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The Journal of Laryngology and Otology May 2021This study aimed to evaluate the effect of resident involvement and the 'July effect' on peri-operative complications after parotidectomy.
OBJECTIVE
This study aimed to evaluate the effect of resident involvement and the 'July effect' on peri-operative complications after parotidectomy.
METHOD
The American College of Surgeons National Surgical Quality Improvement Program database was queried for parotidectomy procedures with resident involvement between 2005 and 2014.
RESULTS
There were 11 733 cases were identified, of which 932 involved resident participation (7.9 per cent). Resident involvement resulted in a significantly lower reoperation rate (adjusted odds ratio, 0.18; 95 per cent confidence interval, 0.05-0.73; p = 0.02) and readmission rate (adjusted odds ratios 0.30; 95 per cent confidence interval, 0.11-0.80; p = 0.02). However, resident involvement was associated with a mean 24 minutes longer adjusted operative time and 23.5 per cent longer adjusted total hospital length of stay (respective p < 0.01). No significant difference in surgical or medical complication rates or mortality was found when comparing cases among academic quarters.
CONCLUSION
Resident participation is associated with significantly decreased reoperation and readmission rates as well as longer mean operative times and total length of stay. Resident transitions during July are not associated with increased risk of adverse peri-operative outcomes after parotidectomy.
Topics: Adult; Aged; Aged, 80 and over; Clinical Competence; Female; Humans; Internship and Residency; Length of Stay; Male; Middle Aged; Operative Time; Parotid Gland; Postoperative Complications; Quality Improvement; Reoperation; Retrospective Studies; Salivary Gland Diseases
PubMed: 33910657
DOI: 10.1017/S0022215121000578 -
American Journal of Otolaryngology 2022Determine rates of intra-parotid and neck nodal metastasis, identify risk factors for recurrence, and report outcomes in patients with primary high-grade parotid...
PURPOSE
Determine rates of intra-parotid and neck nodal metastasis, identify risk factors for recurrence, and report outcomes in patients with primary high-grade parotid malignancy who undergo total parotidectomy and neck dissection.
MATERIALS & METHODS
Retrospective review of patients undergoing total parotidectomy and neck dissection for high-grade parotid malignancy between 2005 and 2015. The presence and number of parotid lymph nodes, superficial and deep, as well as cervical lymph nodes involved with metastatic disease were assessed. Risk factors associated with metastatic spread to the parotid deep lobe were identified and recurrence rates reported.
RESULTS
75 patients with median follow-up time of 47 months. 35 patients (46.7%) had parotid lymph node metastasis. Seven patients (9.3%) had deep lobe nodal metastasis without metastasis to the superficial lobe nodes. Nine patients (12%) had positive intra-parotid nodes without positive cervical nodes. Cervical nodal disease was identified in 49.3% patients (37/75). Local, parotid-bed recurrence rate was 5.3% (4/75). Regional lymph node recurrence rate was also 5.3% (4/75). Rate of distant metastasis was 30.6% (23/75). The overall disease free survival rate for all patients at 2 and 5 years were 71% and 60% respectively.
CONCLUSION
Parotid lymph node metastasis occurred at a similar rate to cervical lymph node metastasis (46.7% and 49.3%, respectively). Deep lobe parotid nodal metastasis occurred in nearly a quarter of patients and can occur without superficial parotid nodal metastasis. Rate of recurrence in the parotid bed, which may represent local or regional recurrence, was similar to regional cervical lymph node recurrence. Total parotidectomy and neck dissection should be considered high-grade parotid malignancy regardless of clinical nodal status.
Topics: Adult; Aged; Aged, 80 and over; Digestive System Surgical Procedures; Female; Follow-Up Studies; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neck; Neck Dissection; Neoplasm Recurrence, Local; Neoplasm Staging; Parotid Gland; Parotid Neoplasms; Retrospective Studies; Risk Factors; Survival Rate; Time Factors; Treatment Outcome
PubMed: 34509079
DOI: 10.1016/j.amjoto.2021.103194 -
Journal of Stomatology, Oral and... Feb 2019Parotidectomy for benign tumours is usually performed after facial nerve trunk discovery through an anterograde approach (AA) of the nerve. More recently, a retrograde... (Review)
Review
INTRODUCTION
Parotidectomy for benign tumours is usually performed after facial nerve trunk discovery through an anterograde approach (AA) of the nerve. More recently, a retrograde approach (RA) toward the facial nerve, which begins on the facial nerve branches and ends on the nerve trunk, has been described. A literature review of the RA was conducted to evaluate the RA and to compare it with AA.
METHODS
A literature review was conducted for the years 1980 through 2016. Nine studies out of 216 were included, including 558 parotidectomies and 370 RA. We studied the operative time (OT), the postoperative complications including facial paralysis (FP), tumour recurrences, and possibilities for reoperation.
RESULTS
Operative time was shorter in RA than in AA. Transitory FP significantly less frequent in RA than in AA in only one studies and not significantly in four studies. Incidence of Frey syndrome was similar in RA and AA. Tumour relapses were reported in 1.8% of cases with RA, comparable to AA.
CONCLUSION
Retrograde parotidectomy is recommendable. OT was significantly shorter for the RA. The FP rate was lower for RA than for AA, but the difference was not significant. The recurrence rate appeared to be similar between RA and AA. Possibilities of reoperation were better after RA.
Topics: Humans; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms; Retrospective Studies; Sweating, Gustatory
PubMed: 30125738
DOI: 10.1016/j.jormas.2018.08.005 -
Head & Neck Aug 2017The primary purpose of this study was to describe the parotid recurrence rates after superficial and total parotidectomy. (Comparative Study)
Comparative Study
BACKGROUND
The primary purpose of this study was to describe the parotid recurrence rates after superficial and total parotidectomy.
METHODS
A retrospective cohort study was performed on patients with cutaneous melanoma metastatic to the parotid gland who underwent parotidectomy from 1998 through 2014. Primary outcome was parotid bed recurrence. Secondary outcomes were facial nerve function postoperatively and at last follow-up.
RESULTS
One hundred twenty-nine patients were included in the study. Thirty-four patients (26%) underwent a total parotidectomy and 95 patients underwent superficial parotidectomy. Twelve patients (13%) developed parotid bed recurrence after superficial parotidectomy alone versus zero after total parotidectomy (P = .035). Facial nerve function, clinically detected disease, stage, and adjuvant treatment were not statistically different between the groups (P = .32, .32, .13, and 0.99, respectively).
CONCLUSION
Parotid bed melanoma recurrence was more common after superficial parotidectomy compared to total parotidectomy, and recurrence resulted in significant facial nerve functional deficit. Our results support total parotidectomy when metastatic melanoma involves the parotid nodal basin.
Topics: Facial Nerve; Female; Humans; Male; Melanoma; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Otorhinolaryngologic Surgical Procedures; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Skin Neoplasms
PubMed: 28481438
DOI: 10.1002/hed.24810 -
Lipofilling after total parotidectomy: a useful option to prevent functional and aesthetic sequelae.Acta Otorhinolaryngologica Italica :... Dec 2022Parotidectomy is the main treatment for parotid tumours, but its functional and aesthetic sequelae can be very disturbing for patients.
OBJECTIVE
Parotidectomy is the main treatment for parotid tumours, but its functional and aesthetic sequelae can be very disturbing for patients.
METHODS
15 patients underwent total conservative parotidectomy, harvesting of a superficial musculoaponeurotic system (SMAS) flap and lipofilling between May 2014 and June 2020 for a benign parotid tumour. Aesthetic, functional sequelae and cosmetic results were assessed with the House-Brackmann scale, Luna-Ortiz's classification and a semiquantitative questionnaire. Lipofilling resorption was analysed by maxillofacial and neck MRI imaging at 2 years after surgery. The results were compared to a group of 21 patients who underwent total parotidectomy without harvesting a SMAS flap and lipofilling.
RESULTS
No complications were observed. No facial defects were seen during follow-up. Post-operative MRI showed fat resorption was less than 20% in 12 patients and from 20 to 30% in 3 patients. Cosmetic satisfaction was 100% in all cases. Only 1 patient (6%) complained of Frey's syndrome.
CONCLUSIONS
Lipofilling is an excellent solution considering its efficacy, safety, simplicity, duration over time and economic costs. Donor site invasiveness is minimal, and reintervention is always possible. Face-lift incision and SMAS flap can improve aesthetic results and minimise the disfiguring impact of the surgical scar.
Topics: Humans; Parotid Gland; Surgical Flaps; Parotid Neoplasms; Sweating, Gustatory; Esthetics; Postoperative Complications; Retrospective Studies
PubMed: 36654517
DOI: 10.14639/0392-100X-N2231 -
Annals of Plastic Surgery Jul 2021Parotid gland pathologies requiring resection present with varying effects on surrounding tissue architecture, and we hypothesize that this spectrum of indications...
BACKGROUND
Parotid gland pathologies requiring resection present with varying effects on surrounding tissue architecture, and we hypothesize that this spectrum of indications confers different risks of adverse events. The purpose of this study is to elucidate the complication profiles of parotidectomy in children across a spectrum of pathologies requiring parotid resection.
METHODS
The American College of Surgeons National Surgical Quality Improvement Program Pediatric data set was queried for parotidectomies performed from 2012 through 2017. Indications were subclassified based on International Classification of Diseases, Ninth Revision and Tenth Revision codes. Complications, readmissions, and reoperations were analyzed with appropriate statistics.
RESULTS
Parotidectomies in children (n = 208) were mostly performed for neoplasms (47.6%), followed by inflammatory conditions (24.0%). Total parotidectomies took significantly longer (P < 0.001) and remained in the hospital significantly longer than superficial parotidectomies (P < 0.001). There was no significant difference (P = 0.417) between benign neoplasms (29.3%) and malignant neoplasms (37.9%) requiring total parotidectomy. However, there was a significant difference (P = 0.014) across various malformations, with 83.3% of lymphatic malformations requiring total parotidectomy. Although lymphatic malformations required more aggressive resection, these procedures had the lowest rate of adverse events (0%). Despite the unappreciable predilection toward total parotidectomy based on nature of neoplasms, parotidectomy performed for malignant neoplasms had a significantly increased risk of nerve injury (P < 0.001; odds ratio [OR], 3563) and medical complications (P < 0.001; OR, 67.2), whereas those performed for benign neoplasms did not have an increased risk of these complications (all P's > 0.209). Parotidectomy performed for vascular malformations had significantly increased risk of bleeding requiring transfusion (P < 0.001; OR, 14.9) and surgical complications (P < 0.001; OR, 9.2). Bleeding requiring transfusion was significantly related to longer surgical procedures (P < 0.001; 409 vs 191 minutes).
CONCLUSIONS
Parotidectomy in pediatric patients for malignant neoplasms is associated with a significantly higher risk of nerve injury compared with parotidectomy for benign neoplasms. Parotidectomy for vascular malformations has a significantly higher risk of bleeding requiring transfusion, whereas parotidectomy for lymphatic malformations is associated with the lowest risk of medical and surgical complications.
Topics: Child; Humans; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Reoperation; Retrospective Studies
PubMed: 33346552
DOI: 10.1097/SAP.0000000000002578 -
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 -
The Journal of Laryngology and Otology Sep 2021Immediate facial nerve reconstruction is the standard of care following radical parotidectomy; however, quality of life comparisons with those undergoing limited... (Comparative Study)
Comparative Study
OBJECTIVE
Immediate facial nerve reconstruction is the standard of care following radical parotidectomy; however, quality of life comparisons with those undergoing limited superficial parotidectomy without facial nerve sacrifice is lacking.
METHOD
Patients who underwent parotidectomy were contacted to determine quality of life using the University of Washington Quality of Life and Parotidectomy Specific Quality of Life questionnaires. A total of 29 patients (15 in the radical parotidectomy and 14 in the limited superficial parotidectomy groups) completed and returned questionnaires.
RESULTS
Using the University of Washington Quality of Life Questionnaire, similar quality of life was noted in both groups, with the radical parotidectomy group having significantly worse speech and taste scores. Using the Parotidectomy Specific Quality of Life Questionnaire, the radical parotidectomy group reported significantly worse speech, eye symptoms and eating issues.
CONCLUSION
Those undergoing radical parotidectomy with reconstruction had comparable overall quality of life with the limited superficial parotidectomy group. The Parotidectomy Specific Quality of Life Questionnaire better identified subtle quality of life complaints. Eye and oral symptoms remain problematic, necessitating better rehabilitation and more focused reconstructive efforts.
Topics: Aged; Combined Modality Therapy; Cross-Sectional Studies; Facial Nerve; Facial Paralysis; Female; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Quality of Life; Plastic Surgery Procedures; Retrospective Studies; Surveys and Questionnaires; Time Factors
PubMed: 34315553
DOI: 10.1017/S0022215121001857 -
Annali Italiani Di Chirurgia 2017Complications after parotid surgery include deficit of the facial nerve, wound complications, as sialocele and salivary fistula, and Frey syndrome; the goal of this...
AIM
Complications after parotid surgery include deficit of the facial nerve, wound complications, as sialocele and salivary fistula, and Frey syndrome; the goal of this study was to evaluate the relationship between the type of parotid surgery performed and the incidence of each of these complications.
MATERIAL OF STUDY
A total of 184 patients were evaluated and 158 were included in the study. Four different kinds of intervention were made: extracapsular dissection, partial superficial parotidectomy; superficial parotidectomy and total parotidectomy. The incidence of each complication was studied and correlated to the type of surgery performed. Statistical analysis was done using the chi-square test of independence.
RESULTS
From all cases examined, 86 patients developed facial nerve complications with 59 minor asymmetry, 19 partial weakness and 8 complete weakness. Forty patients had wound complications, 28 sialocele and 12 salivary fistula. Sixteen patients developed Frey syndrome.
DISCUSSION
Facial nerve complications and Frey syndrome were significantly related to superficial or total parotidectomy, differently extracapsular dissection and partial superficial parotidectomy had more cases of wound complications.
CONCLUSION
The kind of complications that occur after parotid surgery depends on surgery performed. Chi-square test has a statistically significant result and confirms this kind of relationship (P <.0001).
KEY WORDS
Facial nerve, Parotid glands, Parotidectomy.
Topics: Adult; Aged; Aged, 80 and over; Cutaneous Fistula; Cysts; Facial Nerve Injuries; Facial Paralysis; Female; Humans; Intraoperative Complications; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Saliva; Salivary Gland Fistula; Sweating, Gustatory
PubMed: 29051404
DOI: No ID Found -
Journal of Otolaryngology - Head & Neck... Feb 2021Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of... (Comparative Study)
Comparative Study
BACKGROUND
Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of outpatient superficial parotidectomy compared to inpatient parotidectomy.
METHODS
A retrospective review of individuals who underwent superficial parotidectomy between 2006 and 2016 at a tertiary care center was conducted. Primary outcomes included surgical complications, including transient/permanent facial nerve palsy, wound infection, hematoma, seroma, and fistula formation, as well as medical complications in the postoperative period. Secondary outcome measures included unplanned emergency room visits and readmissions within 30 days of operation due to postoperative complications.
RESULTS
There were 238 patients included (124 in outpatient and 114 in inpatient group). There was no significant difference between the groups in terms of gender, co-morbidities, tumor pathology or tumor size. There was a trend towards longer distance to the hospital from home address (111 Km in inpatient vs. 27 in outpatient, mean difference 83 km [95% CI,- 1 to 162 km], p = 0.053). The overall complication rates were comparable between the groups (24.2% in outpatient group vs. 21.1% in inpatient, p = 0.56). There was no difference in the rate of return to the emergency department (3.5% vs 5.6%, p = 0.433) or readmission within 30 days (0.9% vs 0.8%, p = 0.952).
CONCLUSION
Superficial parotidectomy can be performed safely as an outpatient procedure without elevated risk of complications.
Topics: Academic Medical Centers; Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Feasibility Studies; Female; Humans; Inpatients; Male; Middle Aged; Ontario; Otorhinolaryngologic Surgical Procedures; Outpatients; Parotid Diseases; Parotid Gland; Patient Readmission; Postoperative Complications; Retrospective Studies
PubMed: 33579392
DOI: 10.1186/s40463-020-00484-9