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Auris, Nasus, Larynx Dec 2023Sialocele that develops after parotid surgery often prolongs the treatment period and stresses both the surgeon and patient. The extent of surgery and tumor size are...
OBJECTIVE
Sialocele that develops after parotid surgery often prolongs the treatment period and stresses both the surgeon and patient. The extent of surgery and tumor size are known to be associated with sialocele occurrence. We investigated the incidence of post-parotidectomy sialocele and the associated risk factors, with a focus on tumor size.
METHODS
We retrospectively reviewed the medical records of 172 patients who underwent parotidectomy between January 2013 and May 2020 at Haeundae Paik Hospital, Inje University of Korea. We stratified patients into those with and without sialocele (fluid collection in the operative bed). We compared clinical data, patient demographics, and surgical details; we identified risk factors for sialocele development after parotid surgery.
RESULTS
Seventeen patients were diagnosed with post-parotidectomy sialocele (9.88%; 17/172). Univariate logistic regression revealed that the male sex, deep lobe tumor location, and large tumor size were significantly associated with postoperative sialocele (p = 0.015, 0.009, and 0.016, respectively). We subjected these parameters to multivariate analyses; the odds ratios were 3.70, 3.58, and 2.34, respectively. Receiver operating characteristic curve analyses showed that a tumor size > 2.50 cm was the optimal cutoff in terms of predicting post-parotidectomy sialocele.
CONCLUSION
Male sex, a tumor in the deep lobe, and large tumor size were strongly associated with increased risk for sialocele after parotidectomy. Tumor size > 2.50 cm serves as the cutoff identifying patients likely to experience sialocele after parotid surgery.
Topics: Humans; Male; Parotid Neoplasms; Retrospective Studies; Parotid Gland; Cysts; Risk Factors; Salivary Gland Diseases; Postoperative Complications
PubMed: 36922283
DOI: 10.1016/j.anl.2023.02.006 -
Otolaryngology--head and Neck Surgery :... Apr 2015To determine the effectiveness of intraoperative facial nerve monitoring (FNM) in preventing immediate and permanent postoperative facial nerve weakness in patients... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To determine the effectiveness of intraoperative facial nerve monitoring (FNM) in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy.
DATA SOURCES
PubMed-NCBI database from 1970 to 2014.
REVIEW METHODS
A systematic review and meta-analysis of the literature was conducted. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without FNM (intraoperative nerve monitor vs control). Primary and secondary end points were defined as immediate postoperative and permanent facial nerve weakness (House-Brackmann score, ≥2), respectively.
RESULTS
After a review of 1414 potential publications, 7 articles met inclusion criteria, with a total of 546 patients included in the final meta-analysis. The incidence of immediate postoperative weakness following parotidectomy was significantly lower in the FNM group compared to the unmonitored group (22.5% vs 34.9%; P = .001). The incidence of permanent weakness was not statistically different in the long term (3.9% vs 7.1%; P = .18). The number of monitored cases needed to prevent 1 incidence of immediate postoperative facial nerve weakness was 9, given an absolute risk reduction of 11.7% This corresponded to a 47% decrease in the incidence of immediate facial nerve dysfunction (odds ratio, 0.53; 95% CI, 0.35 to 0.79; P = .002).
CONCLUSION
In primary cases of parotidectomy, intraoperative FNM decreases the risk of immediate postoperative facial nerve weakness but does not appear to influence the final outcome of permanent facial nerve weakness.
Topics: Facial Nerve; Facial Nerve Injuries; Humans; Intraoperative Neurophysiological Monitoring; Parotid Diseases; Parotid Gland; Parotid Neoplasms
PubMed: 25628369
DOI: 10.1177/0194599814568779 -
Indian Journal of Otolaryngology and... Oct 2019Salivary gland tumors are rare, comprising less than 3% of all neoplasia of head and neck region. Pleomorphic adenoma is the most common salivary gland tumor, accounting...
Salivary gland tumors are rare, comprising less than 3% of all neoplasia of head and neck region. Pleomorphic adenoma is the most common salivary gland tumor, accounting for 60-80% of benign tumors of salivary glands, which predominantly affect the superficial lobe of the parotid gland. The "pleomorphic" nature of the tumor can be explained on the basis of its epithelial and connective tissue origin. Usually they are found as solitary unilateral, firm and mobile, painless, slow growing mass. The tumor has a female predilection between 30 and 50 years of age. Utmost care is to be taken to preserve the facial nerve while performing superficial or total parotidectomy. We present 10 cases of pleomorphic adenoma of parotid gland over period of 2 years, highlighting the prognosis following surgical management.
PubMed: 31741967
DOI: 10.1007/s12070-018-1245-3 -
Medicina (Kaunas, Lithuania) Nov 2022Facial weakness is the most important complication of parotid gland tumor surgery. The aims of this study are as follows: (1) assessment of the prevalence of...
Facial weakness is the most important complication of parotid gland tumor surgery. The aims of this study are as follows: (1) assessment of the prevalence of postparotidectomy facial nerve dysfunction; (2) clinical and electrophysiological assessment of the facial nerve function before parotidectomy and at 1 and 6 months postoperatively; (3) assessment of the association of postoperative facial palsy with selected risk factors; and (4) assessment of the correlation between the results of clinical and neurophysiological assessments of facial nerve function. : This study comprised 50 patients (aged 24-75 years) who underwent parotidectomy at the Department of Otolaryngology and Laryngological Oncology in Zabrze, Poland between 2015 and 2017. The evaluation included neurological, clinical and electrophysiological assessments of the facial nerve prior to surgery and at 1 and 6 months postoperatively. : No facial palsy was found preoperatively or 6 months postoperatively. Facial nerve dysfunction was found in 74% of patients 1 month postoperatively. In most cases (54%), paresis was mild or moderate (House-Brackmann grades II and III). The results of electrophysiological tests before parotidectomy were either normal or showed some mild abnormalities. We found a statistically significant correlation between the clinical assessment of the facial nerve function (based on the House-Brackmann scale) one month postoperatively and the latency of the CMAP response from the orbicularis oculi and orbicularis oris muscles. In all three studies, a statistically significant correlation was found between the amplitude of the compound muscle action potential (CMAP) of the orbicularis oris muscle and the degree of facial nerve weakness. : The factors that may influence the risk of postoperative facial nerve paralysis (prolonged surgical time and the size and location of the tumor other than in the superficial lobe only) may indirectly suggest that surgery-related difficulties and/or surgeon experience could be crucial to surgery safety.
Topics: Humans; Facial Nerve; Parotid Gland; Prospective Studies; Facial Paralysis; Parotid Neoplasms; Risk Factors; Postoperative Complications; Retrospective Studies
PubMed: 36556928
DOI: 10.3390/medicina58121726 -
European Archives of... Dec 2016The present study investigated the long-term complications of parotidectomy, the differences in these complications in regard to the pathological diagnosis and type of...
The present study investigated the long-term complications of parotidectomy, the differences in these complications in regard to the pathological diagnosis and type of surgery. The patients were questioned regarding the presence of facial paresis-paralysis, pain, loss of sensation, scarring, collapse, and mouth dryness in the area of operation. Complaints of pain (p = 0.287), scarring (p = 0.456), and mouth dryness (p = 0.136) did not show statistically significant differences between the cases with benign or malignant pathological outcomes. However, complaints of loss of sensation (p < 0.001), collapse in the area of operation (p = 0.025), paresis-paralysis (p < 0.001), and fear of repeated surgery (p = 0.032) were present at significantly higher rates. Complaints of pain (p = 0.258), scarring (p = 0.665), mouth dryness (p = 0.113) and fear of repeated surgery (p = 0.053) did not show statistically significant differences between the cases who underwent superficial or total parotidectomy. However, complaints of loss of sensation (p = 0.002), paresis (p < 0.001), and collapse in the area of operation (p = 0.019) were present at significantly higher rates. The type of tumor and surgical approach significantly affect the quality of life; however, parotidectomy generally does not lead to serious long-term complications that would disturb the patients.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cicatrix; Esthetics; Facial Paralysis; Fear; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain; Paresis; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Quality of Life; Reoperation; Xerostomia; Young Adult
PubMed: 27363408
DOI: 10.1007/s00405-016-4173-4 -
Laryngoscope Investigative... Dec 2021Long-term prospective studies on procedure-related complications after parotid surgery for benign neoplasms (BNs) are scarce. This is the first prospective study on the...
OBJECTIVES
Long-term prospective studies on procedure-related complications after parotid surgery for benign neoplasms (BNs) are scarce. This is the first prospective study on the use of extracapsular dissection (ECD) for BNs, and it aimed to examine the incidence of postoperative complications after parotid surgery for BN.
METHODS
We collected data obtained in a prospective study of parotidectomy for BN at a university hospital and analyzed the transient and long-term complications.
RESULTS
The incidence rates of transient facial palsy immediately and 18 months after surgery were 15.0% and 3.7%, respectively. The rates of immediate postoperative facial palsy in patients who underwent ECD, partial superficial, superficial, and total parotidectomy were 5.8%, 29.3%, 20.0%, and 44.1%, respectively. Significant risk factors for facial palsy included multiple and larger lesions as well as surgery duration and extension.
CONCLUSIONS
Postoperative facial palsy remains a common complication after parotidectomy for BN and is associated with the extent of parotidectomy, presence of multiple neoplasms, and operative duration. The results of this study showed that ECD could be a safe technique for avoiding facial palsy. 2.
PubMed: 34938876
DOI: 10.1002/lio2.694 -
American Journal of Otolaryngology 2019To report the patient selection, surgical technique, and outcomes of parotidectomy using local anesthesia under monitored anesthesia care (MAC).
OBJECTIVE
To report the patient selection, surgical technique, and outcomes of parotidectomy using local anesthesia under monitored anesthesia care (MAC).
METHODS
A retrospective chart review was performed for patients undergoing parotidectomy under local anesthesia at an academic head and neck surgery center.
RESULTS
Six patients deemed high risk for general anesthesia (GA) due to medical comorbidities or with a strong preference to avoid GA underwent parotidectomy using local anesthesia and MAC. Parotidectomy was performed for several indications, including benign tumors, malignant tumors, and chronic sialadenitis. Mean age of patients was 78.0 ± 7.9 years, and all had an American Society of Anesthesia score ≥ 2 and Charlson comorbidity index ≥4. Mean operative time was 102.8 ± 38.3 min, comparable to that of parotidectomy under general anesthesia. No major complications occurred. Minor complications included three cases of temporary postoperative facial nerve weakness limited to 1-2 lower division branches. At most recent follow up (10 to 48 months), all patients were medically stable and disease free.
CONCLUSION
In carefully selected patients, parotidectomy under local anesthesia is a viable treatment alternative that can be offered to patients. Successful outcomes require preoperative counseling, meticulous technique, and close collaboration with anesthesia colleagues.
Topics: Aged; Aged, 80 and over; Anesthesia, Local; Humans; Monitoring, Intraoperative; Operative Time; Otorhinolaryngologic Surgical Procedures; Parotid Gland; Parotid Neoplasms; Patient Selection; Retrospective Studies; Sialadenitis; Treatment Outcome
PubMed: 30691973
DOI: 10.1016/j.amjoto.2019.01.002 -
International Journal of Oral and... Apr 2022
Topics: Adenoma, Pleomorphic; Dissection; Humans; Parotid Neoplasms
PubMed: 34426055
DOI: 10.1016/j.ijom.2021.08.004 -
Oral Diseases Jan 2017Benign parotid tumours have historically often been managed surgically by superficial parotidectomy. While this approach usually gives a generous cuff of surrounding... (Review)
Review
Benign parotid tumours have historically often been managed surgically by superficial parotidectomy. While this approach usually gives a generous cuff of surrounding normal parotid tissue to increase tumour margins, it requires a much larger incision than the increasingly used extracapsular dissection (ECD) technique. Furthermore, superficial parotidectomy can result in marked facial hollowing, Frey syndrome and an increased risk of both temporary and permanent facial nerve weakness. ECD has been popularised as a safe alternative to parotidectomy primarily for the removal of mobile, benign parotid tumours with safe outcomes and reduced risk to the facial nerve. In this article, we review the growing body of evidence for ECD and include our own experience confirming the move away from superficial parotidectomy in contemporary practice for the treatment of benign parotid tumours.
Topics: Dissection; Facial Nerve Injuries; Humans; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms
PubMed: 27260128
DOI: 10.1111/odi.12518 -
Journal of Otolaryngology - Head & Neck... Oct 2020Patients undergoing superficial parotidectomy for benign parotid lesions are at risk of postoperative complications, most notably cosmetic complications such as facial...
BACKGROUND
Patients undergoing superficial parotidectomy for benign parotid lesions are at risk of postoperative complications, most notably cosmetic complications such as facial paralysis and contour defects, and functional complications including Frey's syndrome. Traditionally, surgical drains have been placed at the end of surgery to prevent hematoma and sialocele formation. However, this can increase the risk of postoperative complications and contribute to a prolonged course in hospital. To try and prevent these risks and complications, we introduced a novel technique of a drainless parotidectomy by reconstructing the resulting parotid bed defect with a superiorly based sternocleidomastoid (SCM) rotational flap and by placement of gelfoam into the wound bed and a facelift dressing postoperatively to provide additional hemostasis and avoid drain placement.
METHODS
All patients with benign parotid disease undergoing a drainless superficial parotidectomy and reconstruction with a superiorly based SCM rotational flap at our center were identified within a prospective cohort database between July 2010-2018. Primary outcomes included postoperative cosmetic and functional outcomes, complications and length of hospital stay. A secondary cost analysis was done to compare this novel technique to traditional superficial parotidectomy with surgical drain placement.
RESULTS
Fifty patients were identified within the database and were included in the final analysis. The average length of hospital stay was 1.02 days. All patients were satisfied with their aesthetic outcome at 1 year. During long term follow-up, 63% of patients reported normal appearance of the operated side. Seven patient's (14%) developed temporary facial paresis following surgery. All patients had resultant normal facial function at follow-up in 1 year. No patients developed subjective Frey's Syndrome. Two patients (4%) developed a postoperative sialocele requiring drainage and one patient (2%) developed a hematoma on extubation requiring evacuation and drain placement. Cost analysis demonstrated a cost savings of approximately $975 per person following surgery.
CONCLUSION
In the current study, we introduced a novel approach of a drainless superficial parotidectomy using a superiorly based SCM flap, gelfoam and placement of a post-operative facelift dressing. This drainless approach was associated with good long-term cosmetic and functional outcomes with few postoperative complications. This new technique may also offer the potential for long-term savings to the health care system.
Topics: Adult; Aged; Costs and Cost Analysis; Drainage; Female; Humans; Male; Middle Aged; Parotid Diseases; Parotid Gland; Postoperative Complications; Prospective Studies; Plastic Surgery Procedures; Surgical Flaps; Sweating, Gustatory; Treatment Outcome
PubMed: 33023674
DOI: 10.1186/s40463-020-00472-z