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The Journal of Laryngology and Otology Jun 2023The extent of parotidectomy in the management of regional metastatic disease is controversial. This systematic review aimed to appraise data from studies evaluating... (Review)
Review
OBJECTIVE
The extent of parotidectomy in the management of regional metastatic disease is controversial. This systematic review aimed to appraise data from studies evaluating superficial and total parotidectomy in metastatic cutaneous squamous cell carcinoma and cutaneous malignant melanoma of the head and neck.
METHOD
A systematic search of PubMed, Embase and Cochrane Library was performed. The protocol was registered with Prospero (CRD42020217962).
RESULTS
A total of five studies evaluated cutaneous malignant melanoma. Only one compared outcomes of superficial and total parotidectomy: they found higher parotid area recurrence following superficial parotidectomy. Seven studies reported outcomes following cutaneous squamous cell carcinoma; some studies found higher regional recurrence and reduced survival in total parotidectomy, but there was likely selection bias in these studies. Others found no difference in survival between superficial and total parotidectomy.
CONCLUSION
The effect of the extent of parotidectomy on outcomes is unclear in cutaneous malignant melanoma and cutaneous squamous cell carcinoma. This systematic review highlights the need for well-designed studies to direct better care.
Topics: Humans; Skin Neoplasms; Carcinoma, Squamous Cell; Parotid Neoplasms; Neoplasm Staging; Melanoma; Parotid Gland; Retrospective Studies; Neoplasm Recurrence, Local; Melanoma, Cutaneous Malignant
PubMed: 35912693
DOI: 10.1017/S0022215122001724 -
The Journal of Laryngology and Otology Dec 2023Complications of parotidectomy can have a massive impact on patients' quality of life. This study aimed to evaluate the readability and quality of online health...
OBJECTIVE
Complications of parotidectomy can have a massive impact on patients' quality of life. This study aimed to evaluate the readability and quality of online health information on parotidectomy.
METHOD
The search terms 'parotidectomy', 'parotid surgery', 'parotidectomy patient information' and 'parotid surgery patient information' were parsed through three popular search engines.
RESULTS
The websites were analysed using readability scores of the Flesch Reading Ease test and the Gunning Fog Index. The DISCERN instrument was used to assess quality and reliability. The average Flesch Reading Ease score was 50.2 ± 9.0, indicating that the materials were fairly difficult to read, the Gunning Fog Index score showed that the patient health information was suitable for an individual above 12th grade level, and the DISCERN score indicated that the online patient health information had fair quality. The Kruskal-Wallis test showed a significant difference in Flesch Reading Ease and DISCERN tool scores according to website category ( < 0.05).
CONCLUSION
Current online patient health information on parotidectomy is too difficult for the public to understand, and it exceeds the reading levels recommended by Health Education England and the American Medical Association.
Topics: United States; Humans; Reproducibility of Results; Comprehension; Quality of Life; Consumer Health Information; Search Engine; Internet
PubMed: 37606526
DOI: 10.1017/S0022215123000336 -
Otolaryngologic Clinics of North America Jun 2021Facial nerve injury is the most feared complication during parotid surgery. Intraoperative electromyographic nerve monitoring can be used to identify the facial nerve,... (Review)
Review
Facial nerve injury is the most feared complication during parotid surgery. Intraoperative electromyographic nerve monitoring can be used to identify the facial nerve, map its course, identify surgical maneuvers detrimental to the nerve, and provide prognostic information. Data regarding outcomes with facial nerve monitoring are heterogeneous. In contrast, the incidence of permanent weakness has not been shown to be significantly affected by use of nerve monitoring. For revision surgery, studies show that monitored patients had (1) weakness that was less severe with quicker recovery and (2) shorter operative times compared with unmonitored patients.
Topics: Electromyography; Facial Nerve; Facial Nerve Injuries; Facial Paralysis; Humans; Monitoring, Intraoperative; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies
PubMed: 34024477
DOI: 10.1016/j.otc.2021.02.001 -
The Laryngoscope Mar 2021To report descriptive statistics for minor parotidectomy complications.
OBJECTIVES
To report descriptive statistics for minor parotidectomy complications.
METHODS
A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor.
RESULTS
The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4-3.5), wound infection 2.3% (95% CI: 1.8-2.9), sialocele 4.5% (95% CI: 3.5-5.7), salivary fistula 3.1% (95% CI: 2.6-3.7), flap necrosis 1.7% (95% CI: 1.1-2.5), scar issues 3.6% (95% CI: 2.4-5.4), numbness 33.9% (95% CI: 25.6-43.4), and deformity 11.8 (95% CI: 6.9-19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections.
CONCLUSIONS
Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 131:571-579, 2021.
Topics: Adult; Aged; Female; Hematoma; Humans; Hypesthesia; Incidence; Male; Middle Aged; Parotid Diseases; Parotid Gland; Postoperative Complications; Salivary Gland Fistula; Surgical Flaps; Surgical Wound Infection
PubMed: 32678921
DOI: 10.1002/lary.28912 -
Facial Plastic Surgery Clinics of North... Aug 2021Radical parotidectomy may result from treating advanced parotid malignancies invading the facial nerve. Survival is often enhanced with multimodality treatment... (Review)
Review
Radical parotidectomy may result from treating advanced parotid malignancies invading the facial nerve. Survival is often enhanced with multimodality treatment protocols, including postoperative radiation therapy. In addition to the reconstructive challenge of restoring facial nerve function, patients may be left with a significant cervicofacial concavity and inadequate skin coverage. This should be addressed with stable vascularized tissue that is resistant to radiation-induced atrophy. This article describes a comprehensive strategy, includes the use of the anterolateral thigh free flap, the temporalis regional muscle transfer, motor nerve to vastus lateralis grafts, nerve to masseter transfer, and fascia lata grafts for static suspension.
Topics: Free Tissue Flaps; Humans; Parotid Gland; Parotid Neoplasms; Plastic Surgery Procedures; Thigh
PubMed: 34217443
DOI: 10.1016/j.fsc.2021.03.013 -
Journal of Otolaryngology - Head & Neck... Feb 2021Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of... (Comparative Study)
Comparative Study
BACKGROUND
Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of outpatient superficial parotidectomy compared to inpatient parotidectomy.
METHODS
A retrospective review of individuals who underwent superficial parotidectomy between 2006 and 2016 at a tertiary care center was conducted. Primary outcomes included surgical complications, including transient/permanent facial nerve palsy, wound infection, hematoma, seroma, and fistula formation, as well as medical complications in the postoperative period. Secondary outcome measures included unplanned emergency room visits and readmissions within 30 days of operation due to postoperative complications.
RESULTS
There were 238 patients included (124 in outpatient and 114 in inpatient group). There was no significant difference between the groups in terms of gender, co-morbidities, tumor pathology or tumor size. There was a trend towards longer distance to the hospital from home address (111 Km in inpatient vs. 27 in outpatient, mean difference 83 km [95% CI,- 1 to 162 km], p = 0.053). The overall complication rates were comparable between the groups (24.2% in outpatient group vs. 21.1% in inpatient, p = 0.56). There was no difference in the rate of return to the emergency department (3.5% vs 5.6%, p = 0.433) or readmission within 30 days (0.9% vs 0.8%, p = 0.952).
CONCLUSION
Superficial parotidectomy can be performed safely as an outpatient procedure without elevated risk of complications.
Topics: Academic Medical Centers; Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Feasibility Studies; Female; Humans; Inpatients; Male; Middle Aged; Ontario; Otorhinolaryngologic Surgical Procedures; Outpatients; Parotid Diseases; Parotid Gland; Patient Readmission; Postoperative Complications; Retrospective Studies
PubMed: 33579392
DOI: 10.1186/s40463-020-00484-9 -
The Laryngoscope Jun 2023To investigate long-term outcomes, imaging, and pathologic findings in pediatric patients who underwent superficial parotidectomy for recalcitrant juvenile recurrent...
OBJECTIVES
To investigate long-term outcomes, imaging, and pathologic findings in pediatric patients who underwent superficial parotidectomy for recalcitrant juvenile recurrent parotitis (JRP).
METHODS
Records for 20 children (23 parotidectomies; 9 females, 11 males; age at surgery of 8.6 ± 3.7 years) collected over a 10-year period (2012-2021) were reviewed. Parents were contacted via telephone to obtain extended follow-up. A simplified scoring system was used to assess imaging findings and an additional pathologic review was conducted to further clarify the underlying disease process.
RESULTS
All but one patient experienced resolution of their recurrent symptoms after superficial parotidectomy. Three of the patients studied required surgery on the contralateral side, and this could be predicted based on their imaging at the time of the initial surgery. Pathologic findings included ductal fibrosis, metaplasia, and dilatation as well as parenchymal atrophy and fatty deposition. There were no major surgical complications, however, the incidence of Frey's syndrome in this sample was 43.5% of surgical sites.
CONCLUSION
For patients with frequent recalcitrant symptoms or significant quality of life impairment related to JRP, superficial parotidectomy represents a potential treatment option with the noted reduction in symptom burden following surgery. Further longitudinal studies are needed.
LEVEL OF EVIDENCE
4 Laryngoscope, 133:1495-1500, 2023.
Topics: Child; Child, Preschool; Female; Humans; Male; Parotid Gland; Parotitis; Quality of Life; Retrospective Studies
PubMed: 37158262
DOI: 10.1002/lary.30349 -
Iranian Journal of Otorhinolaryngology Mar 2021The facial nerve is an important structure related to parotid gland surgery. Its identification at the time of surgery is critical. Multiple anatomical landmarks have...
INTRODUCTION
The facial nerve is an important structure related to parotid gland surgery. Its identification at the time of surgery is critical. Multiple anatomical landmarks have been described to aid in its identification. The objective of this study is to assess whether the tympanomastoid suture is a better surgical landmark than the tragal pointer for identifying the facial nerve while performing parotidectomy.
MATERIALS AND METHODS
Sixty patients presenting over a period of 3 years from 2016 to 2018 with a parotid swelling without pre-operative facial weakness were included in the study. The average distances between the facial nerve (FN) and the tragal pointer (TP), and the facial nerve (FN) and tympanomastoid suture (TMS) were calculated intra-operatively and compared.
RESULTS
Out of the 60 patients operated, 54 underwent superficial parotidectomy and 6 underwent total conservative parotidectomy. The mean distance between the FN (main trunk) and TP was found to be 18.38 ± 6.85 mm and that between FN and TMS was found to be 2.92 ± 0.6 mm (P<0.0001).
CONCLUSION
Tympanomastoid suture is a fairly constant and consistent bony landmark to locate the facial nerve during parotid surgeries as compared to the more commonly used cartilaginous tragal pointer. The results of this study can guide surgeons during parotidectomy, to correctly and promptly identify the facial nerve thereby reducing the risk of injury.
PubMed: 33912484
DOI: 10.22038/ijorl.2020.43760.2446 -
American Journal of Otolaryngology 2022Determine rates of intra-parotid and neck nodal metastasis, identify risk factors for recurrence, and report outcomes in patients with primary high-grade parotid...
PURPOSE
Determine rates of intra-parotid and neck nodal metastasis, identify risk factors for recurrence, and report outcomes in patients with primary high-grade parotid malignancy who undergo total parotidectomy and neck dissection.
MATERIALS & METHODS
Retrospective review of patients undergoing total parotidectomy and neck dissection for high-grade parotid malignancy between 2005 and 2015. The presence and number of parotid lymph nodes, superficial and deep, as well as cervical lymph nodes involved with metastatic disease were assessed. Risk factors associated with metastatic spread to the parotid deep lobe were identified and recurrence rates reported.
RESULTS
75 patients with median follow-up time of 47 months. 35 patients (46.7%) had parotid lymph node metastasis. Seven patients (9.3%) had deep lobe nodal metastasis without metastasis to the superficial lobe nodes. Nine patients (12%) had positive intra-parotid nodes without positive cervical nodes. Cervical nodal disease was identified in 49.3% patients (37/75). Local, parotid-bed recurrence rate was 5.3% (4/75). Regional lymph node recurrence rate was also 5.3% (4/75). Rate of distant metastasis was 30.6% (23/75). The overall disease free survival rate for all patients at 2 and 5 years were 71% and 60% respectively.
CONCLUSION
Parotid lymph node metastasis occurred at a similar rate to cervical lymph node metastasis (46.7% and 49.3%, respectively). Deep lobe parotid nodal metastasis occurred in nearly a quarter of patients and can occur without superficial parotid nodal metastasis. Rate of recurrence in the parotid bed, which may represent local or regional recurrence, was similar to regional cervical lymph node recurrence. Total parotidectomy and neck dissection should be considered high-grade parotid malignancy regardless of clinical nodal status.
Topics: Adult; Aged; Aged, 80 and over; Digestive System Surgical Procedures; Female; Follow-Up Studies; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neck; Neck Dissection; Neoplasm Recurrence, Local; Neoplasm Staging; Parotid Gland; Parotid Neoplasms; Retrospective Studies; Risk Factors; Survival Rate; Time Factors; Treatment Outcome
PubMed: 34509079
DOI: 10.1016/j.amjoto.2021.103194 -
The Journal of Laryngology and Otology Oct 2021The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful...
OBJECTIVE
The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery.
METHOD
A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay.
RESULTS
A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay.
CONCLUSION
Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.
Topics: Blood Loss, Surgical; Dissection; Drainage; Electrocoagulation; Facial Nerve; Facial Paralysis; Female; Hemostasis, Surgical; Humans; Length of Stay; Male; Meta-Analysis as Topic; Middle Aged; Operative Time; Outcome Assessment, Health Care; Parotid Gland; Postoperative Period; Surgical Instruments
PubMed: 34423755
DOI: 10.1017/S0022215121001973