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Head & Neck Sep 2019To investigate the feasibility of an endoscopic-assisted postauricular-groove approach parotidectomy and to evaluate the advantages and limitations of such an approach. (Comparative Study)
Comparative Study
BACKGROUND
To investigate the feasibility of an endoscopic-assisted postauricular-groove approach parotidectomy and to evaluate the advantages and limitations of such an approach.
METHODS
A total of 72 patients with parotid gland tumors underwent a parotidectomy procedure between January 2014 and January 2016. Of the aforementioned patients, 15 were treated by a postauricular-groove approach (group I), whereas the remaining 57 were treated by the Blair "S" incision (group II).
RESULTS
Difference in visual analogue scale score for aesthetic outcome (0 vs 3) and median intraoperative blood loss (30 vs 50 mL) was statistically significant. Operation time and transient facial nerve paralysis were comparable. No recurrence of tumors was found in either group.
CONCLUSION
The endoscopic-assisted postauricular-groove approach for limited parotid tumor resection offers several advantages over the conventional "S" incision parotidectomy. In addition, it is arguably safer and results in a superior aesthetic outcome.
Topics: Blood Loss, Surgical; Endoscopy; Esthetics; Facial Paralysis; Feasibility Studies; Female; Humans; Male; Middle Aged; Operative Time; Parotid Gland; Parotid Neoplasms; Patient Satisfaction; Postoperative Complications; Visual Analog Scale
PubMed: 30869186
DOI: 10.1002/hed.25720 -
Cureus Jul 2023Pleomorphic adenomas (PA) are the most common benign salivary gland tumors. They arise from the major salivary glands, as well as the minor salivary glands. They may... (Review)
Review
Pleomorphic adenomas (PA) are the most common benign salivary gland tumors. They arise from the major salivary glands, as well as the minor salivary glands. They may arise rarely from the palate, oral cavity, neck, and nasal cavity also. Yet, the fourth, fifth, and sixth decades of life are the most common for them to manifest. Forty percent of them occur in males and 60% in females. It is a benign mixed tumor, which has three components: an epithelial component, a myoepithelial cell component, and a mesenchymal component. A fibrous capsule separates these cells from the surrounding tissues. It generally presents as a slowly progressing painless swelling, which is well-delineated, nonsymptomatic, and not involving the facial nerve. Salivary gland tumors can be accurately diagnosed before surgery using fine-needle aspiration (FNA), ultrasonography (USG), and computed tomography (CT) scan. Calponin, cluster of differentiation 9 (CD9), glial fibrillary acidic protein (GFAP), Mcl-2, metastasis suppressor gene (NM23), p63, S-100, smooth muscle actin (SMA), and SRY-box transcription factor 10 (SOX10) exhibit the majority of the positive reactions in pleomorphic adenomas. The diagnostic marker pleomorphic adenoma gene 1 (PLAG1) is frequently employed since it is specific for pleomorphic adenoma. Although benign, these epithelial tumors have a propensity to recur and undergo malignant transformation if incompletely excised, leading to increased morbidity in these patients. A review of the consensus guidelines and literature was conducted, and the online literature on the subject from 2002 was included. This article is not a complete review of all the available literature; rather, it is a comprehensive review of the topic.
PubMed: 37614271
DOI: 10.7759/cureus.42311 -
World Journal of Otorhinolaryngology -... Jun 2022Parotidectomy is the mainstay treatment for tumors of the parotid gland. In an effort to improve clinical outcomes, several modern surgical techniques and perioperative... (Review)
Review
Parotidectomy is the mainstay treatment for tumors of the parotid gland. In an effort to improve clinical outcomes, several modern surgical techniques and perioperative interventions have been evaluated and refined. This review discusses current and actively debated perioperative interventions aimed at improving patient safety and the quality of parotidectomy. Relevant high-impact literature pertaining to preoperative diagnostic modalities, intraoperative surgical techniques, and postoperative care will be described.
PubMed: 35782399
DOI: 10.1002/wjo2.50 -
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 -
Journal of Otolaryngology - Head & Neck... Nov 2019Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction...
BACKGROUND
Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy.
METHODS
A retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events.
RESULTS
There were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation.
CONCLUSIONS
There are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting.
Topics: Aged; Aged, 80 and over; Female; Humans; Incidence; Male; Middle Aged; Parotid Neoplasms; Patient Readmission; Postoperative Complications; Plastic Surgery Procedures; Reoperation; Retrospective Studies; United States
PubMed: 31744535
DOI: 10.1186/s40463-019-0387-y -
American Journal of Otolaryngology 2023Parotidectomies have historically been performed on an inpatient basis despite being well-tolerated surgeries with minimal postoperative wound care and low rates of...
BACKGROUND
Parotidectomies have historically been performed on an inpatient basis despite being well-tolerated surgeries with minimal postoperative wound care and low rates of complications at high-volume institutions. Past studies have supported the safety of outpatient surgery for parotidectomy but have been limited to superficial parotidectomy and have not addressed the patient experience surrounding the surgical intervention such as pre-operative and post-operative care and communication.
PURPOSE
This study assesses the impact of outpatient superficial, deep, and partial parotid surgery on various parameters including surgical safety, distance traveled for care, utilization of telehealth, and patient-initiated communication.
MATERIALS AND METHODS
Retrospective study from January 2020 to October 2021. Patients undergoing superficial lobe, deep lobe, and partial parotidectomies for benign and malignant pathologies were divided into inpatient and outpatient cohorts. A multivariable model examined the relationship between admission status and surgical complications, adjusted for age, sex, and tumor size.
RESULTS
159 patients total, 94 outpatient and 65 inpatients. No statistical difference in rates of surgical complications with the exception of salivary leak. There was an increased rate of salivary leak reported in the inpatient group (OR 5.4, 95 % CI 1.6 to 18.0, p = 0.01). Mean patient travel distance of 354 miles one-way. Post-operatively, 76 % were evaluated via video visit. Following discharge, >55 % of patients initiated communication with the surgical team, which was not statistically different between the groups.
CONCLUSIONS
Outpatient parotidectomy is safe and can be more convenient, but telehealth communication must be balanced with rigorous attention to patient education.
Topics: Humans; Parotid Neoplasms; Outpatients; Retrospective Studies; Postoperative Complications; Salivary Glands; Parotid Gland
PubMed: 36842422
DOI: 10.1016/j.amjoto.2023.103806 -
ORL; Journal For Oto-rhino-laryngology... 2020The modified Blair incision is the standard facial incision for the vast majority of parotid gland lesions. We utilize three types of incisions: "classic mini-Blair" for...
BACKGROUND
The modified Blair incision is the standard facial incision for the vast majority of parotid gland lesions. We utilize three types of incisions: "classic mini-Blair" for parotid body tumors, "cervical mini-Blair" for parotid tail tumors, and "vertical mini-Blair" for anterior parotid tumors. In this study, we describe the surgical and esthetic outcomes of these individually tailored incisions.
METHODS
Patients undergoing parotidectomy between 2011 and 2013 were included. The surgical outcomes and patients' satisfaction were assessed.
RESULTS
Of 122 patients, 89 were included. All patients completed a questionnaire assessing the postoperative course and patients' satisfaction regarding the surgery in general and the scar in particular. Among these patients, 78 (87%) had a benign pathology and 11 (13%) had malignant tumors. The tumors were located at the parotid body in 57 patients (64%), at the parotid tail in 19 (21%), at the deep lobe in 8 (9%), and at the anterior parotid gland in 5 (6%). All tumors were removed successfully with negative margins on pathology. No inadvertent permanent facial nerve paralysis occurred. The median operation time was 72 min (23-211). The average patient scores of satisfaction with the surgical scar and with the surgery were 9.54 and 9.72, respectively.
CONCLUSIONS
Individualized mini-Blair incision is feasible for benign as well as selected malignant parotid tumors.
Topics: Cicatrix; Esthetics; Facial Paralysis; Humans; Parotid Gland; Parotid Neoplasms; Postoperative Complications
PubMed: 32097928
DOI: 10.1159/000505192 -
The Journal of Laryngology and Otology Oct 2021To report the clinical outcomes of patients with chronic parotid sialadenitis treated with superficial parotidectomy, and to review the literature. (Comparative Study)
Comparative Study Review
OBJECTIVES
To report the clinical outcomes of patients with chronic parotid sialadenitis treated with superficial parotidectomy, and to review the literature.
METHODS
A retrospective case series was conducted of all patients undergoing parotidectomy for chronic parotid sialadenitis at our institution between 2009 and 2018.
RESULTS
Eighteen superficial parotidectomies were performed, resulting in complete symptom resolution in 17 patients. There was only one recurrence, of a milder form of the disease, requiring no specific treatment. Eight temporary post-operative facial nerve palsies and one permanent palsy occurred. Further complications included post-operative wound haematoma, seroma, Frey's syndrome, neuropathic pain and wound infection.
CONCLUSION
Superficial parotidectomy is sufficient to control patient symptoms, avoiding the increased morbidity associated with near-total parotidectomy. The literature does not point to a clear difference in either the incidence of recurrence or the risk of a facial nerve palsy between the two procedures. Furthermore, the symptoms attributed to recurrence are often not severe enough to warrant salvage near-total parotidectomy.
Topics: Adult; Aged; Facial Nerve Diseases; Facial Paralysis; Female; Hematoma; Humans; Incidence; Male; Middle Aged; Neuralgia; Parotid Diseases; Postoperative Complications; Recurrence; Retrospective Studies; Seroma; Sialadenitis; Surgical Wound Infection; Sweating, Gustatory; Treatment Outcome; Wounds and Injuries
PubMed: 34353395
DOI: 10.1017/S0022215121002115 -
Head & Neck Jul 2019Superficial parotidectomy has traditionally been completed with a drain and overnight hospital stay. We report perioperative and postoperative outcomes for patients... (Comparative Study)
Comparative Study
BACKGROUND
Superficial parotidectomy has traditionally been completed with a drain and overnight hospital stay. We report perioperative and postoperative outcomes for patients undergoing drainless outpatient parotidectomy vs traditional drained extended stay parotidectomy.
METHODS
Retrospective chart review from a single surgeon from 2009 to 2017 of patients undergoing parotidectomy, including demographic data, surgical approach, tumor pathology and size, blood loss, drain placement, postoperative pain control, and complications, was done. A comparison was performed between patients undergoing drain placement and those treated with "drainless" technique.
RESULTS
Ninety-one patients underwent parotidectomy (42 drainless; 49 drained). Intraoperative blood loss was lower in the "drainless" group (16.0 mL vs 34.9 mL, P < .001). There was a lower rate of facial nerve paresis in the "drainless" group compared with the "drained" cohort (7% vs 16.3%, P = .18). Seroma formation and infection rate was similar.
CONCLUSION
In the properly selected patient, outpatient drainless parotidectomy is a viable procedure with comparable outcomes to traditional extended stay drained parotidectomy.
Topics: Adenolymphoma; Adenoma, Pleomorphic; Ambulatory Surgical Procedures; Blood Loss, Surgical; Drainage; Facial Paralysis; Female; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Seroma
PubMed: 30706566
DOI: 10.1002/hed.25671