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Oral and Maxillofacial Surgery Clinics... May 2021Transoral parotidectomy allows for the management of parapharyngeal space tumors and accessory parotid gland tumors without the need for a transfacial/transparotid or... (Review)
Review
Transoral parotidectomy allows for the management of parapharyngeal space tumors and accessory parotid gland tumors without the need for a transfacial/transparotid or mandible splitting procedure. It is a minimally invasive approach that permits a faster recovery and with a lesser risk of facial palsy.
Topics: Humans; Parotid Gland; Parotid Neoplasms
PubMed: 33478916
DOI: 10.1016/j.coms.2020.12.002 -
Indian Journal of Otolaryngology and... Dec 2022Traditional parotidectomy incision was devised by Blair (1912) which was modified by Bailey (1941). Over the years various approaches and techniques have evolved to...
Traditional parotidectomy incision was devised by Blair (1912) which was modified by Bailey (1941). Over the years various approaches and techniques have evolved to improve the aesthetic outcome and at the same time for complete disease clearance with reduced complications. In this study, we evaluated the feasibility of our mini-incision parotidectomy technique along with the surgical and quality of life (QOL) outcomes. This prospective case series was conducted at Apollo Hospitals, Bangalore over a period of 2 years (June 2018-August 2020) and includes 20 patients. The surgical outcomes were assessed in terms of feasibility of mini-incision technique with respect to levels of parotid involved and functional outcomes in terms of presence or absence of complications like facial palsy (temporary or permanent), seroma and Frey's syndrome. Patient related quality of life (QOL) outcomes were assessed in terms of post-operative pain score, patient comfort score and cosmetic score by using numerical rating scale-11 (NRS-11). The mini-incision parotidectomy technique is feasible for lesions in all the parotid levels and conversion or lengthening of incision was not needed in any of the cases. 2(10%) patients had temporary facial palsy (House-Brackman grade III) which was recovered within 3 weeks after surgery. One patient (5%) with adenoid cystic carcinoma had permanent facial palsy. Out of 20 patients 2(10%) had seroma and 1(5%) patient presented with Frey's syndrome. Mean post-operative pain score at 0, 6 and 24 h were 4.8, 3.4 and 1.8 out of 10 respectively. Mean comfort score was 9 out of 10 and mean cosmetic score was 9.5 out of 10. Mini-incision parotidectomy technique can render improved functional as well as aesthetic outcomes after parotidectomy without compromising the surgical clearance of the disease process.
PubMed: 36742673
DOI: 10.1007/s12070-021-02882-5 -
Otolaryngologic Clinics of North America Jun 2021The parotid gland is located in a cosmetically sensitive area. Given cultural emphasis on cosmesis, using minimally invasive or hidden incisions, when appropriate, can... (Review)
Review
The parotid gland is located in a cosmetically sensitive area. Given cultural emphasis on cosmesis, using minimally invasive or hidden incisions, when appropriate, can significantly improve patient satisfaction and quality of life following surgery. Facelift-style incisions have been used since the late 1960s to approach parotid pathology. Several alternative incisions, including technology-assisted approaches, also have been described in the literature. To that end, this article explore the existing data regarding several historical and emerging cosmetic approaches to the parotid gland comparing relative advantages and disadvantages of each.
Topics: Humans; Parotid Gland; Parotid Neoplasms; Patient Satisfaction; Quality of Life; Rhytidoplasty
PubMed: 34024485
DOI: 10.1016/j.otc.2021.02.010 -
Journal of Vascular Surgery Cases and... Mar 2022A 72-year-old man had presented with a 4-day history of progressive left-sided facial swelling associated with pain. The physical examination revealed left facial...
A 72-year-old man had presented with a 4-day history of progressive left-sided facial swelling associated with pain. The physical examination revealed left facial fullness over the parotid gland without tenderness to palpation. His vital signs and laboratory test findings were within normal limits. A computed tomography scan demonstrated a left facial varix measuring 3.4 cm × 2.8 cm within an unremarkable-appearing parotid gland. Parotidectomy vs close observation were discussed, and the patient decided to pursue nonoperative management. Ultimately, his symptoms were self-limited, and the swelling had resolved within 6 months after the diagnosis. Interval computed tomography demonstrated a thrombosed left facial varix measuring 1.3 cm × 1.1 cm.
PubMed: 35036666
DOI: 10.1016/j.jvscit.2021.08.006 -
Annals of Plastic Surgery Oct 2021In the last 2 decades, authors have gained considerable interest in modifying the age-old classical parotidectomy incisions to address cosmetic concerns of their... (Review)
Review
In the last 2 decades, authors have gained considerable interest in modifying the age-old classical parotidectomy incisions to address cosmetic concerns of their patients. The article reviews all the incisions that have been introduced over time after modified facelift and Blair incision for performing parotidectomy. These include retroauricular hairline approach, Arden technique, trichophytic incision, periauricular incision, intraauricular modification of facelift approach, endaural approach, postaural approach, Panda technique, preauricular crutch approach, and mini Blair incision. Although these have been reported to be safe, feasible, and cosmetically better approaches, at present, the absence of well-designed prospective observational and interventional studies do not warrant them to be widely used in clinical practice. This will guide surgeons in making patient curated parotidectomy incisions under special circumstances. Currently, these remain limited to the hands of experienced surgeons in high volume centers.
Topics: Humans; Observational Studies as Topic; Parotid Neoplasms; Rhytidoplasty
PubMed: 33625025
DOI: 10.1097/SAP.0000000000002757 -
Indian Journal of Otolaryngology and... Oct 2022To assess the parameters' setting of the microscope during parotidectomy and the impact of microscopic parotidectomy on facial nerve functional status. A prospective...
To assess the parameters' setting of the microscope during parotidectomy and the impact of microscopic parotidectomy on facial nerve functional status. A prospective study was conducted on 28 patients in a tertiary care center, who underwent microscopic parotidectomy. Microscope's settings' like magnification, focal length, diameter of the visualized field, and clock position were recorded. Facial nerve functional status was also recorded. All surgeries were performed by right-handed surgeons using Leica F 20 M525 microscope. Clock position of microscope for right parotidectomy ranged between 7 and 10 o clock and for left, it ranged between 7 and 12 o clock. Magnification ranged between 1.3 × and 3.2 ×; magnifications of 1.3 × and 1.8 × were preferred from incision to separation of parotid from sternocleidomastoid muscle, 1.8 × and 2 × for dissection of the facial nerve trunk, and 2 × and 3.2 × for individual branches of the facial nerve. Focal length ranged between 251 and 410 mm and the diameter of the visualized field ranged between 7 and 14.7 cm. Out of 24 cases of benign lesions, 2 (8.3%) developed facial paresis which resolved in 3 months. Two out of four cases of malignancy developed permanent palsy as nerve branches were sacrificed to achieve tumor clearance. Using a microscope for parotidectomy is advantageous for facial nerve dissection, reducing chances of facial paralysis. The microscope was also found to be useful for teaching. The use of appropriate microscopic parameters avoids the glitch of transition from open to microscopic approach.
PubMed: 36452574
DOI: 10.1007/s12070-020-02106-2 -
American Journal of Otolaryngology 2023Parotidectomies are rarely performed on an outpatient basis. The specific perioperative outcomes and their management remains insufficiently described to change daily...
PURPOSE
Parotidectomies are rarely performed on an outpatient basis. The specific perioperative outcomes and their management remains insufficiently described to change daily practice. The objectives were to study the outcomes, the complications and the patient satisfaction rate in parotidectomy performed on an outpatient basis.
MATERIALS AND METHODS
We conducted a retrospective monocentric database study on 85 patients who underwent parotidectomy as a first and sole procedure from 2015 to 2020. We analyzed perioperative outcomes between outpatients and inpatients.
RESULTS
Among 28 outpatients and 57 inpatients, no significant differences in total perioperative complications (p = .66; OR = 1.25; 95 % confidence interval (CI) [0.47; 3.36]), reoperations (p = .55), readmissions (p = 1), or unplanned visits (p = .52) were shown in multivariate analysis. The conversion rate for surgical reasons was 8.6 %, and the satisfaction rate was high.
CONCLUSION
Although outpatient parotidectomies should be as safe as for inpatients, the high rate of minor complications requires specific perioperative management, such as a systematic early postoperative visit and optimized preoperative information in order to be carried out with minimal issues.
Topics: Humans; Retrospective Studies; Outpatients; Postoperative Complications; Ambulatory Surgical Procedures; Personal Satisfaction
PubMed: 37437335
DOI: 10.1016/j.amjoto.2023.103974 -
The Annals of Otology, Rhinology, and... Feb 2022The objective of this study is to investigate the safety, efficacy, and potential cost-savings of the outpatient parotidectomy procedure.
OBJECTIVE
The objective of this study is to investigate the safety, efficacy, and potential cost-savings of the outpatient parotidectomy procedure.
METHODS
This is a retrospective chart review of all patients who underwent a parotidectomy at a large academic center from 2015 through 2019 including demographic data, postoperative complications, drain placement, readmission, and financial cost. A comparison was performed between patients who underwent an outpatient vs inpatient parotidectomy.
RESULTS
A total of 335 patients underwent parotidectomy (136 outpatient; 199 inpatient). Comparison of patient demographics, common comorbidities, tumor size, tumor type, postoperative complications, and readmission rate was similar between the inpatient and outpatient cohorts. The overall mean cost difference between inpatient parotidectomy and outpatient parotidectomy for all years was $1528.58 (95%CI: $1139-$1916).
CONCLUSION
The outpatient parotidectomy procedure has a comparable safety profile to the inpatient procedure while providing a significant cost-savings benefit.
PubMed: 33980056
DOI: 10.1177/00034894211016714