (without tissue sealant), and Group 2 (with tissue sealant). Patients were also divided based on extent of surgery 1) Extracapsular dissection/Partial superficial parotidectomy 2) Superficial/total parotidectomy.
RESULTS
Of 202 included patients, there were 146 in Group 1 (143 with drain), and 56 in Group 2 (7 with drain). Compared to Group 1, Group 2 had a significantly shorter LOS (mean 1.4 ± 0.98 versus 3.1 ± 1.29 days, p < 0.05) and estimated cost (€1386 versus €2736). There was no significant difference in the complication rates (15.8% Group 1 versus 10.7% Group 2, p = 0.50). Group 1 showed a higher incidence of complications in patients undergoing less extensive parotidectomy (19/70 versus 4/76, p = 0.02), whereas in Group 2, the difference was not significant (5/30 versus 1/26, p = 0.20).
CONCLUSION
The use of tissue sealant as an alternative to surgical drains after parotidectomy facilitates reduced LOS and cost savings without increase in morbidity.
Topics: Drainage; Humans; Length of Stay; Parotid Gland; Postoperative Complications; Retrospective Studies
PubMed: 34103269
DOI: 10.1016/j.surge.2021.05.001 -
The Laryngoscope Oct 2023The aim of this study was to evaluate the quality and the educational content of YouTube videos showing parotidectomy.
OBJECTIVE
The aim of this study was to evaluate the quality and the educational content of YouTube videos showing parotidectomy.
METHODS
We searched for videos displaying parotidectomy on YouTube. To rate parotidectomy videos, we introduced the "Instructional Videos in Otorhinolaryngology by YO-IFOS (IVORY)-grading-system (GS)" derived from the IVORY Guidelines, which pose established consensus recommendations for the production of educational surgical videos in otolaryngology. The videos were rated using the IVORY-GS, and the total score was tested for statistical association with views, likes, likes/dislikes-ratio, age, and length of the videos for validation of the IVORY-GS.
RESULTS
Overall, 50 parotidectomy videos were identified. Sixty-eight (68%) of the videos showed a superficial parotidectomy. The mean IVORY-GS total score was 24.9 (out of a maximum of 44 points). Video education quality was rated as moderate in 22% and high in 4%. There was a statistically significant correlation between the total score and the number of views (p = 0.03), the total score and the number of likes (p < 0.01), and the total score and the likes/dislikes ratio (p < 0.01). A higher total score was a significant predictor of more likes (p = 0.01) and a higher likes/dislikes ratio (p < 0.01).
CONCLUSION
Our modification of the IVORY Guidelines is otolaryngology-specific, suitable, and recommended to evaluate parotidectomy videos. To date, most videos are of poor educational quality. Future efforts in otolaryngology surgical video education could focus on the establishment of an online video platform.
LEVEL OF EVIDENCE
NA Laryngoscope, 133:2631-2637, 2023.
Topics: Humans; Social Media; Video Recording; Information Dissemination
PubMed: 36734324
DOI: 10.1002/lary.30593 -
American Journal of Otolaryngology 2022Parotid gland incidentaloma (PGI) management has not been well characterized in the literature. This study assesses clinicopathologic features, initial evaluation,...
PURPOSE
Parotid gland incidentaloma (PGI) management has not been well characterized in the literature. This study assesses clinicopathologic features, initial evaluation, management, and outcomes of PGIs discovered on various imaging modalities.
MATERIALS AND METHODS
This is a retrospective case series from a single academic institution. The study cohort included 34 patients with parotid gland incidentalomas discovered between January 2009 and December 2019.
RESULTS
Parotid gland incidentalomas were most frequently identified on magnetic resonance imaging (16 patients, 47.1%). Most patients (26 patients, 76.5%) underwent further evaluation with subsequent imaging, most often magnetic resonance imaging (18 patients, 69.2%), and fine needle aspiration biopsy (33 patients, 97.1%). Most tumors were benign on fine needle aspiration biopsy (19 patients, 57.6%). Most cases (21 patients, 61.8%) were managed with observation without parotidectomy. Malignant findings on fine needle aspiration cytology were associated with increased likelihood of undergoing parotidectomy (25% vs 0%; p = 0.04). Among the patients who received a parotidectomy, most (8 patients, 61.5%) had benign findings on final histopathology.
CONCLUSION
Parotid gland incidentalomas were discovered across a diverse set of imaging modalities in our institution. Magnetic resonance imaging and fine needle aspiration were often performed for further evaluation. Most cases were found to be benign on fine needle aspiration and were managed with observation. These findings highlight the necessity of appropriate work-up for these tumors, and the need for shared decision making between the patient and the physician in selecting the appropriate treatment strategy.
Topics: Biopsy, Fine-Needle; Humans; Parotid Gland; Parotid Neoplasms; Retrospective Studies; Sensitivity and Specificity
PubMed: 34894452
DOI: 10.1016/j.amjoto.2021.103296 -
European Annals of Otorhinolaryngology,... May 2023To describe the key technical points for preserving the great auricular nerve during parotidectomy for tumor, and to discuss the literature regarding the benefits,...
To describe the key technical points for preserving the great auricular nerve during parotidectomy for tumor, and to discuss the literature regarding the benefits, limitations and indications for nerve-sparing surgery. Data suggested that great auricular nerve preservation should be discussed in the preoperative consultation, attempted intraoperatively and mentioned in the operative report once parotidectomy completed.
Topics: Humans; Parotid Gland; Parotid Neoplasms; Quality of Life; Postoperative Complications
PubMed: 35902353
DOI: 10.1016/j.anorl.2022.07.005