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Translational Cancer Research Jul 2022Endoscopic parotidectomy has the potential to become a reliable procedure for benign and low-grade malignant parotid gland tumors. Based on the previous literature...
Endoscopic parotidectomy has the potential to become a reliable procedure for benign and low-grade malignant parotid gland tumors. Based on the previous literature review and our own clinical experience, we introduced in detail the surgical procedure of single incision-plus approach for gasless endoscopic parotidectomy. This method contributes a logical approach to achieving endoscopic resection of parotid gland tumor and preservation of facial nerve, which can be summarized into the following seven-step method: preoperative preparation; design of retroauricular-hairline incision and plus-incision; surgical cavities creation and coalescence; separation of surgical boundaries; separation and protection of the facial nerve trunk; processing of the branches of facial nerve; en bloc resection of the superficial parotid gland and tumor. Endoscopic parotidectomy is a more difficult procedure than conventional parotid surgery, requiring more precision as well as more experience and equipment. The learning curve of time and frequency is influenced by many factors, like anatomy, instruments, procedures and patience. We contribute our clinical exploration of anatomical precautions, feasible instruments, and surgical procedures and summarize precautions under single incision-plus in gasless endoscopic parotidectomy. Given the growing interest in the aesthetic process of the parotid region, the seven-step method may have the potential to be a method for teaching gasless endoscopic parotidectomy.
PubMed: 36249887
DOI: 10.21037/tcr-22-226 -
The British Journal of Oral &... Jul 2020Our aim was to investigate the clinical outcomes (recurrences, duration of follow-up, and effectiveness) after extracapsular dissection and superficial parotidectomy for...
Our aim was to investigate the clinical outcomes (recurrences, duration of follow-up, and effectiveness) after extracapsular dissection and superficial parotidectomy for pleomorphic adenoma of the parotid gland. We retrospectively studied 261 patients whose adenomas were treated at the Maxillofacial Unit of Magna Graecia University of Catanzaro between January 2003 and December 2015 and had been followed up for at least three years after either extracapsular dissection or superficial parotidectomy. The difference in recurrences and complications between the two techniques were measured by univariate analysis (Fisher's exact test). The level of significance was set at p ≤ 0.05. Of the 261 patients 125 were male (48%) and 136 female (52%), mean (range) age 47 (14-78) years. A total of 210 of the 261 patients had an extracapsular dissection (80%, 101 male and 109 female), and 51 had a superficial parotidectomy (24 male and 27 female). Postoperative complications were recorded in 48 of the 261 patients; complication rate was 10% in the extracapsular dissection group, and a third after superficial parotidectomy. There were more complications in the parotidectomy group (p=0.042). For pleomorphic adenomas located in the superficial portion of the parotid gland, extracapsular dissection is a viable alternative to traditional superficial parotidectomy in the hands of experienced parotid surgeons with regard to clinical outcomes, and it may be superior with regard to cost.
Topics: Adenoma, Pleomorphic; Dissection; Female; Humans; Male; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Salivary Gland Neoplasms
PubMed: 32307129
DOI: 10.1016/j.bjoms.2020.03.020 -
European Archives of... Nov 2017Different surgical options are currently available for treating benign tumors of the parotid gland, and the discussion on optimal treatment continues despite several... (Review)
Review
Different surgical options are currently available for treating benign tumors of the parotid gland, and the discussion on optimal treatment continues despite several meta-analyses. These options include more limited resections (extracapsular dissection, partial lateral parotidectomy) versus more extensive and traditional options (lateral parotid lobectomy, total parotidectomy). Different schools favor one option or another based on their experience, skills and tradition. This review provides a critical analysis of the literature regarding these options. The main limitation of all the studies is the bias of selection for different surgical approaches. For this reason, we propose a staging system that could facilitate clinical decision making and the comparison of results. We propose four categories based on the size of the tumor and its location within the parotid gland. Category I includes tumors up to 3 cm, which are mobile, close to the outer surface and close to the parotid borders. Category II includes deeper tumors up to 3 cm. Category III comprises tumors greater than 3 cm involving two levels of the parotid gland, and category IV tumors are greater than 3 cm and involve more than 2 levels. For each category and for the various pathologic types, a guideline of surgical extent is proposed. The objective of this classification is to facilitate prospective multicentric studies on surgical techniques in the treatment of benign parotid tumors and to enable the comparison of results of different clinical studies.
Topics: Clinical Decision-Making; Dissection; Humans; Parotid Gland; Parotid Neoplasms
PubMed: 28639060
DOI: 10.1007/s00405-017-4650-4 -
Laryngoscope Investigative... Feb 2023We previously reported that >50% of postoperative opioids prescribed at our institution went unused for common otolaryngologic procedures. Based on these findings, we...
OBJECTIVES
We previously reported that >50% of postoperative opioids prescribed at our institution went unused for common otolaryngologic procedures. Based on these findings, we instituted multimodal, evidence-based guidelines for postoperative pain management. In the second part of our multiphasic study, we evaluated the effects of these guidelines on (1) quantity of unused opioids, (2) patient satisfaction, and (3) institutional perceptions toward the opioid epidemic and prescribing guidelines.
METHODS
Standardized, procedure-specific opioid prescription guidelines were created using prospective data from the first phase of our study and evidence from current literature. Again, we examined sialendoscopy, parotidectomy, parathyroidectomy/thyroidectomy, and transoral robotic surgery (TORS). Patients were surveyed at their first postoperative appointment. Groups from Phases I and II were compared. Attending physicians were surveyed before the start of the multiphasic project and after prescribing guidelines were implemented.
RESULTS
Prescribing guidelines led to an average reduction in prescribed morphine milligram equivalents (MME) per patient by: 48% (sialendoscopy), 63% (parotidectomy), 60% (para/thyroidectomy), and 42% (TORS). Average used MME per patient for parotidectomy was significantly reduced (64%). The proportion of unused MME per patient and patient satisfaction scores did not significantly change after guidelines were implemented.
CONCLUSION
Implementation of opioid-prescribing guidelines and the use of multimodal analgesia substantially reduced the amount of opioids prescribed across all procedures without impacting patient satisfaction.
LEVEL OF EVIDENCE
2.
PubMed: 36846420
DOI: 10.1002/lio2.990 -
International Journal of Oral and... Oct 2021The aim of this study was to investigate the prevalence of first bite syndrome (FBS) among post-parotidectomy patients and to analyse the risk factors for its...
The aim of this study was to investigate the prevalence of first bite syndrome (FBS) among post-parotidectomy patients and to analyse the risk factors for its occurrence. The study involved 111 adult patients operated for benign parotid tumours. After surgery, the participants were asked to assess the presence of food-related pain and the nature of the pain. Participants also answered questions on complications after parotidectomy. FBS was found in seven patients (6.3%). Sex (P=0.036) and age (P=0.002) differed significantly between patients with and without FBS. Female patients were found to be at higher risk of FBS, and the lower the patient's age, the more likely FBS was to occur after surgery. Tumour location (P=0.002) and the occurrence of disturbing symptoms before surgery (P=0.009) had a statistically significant effect on the occurrence of FBS. A tendency towards significance for paresis of cranial nerve VII after surgery (P=0.051) was found; this complication was more frequent in the FBS patients. FBS is a rare pain syndrome that can occur after parotidectomy and should be distinguished from postoperative pain. Proper diagnosis and implementation of the appropriate treatment can significantly improve patient quality of life.
Topics: Adult; Female; Humans; Pain, Postoperative; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Quality of Life; Retrospective Studies; Syndrome
PubMed: 33731266
DOI: 10.1016/j.ijom.2021.02.029 -
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 -
The Laryngoscope Apr 2020Description of a novel use of a submandibular gland (SMG) flap pedicled on the facial vessels to restore facial volume after parotidectomy, and comparison of clinical...
OBJECTIVES/HYPOTHESIS
Description of a novel use of a submandibular gland (SMG) flap pedicled on the facial vessels to restore facial volume after parotidectomy, and comparison of clinical outcomes with alternative modes of reconstruction.
STUDY DESIGN
Retrospective chart review.
METHODS
The surgical technique for a SMG flap is described. Retrospective chart review of cases of parotidectomy at a single tertiary medical center was conducted (n = 43). Cases were grouped in three cohorts of consecutive patients depending on reconstruction technique: SMG flap (n = 13), sternocleidomastoid muscle (SCM) flap (n = 15), and no flap (n = 15). Cohort characteristics and complication rates are reported.
RESULTS
The SMG flap was more often used for a malignant pathology (92%) and in conjunction with a neck dissection (100%), compared to the SCM flap (47% and 15%) or no flap (0% and 0%), respectively. The mean House-Brackmann score in the immediate postoperative period in the SMG-flap group was slightly elevated compared to the other groups: 1.6 (standard deviation [SD] ± 0.5) versus 1.1 (SD ± 0.3) and 1.0 (SD ± 0.0). Otherwise, the complication rate was similar across groups.
CONCLUSIONS
The SMG flap is a safe and effective option for volume restoration after parotidectomy. It provides durable volume that will not atrophy and is already exposed in the field of dissection for patients undergoing concurrent level I neck dissection.
LEVEL OF EVIDENCE
3 Laryngoscope, 130:E155-E162, 2020.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Muscle, Skeletal; Parotid Gland; Plastic Surgery Procedures; Retrospective Studies; Submandibular Gland; Surgical Flaps
PubMed: 31069823
DOI: 10.1002/lary.28037 -
Acta Oto-laryngologica Dec 2019Retrospective analysis of extracapsular dissection (ECD) and superficial parotidectomy (SP). Comparing the outcomes of ECD and SP in surgery of benign parotid masses.... (Comparative Study)
Comparative Study
Retrospective analysis of extracapsular dissection (ECD) and superficial parotidectomy (SP). Comparing the outcomes of ECD and SP in surgery of benign parotid masses. Total of 136 patients included in the study. The inclusion criteria were pathologically proven benign FNA biopsy, lack of deep lobe invasion and single tumour diameter lower than 4 cm, absence of radiologically and clinically malignant lesion and facial paralysis at the time of diagnosis. Drain volumes and seroma presence, clinical evaluation of face nerve function; signs of infective complications were collected from patients' clinic chart. Complications and recurrence rates were obtained from follow-up forms. The mean follow-up period was 42.53 ± 14.88 months. In SP group, three patients with disease recurrence were found, 8 (10.2%) had early facial nerve paralysis (grade 2 and 3) and 11 (14.1%) had Frey's syndrome. No postoperative complication, early facial paralysis and recurrence were observed in ECD group. ECD procedure was found to be as successful as SP in the selected patient group in approach to the pathologically proven and single benign parotid masses with similar recurrence and lower complication rates compared to the SP.
Topics: Adenolymphoma; Adenoma, Pleomorphic; Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Young Adult
PubMed: 31560243
DOI: 10.1080/00016489.2019.1669821 -
Journal of Oral Pathology & Medicine :... Mar 2022Superficial parotidectomy has been the gold standard for surgical removal of benign mobile parotid gland tumours. The comparatively newer technique of extracapsular... (Review)
Review
Superficial parotidectomy has been the gold standard for surgical removal of benign mobile parotid gland tumours. The comparatively newer technique of extracapsular dissection, which involves careful dissection of the tumour itself without the need for formal gland excision, has gained popularity in recent years. Tumours can be removed via smaller incision, and the technique reduces the risk of Frey's syndrome (gustatory sweating) and hollowing at the site of surgery. The risk of facial nerve damage can also be lower with extracapsular dissection. If done carefully, the incidence of tumour recurrence, particularly for pleomorphic adenomas, is comparable with formal parotidectomy. We provide a brief update overview of the current evidence for extracapsular dissection in the treatment of benign parotid tumours and include several meta-analyses which provide evidence for the safety of the technique. We have also included our audited results of over 100 recent extracapsular dissections, with 0% incidence of permanent facial nerve weakness, reported Frey's syndrome and recurrence rates over the last 5 years.
Topics: Adenoma, Pleomorphic; Humans; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Sweating, Gustatory
PubMed: 34697837
DOI: 10.1111/jop.13251 -
The Annals of Otology, Rhinology, and... Oct 2021Frey's syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been...
BACKGROUND
Frey's syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, and prevent Frey's syndrome. Free dermal-fat-fascial graft (DFFG) is one such technique; however, its use is largely undocumented in the literature. In this case series, we investigate the efficacy of free DFFG in reconstructing parotidectomy defects at 2 tertiary care centers.
MATERIALS AND METHODS
Medical records of 54 patients who underwent primary parotidectomy and immediate reconstruction with autologous abdominal free DFFG by 2 surgeons in George Washington University Hospital and McGill University Health Centre between 2007 and 2019 were collected prospectively. Patients responded to 2 questionnaires addressing postoperative outcomes.
RESULTS
Fifty-four patients were included; 32 superficial parotidectomies and 22 total parotidectomies were performed for 39 benign and 15 malignant tumors. Thirty-seven patients could be reached. Out of 37 patients who responded to the first questionnaire, 59% (22) reported complete facial symmetry, 27% (10) reported mild hollowness, and 14% (5) reported mild fullness. None declared noticeable hollowness or fullness. While 81% (30) did not experience Frey's syndrome, 5.4% (2) experienced mild symptoms without disability, and 13.5% (5) experienced debilitating symptoms. Out of 37 patients, 8 patients responded to a second questionnaire addressing the outcome of the abdominal graft donor site. In regard to the donor site, 87.5% (7) were satisfied or very satisfied from its cosmetic appearance, 75% (6) were not bothered by its cosmetic appearance, and 87.5% (7) had no discomfort at the graft donor site. Patients did not report any other symptom at the graft donor site.
CONCLUSION
In this large series of total parotidectomies including malignant pathologies, autologous abdominal free DFFG effectively prevented Frey's syndrome and preserved facial cosmesis in most patients.
Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Prospective Studies; Skin Transplantation; Surgical Flaps; Transplantation, Autologous; Young Adult
PubMed: 33657862
DOI: 10.1177/0003489421999542