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The Journal of International Medical... Jul 2022This study was performed to report and analyze the prevalence of permanent facial nerve paralysis following parotidectomy for various benign and malignant lesions in a...
OBJECTIVE
This study was performed to report and analyze the prevalence of permanent facial nerve paralysis following parotidectomy for various benign and malignant lesions in a single center.
METHODS
This single-center retrospective study included all patients who underwent parotidectomy (total and superficial) for benign and malignant tumors and chronic inflammatory diseases during a 6-year period. Patients who had previously undergone an operation of the parotid gland and those with preoperative facial weakness were excluded.
RESULTS
The study included 127 patients ranging in age from 14 to 83 years (median, 45.89 years). Most patients were female (n = 83, 65.4%). The most prevalent procedure was superficial parotidectomy (n = 117, 92.1%), followed by total parotidectomy (n = 6, 4.7%). The average operative duration was 138 minutes (range, 80-400 minutes). Histopathology revealed that 109 (85.8%) patients had benign tumors, 14 (11.0%) had malignant tumors, and 4 (3.1%) had chronic sialadenitis. Only two patients sustained an injury to the cervical branch of the facial nerve.
CONCLUSION
In this single-center experience of parotid surgery, the rates of transient and permanent facial paralysis were acceptably low at 9.0% and 1.6%, respectively, for all pathologies.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Facial Nerve; Facial Paralysis; Female; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Young Adult
PubMed: 35808820
DOI: 10.1177/03000605221108930 -
JAMA Otolaryngology-- Head & Neck... Nov 2020There is no consensus regarding optimal management of pleomorphic adenoma in adults. (Comparative Study)
Comparative Study Observational Study
IMPORTANCE
There is no consensus regarding optimal management of pleomorphic adenoma in adults.
OBJECTIVES
To compare parotidectomy with observation for the management of pleomorphic adenoma in patients 50 years or older by age.
DESIGN AND SETTING
This decision analytical model was performed from November 21, 2019, to June 15, 2020, using a Markov model. Model variables and ranges were selected based on a literature review. A 1-way sensitivity analysis was performed to evaluate the age threshold at which each algorithm, either upfront elective parotidectomy or observation, would be favored. A Monte Carlo probabilistic sensitivity analysis using variable ranges was then performed 5 times with patients in the model assigned a starting age of 50, 60, 70, 80, and 90 years to assess how age at diagnosis would be associated with the model results.
MAIN OUTCOMES AND MEASURES
Model outcomes were measured with quality-adjusted life-years (QALYs).
RESULTS
In the study models, the age thresholds at which observation became more beneficial than parotidectomy were 88.5 years for patients with superficial lobe tumors (5.37 QALYs in favor of parotidectomy below this age, and 5.37 QALYs in favor of observation above this age) and 83.4 years for patients with deep lobe tumors (7.51 QALYs in favor of surgery below this age, and 7.51 QALYs in favor of observation above this age). There was no significant difference in outcomes between parotidectomy and observation among patients aged 70 to 80 years.
CONCLUSIONS AND RELEVANCE
This study suggests that the outcomes associated with parotidectomy and observation are similar at 70 years or older among patients with pleomorphic adenoma and that observation may be the favorable treatment in that age group.
Topics: Adenoma, Pleomorphic; Aged; Aged, 80 and over; Decision Making; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Parotid Gland; Parotid Neoplasms; Quality-Adjusted Life Years; Retrospective Studies
PubMed: 32970111
DOI: 10.1001/jamaoto.2020.2944 -
Journal of Oral and Maxillofacial... Sep 2018The type and extent of surgery for benign parotid tumors are a subject of debate. We aimed to measure and compare hospital stay, operative time, and complication rates... (Comparative Study)
Comparative Study
PURPOSE
The type and extent of surgery for benign parotid tumors are a subject of debate. We aimed to measure and compare hospital stay, operative time, and complication rates associated with superficial parotidectomy (SP) and partial superficial parotidectomy (PSP).
MATERIALS AND METHODS
This retrospective cohort study included all patients who underwent surgery for benign parotid gland tumors in our tertiary center between January 2006 and March 2014 and were followed up for at least 3 years. The predictor variable was the type of parotidectomy, and the main outcome parameters were operative time, hospital stay, and postoperative complications. The demographic characteristics (age and gender), clinical history, and preoperative findings were obtained from patient records. The Kolmogorov-Smirnov test, Mann-Whitney U test, and χ test were used to analyze the data. P < .05 was considered statistically significant.
RESULTS
The sample was composed of 321 patients (184 men and 137 women) with a mean age of 54.0 ± 14.7 years (range, 18 to 87 years). Of these, 190 underwent SP and 131 underwent PSP. Pleomorphic adenoma was the most common tumor (83 patients, 53%), followed by Warthin tumor (50 patients, 32%). The mean hospital stay was 6.7 ± 2.3 days in the SP group and 4.8 ± 2.4 days in the PSP group (P < .001). The mean operative times in the SP and PSP groups were 134.0 ± 24.6 and 92.1 ± 21.9 minutes, respectively (P < .001). The overall complication rates were 21.6% and 12.2% in the SP and PSP groups, respectively (P = .031). No tumor recurrence was observed in either group.
CONCLUSIONS
Compared with the SP group, the PSP group had shorter operative and hospital stay durations and fewer postoperative complications with a comparable recurrence rate. Therefore, PSP should be considered in suitable cases.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Length of Stay; Male; Middle Aged; Operative Time; Oral Surgical Procedures; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 29715449
DOI: 10.1016/j.joms.2018.04.001 -
Aesthetic Plastic Surgery Apr 2020Patients who have previously undergone superficial parotidectomy may also seek facelift surgery for facial aging and rejuvenation. These patients present unique...
INTRODUCTION
Patients who have previously undergone superficial parotidectomy may also seek facelift surgery for facial aging and rejuvenation. These patients present unique challenges compared to a standard facelift patient. Most concerning is the location of facial nerve branches, which may be superficial and displaced. In addition, significant contour deformities and abnormal scar patterns may be present. The purpose of the study is to review our series of patients and assess potential morbidity and safety of facelift surgery in superficial parotidectomy patients.
METHODS
A retrospective case series was performed reviewing all patients who underwent facelift surgery following superficial parotidectomy from 2000 to 2017. Data were collected for: postoperative facial nerve deficit, soft tissue contour and scar deformities, facelift technique, ancillary soft tissue augmentation procedures and pre- and postoperative photographs. An evidence-based treatment algorithm to address specific problems in this patient population was developed.
RESULTS
A total of seven patients were identified who underwent facelift surgery following parotidectomy. Patients underwent one of the standard SMAS procedure on the non-parotidectomy side, and surgical modifications were made to address the parotidectomy side; soft tissue augmentation was performed in two patients. Precautions to identify the facial nerve and prevent injury, including nerve monitoring and stimulation, were utilized in all seven patients. No permanent postoperative facial nerve injury was noted.
CONCLUSION
Facelift following superficial parotidectomy was safely performed in all cases. Special consideration should be given to contour deformities, facial nerve location and scar placement. However, if approached properly, these patients can still be considered as suitable candidates for facelift surgery.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Topics: Cicatrix; Humans; Parotid Gland; Postoperative Complications; Rejuvenation; Retrospective Studies; Rhytidoplasty
PubMed: 31980862
DOI: 10.1007/s00266-019-01608-x -
Ear, Nose, & Throat Journal Dec 2022First bite syndrome (FBS) is a rare but potentially debilitating complication observed after surgery involving the upper cervical region. Patients classically complain... (Review)
Review
INTRODUCTION
First bite syndrome (FBS) is a rare but potentially debilitating complication observed after surgery involving the upper cervical region. Patients classically complain of severe facial pain in the ipsilateral parotid region with the first few bites of a meal.
OBJECTIVE
The aim of this study is to shed light on the incidence and potential risk factors of FBS, including a series of cases depicting FBS observed after parotidectomy.
METHODS
Retrospective review of 419 patients who underwent parotidectomy at a single tertiary care facility between December 2016 and June 2020.
RESULTS
With a mean follow-up time of 16.5 months, 8 (2%) patients were documented to have symptoms of FBS after parotid gland surgery. Six of these patients underwent partial parotidectomy by dissection of the deep lobe of the parotid (DLP).
CONCLUSION
Patients undergoing dissection of the DLP are particularly at risk for the development of FBS. All patients should be appropriately counseled during informed consent discussions, especially in high-risk cases.
Topics: Humans; Mastication; Parotid Gland; Parotid Region; Syndrome; Retrospective Studies; Facial Pain; Parotid Neoplasms; Postoperative Complications
PubMed: 33314982
DOI: 10.1177/0145561320980179 -
Head & Neck Mar 2022Postparotidectomy sialocele is a frustrating challenge. Published rates of postparotidectomy fluid collections range from 6% to 39%. We report our experience of 398...
BACKGROUND
Postparotidectomy sialocele is a frustrating challenge. Published rates of postparotidectomy fluid collections range from 6% to 39%. We report our experience of 398 parotidectomies performed over a 6-year period.
METHODS
A retrospective chart review of parotidectomies performed over a 6-year period was completed. Drain placement, smoking status, tumor size, and postoperative utilization of scopolamine were analyzed. Binary logistical regression and odds ratio calculations were performed.
RESULTS
Postparotidectomy sialocele occurred in 25% of patients. Neither suction drain placement nor usage of immediate postoperative scopolamine (in a 22-patient subset) prevented sialocele formation. Smoking status also did not correlate. Increasing resection size was linearly correlated with the risk of sialocele.
CONCLUSION
Drain placement and smoking status do not correlate with sialocele prevention after parotidectomy. Sialocele formation directly correlates with the resection size. These data may guide preoperative counseling; however, additional work is necessary to identify effective prevention mechanisms for postparotidectomy sialocele.
Topics: Humans; Parotid Diseases; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies
PubMed: 34957635
DOI: 10.1002/hed.26969 -
Clinical Otolaryngology : Official... May 2023Parotid surgery is historically performed as an inpatient procedure and suctions drains are predominantly used during surgery. Recent literature provides evidence that...
OBJECTIVE
Parotid surgery is historically performed as an inpatient procedure and suctions drains are predominantly used during surgery. Recent literature provides evidence that outpatient parotid surgery is safe and effective. Our study aims to describe the results of drainless outpatient parotidectomy and outpatient parotidectomy with drain placement and compare their outcomes.
DESIGN
Retrospective cohort study.
SETTING
Bi-institutional retrospective cohort study.
PARTICIPANTS
Patients that underwent outpatient drain-less parotidectomy and patients that underwent outpatient parotidectomy with post-operative drain placement.
MAIN OUTCOME MEASURES
Complication rates, unplanned post-operative visits, unplanned prolonged stay.
RESULTS
Three hundred eighty patients underwent outpatient parotidectomy with drain placement and 31 patients underwent outpatient drainless parotidectomy in two different hospitals. The incidence of haematoma (drain: 3.1% vs. drainless: 0%, p = 1), infection (drain: 14.3% vs. drainless: 13.8%, p = 1) and salivary fistula (drain: 5.6% vs. drainless: 3.4, p = 1) were comparable between both groups. Seroma or sialocele was more frequently seen in the drain-less group (27.6% vs. 6.2%, p < .001), but were all managed conservatively. Within 10 days after surgery, unplanned visits seemed more frequent in the drain group, although the difference was not statistically significant (14.9% vs. 3.4%, p = .16).
CONCLUSIONS
Outpatient parotid surgery with or without the use of a post-operative drain is safe, practical and feasible. Same-day discharge with and without drain placement yield comparable outcomes. However, the results need to be interpreted cautiously as this study was limited by a small cohort of parotidectomies without drain placement. Future studies should further compare both approaches.
Topics: Humans; Retrospective Studies; Outpatients; Postoperative Complications; Parotid Gland; Salivary Gland Diseases; Parotid Neoplasms
PubMed: 36585381
DOI: 10.1111/coa.14028 -
The Journal of Craniofacial Surgery Jun 2022When repaired with interposition nerve grafts, segmental facial nerve defects are traditionally treated with nerve autograft. The authors present a patient who presented...
When repaired with interposition nerve grafts, segmental facial nerve defects are traditionally treated with nerve autograft. The authors present a patient who presented after partial resection of a basal cell carcinoma over the left zygomatic region with positive deep and peripheral margins and complete loss of frontal and zygomatic facial nerve function. She was subsequently treated with wide resection, superficial parotidectomy, and cervicofacial flap. The parotidectomy was performed for deep margin control and the facial nerve was dissected distally demonstrating the prior resection of a segment of frontal and zygomatic branches consistent with clinical exam. For acute segmental facial nerve defects, nerve autograft has been the gold standard. in our patient, segmental repair using processed nerve allograft demonstrated rapid and complete recovery. This is a viable option for facial nerve reconstruction with various benefits of avoiding donor site morbidity, ease of allograft nerve handling and decreased operative time.
Topics: Allografts; Face; Facial Nerve; Female; Humans; Plastic Surgery Procedures; Surgical Flaps
PubMed: 34690309
DOI: 10.1097/SCS.0000000000008313 -
European Archives of... Mar 2023Facial nerve dysfunction (FND) is a frequent and serious parotidectomy outcome. Intraoperative facial nerve monitoring (IFNM) is an increasingly used technique to...
PURPOSE
Facial nerve dysfunction (FND) is a frequent and serious parotidectomy outcome. Intraoperative facial nerve monitoring (IFNM) is an increasingly used technique to identify the facial nerve (FN) and minimize its injury. This study aimed to evaluate the determinant factors in the presence and severity of FND after parotidectomy, including IFNM.
STUDY DESIGN, SETTING AND METHODS
A total of 48 patients consecutively submitted to parotidectomy between 2005 and 2020 in a tertiary hospital were retrospectively analyzed. The House-Brackmann Scale (HBS) was used to assess the severity of FND.
RESULTS
There was a mean age of 54.2 ± 17.8 years, 50% were male. Pleomorphic adenoma (41.7%) and Warthin's tumor (25.0%) were most common. From the 23 patients (47.9%) who developed some degree of FND (HBS score of 3.41 ± 1.53), 19 (82.6%) showed facial movement recovery, with a mean recovery time of 4.78 ± 2.53 months. IFNM was performed in 39.6% of the surgeries. The use of IFNM (p = 0.514), the type of surgery-partial or total parotidectomy-(p = 0.853) and the type of histology-benign or malignant lesion-(p = 0.852) did not significantly influence the presence of FND in the postoperative period. However, in the subgroup of patients who developed FND, the HBS value was significantly lower in cases of benign pathology (p = 0.002) and in patients who underwent IFNM (p = 0.017), denoting a significantly lower severity.
CONCLUSION
In the present study, IFNM and the existence of a benign lesion have been shown to be associated with lower severity of FND.
Topics: Humans; Male; Adult; Middle Aged; Aged; Female; Facial Nerve; Parotid Neoplasms; Retrospective Studies; Facial Nerve Injuries; Face; Parotid Gland; Postoperative Complications
PubMed: 36333562
DOI: 10.1007/s00405-022-07720-0