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European Archives of... Apr 2021Facial nerve injury remains the most severe complication of parotid gland surgery. However, the use of intraoperative facial nerve monitoring (IFNM) during parotid gland... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Facial nerve injury remains the most severe complication of parotid gland surgery. However, the use of intraoperative facial nerve monitoring (IFNM) during parotid gland surgery among Otolaryngologist-Head and Neck Surgeons continues to be a matter of debate.
MATERIALS AND METHODS
A systematic review and meta-analysis of the literature was conducted including articles from 1970 to 2019 to try to determine the effectiveness of intraoperative facial nerve monitoring in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without intraoperative facial nerve monitoring.
RESULTS
Ten articles met inclusion criteria, with a total of 1069 patients included in the final meta-analysis. The incidence of immediate and permanent postoperative weakness following parotidectomy was significantly lower in the IFNM group compared to the unmonitored group (23.4% vs. 38.4%; p = 0.001) and (5.7% vs. 13.6%; p = 0.001) when all studies were included. However, when we analyze just prospective data, we are not able to find any significant difference.
CONCLUSION
Our study suggests that IFNM may decrease the risk of immediate post-operative and permanent facial nerve weakness in primary parotid gland surgery. However, due to the low evidence level, additional prospective-randomized trials are needed to determine if these results can be translated into improved surgical safety and improved patient satisfaction.
Topics: Facial Nerve; Facial Nerve Injuries; Facial Paralysis; Humans; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Prospective Studies; Retrospective Studies
PubMed: 32654023
DOI: 10.1007/s00405-020-06188-0 -
Oral Surgery, Oral Medicine, Oral... Jul 2022The aim of this study was to evaluate the efficacy of acellular dermal matrix (ADM) use in reducing Frey syndrome (FS) rates in patients postparotidectomy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this study was to evaluate the efficacy of acellular dermal matrix (ADM) use in reducing Frey syndrome (FS) rates in patients postparotidectomy.
STUDY DESIGN
We performed a systematic review and meta-analysis of existing literature comparing rates of FS with and without ADM use.
RESULTS
Eight studies were shortlisted for qualitative study, of which 7 compared rates of FS with and without the use of ADM. A total of 211 patients underwent parotidectomy with the use of ADM. Of these, mean patient age was 44.7 (SD ± 7.2); 89 of 159 were pleomorphic adenoma (55.9%), 29 of 159 with histological diagoses stated were Warthin's tumor (18.2%), and 159 of 211 were other histologic diagnoses (25.7%). Subjective and objective incidence rates for FS were 23 of 211 (10.9%) and 7 of 211 (3.3%), respectively. Patients in whom ADM barriers were used had significantly lower rates of subjective and objective FS (relative risk = 0.22; 95% confidence interval, 0.09-0.57; P = .002; and relative risk = 0.07; 95% confidence interval, 0.07-0.33; P < .001), respectively, compared to patients with no ADM.
CONCLUSION
The use of ADM was associated with lower FS rates compared to no ADM and should be considered in routine use to prevent this condition.
Topics: Acellular Dermis; Adenoma, Pleomorphic; Humans; Sweating, Gustatory
PubMed: 35431179
DOI: 10.1016/j.oooo.2021.12.123 -
The British Journal of Oral &... Apr 2021The objective of this review was to conduct a systematic review and meta-analysis to compare endoscopic with conventional parotid tumour excision. Online databases... (Meta-Analysis)
Meta-Analysis Review
The objective of this review was to conduct a systematic review and meta-analysis to compare endoscopic with conventional parotid tumour excision. Online databases including MEDLINE, EMBASE, EMCare, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), the World Health Organization International Clinical Trials Registry (ICTRP), and the ISRCTN registry were all searched. All randomised controlled trials and observational studies comparing endoscopic with conventional parotid tumour excision were included. Five studies were identified and analysis was reported in forest plots with 95% confidence intervals. Outcomes of interest included operating time, cosmesis, blood loss, facial nerve injury, Frey syndrome, duration of hospital stay, and tumour recurrence. Endoscopic tumour excision had a comparable operating time to conventional resection with an insignificant mean difference (p=0.08). Scar cosmesis in the endoscopic group was superior (mean difference: 2.95, p<0.05) and it also reported a lower volume of blood loss (mean difference: -31.84, p<0.05). No significant difference was found in the incidence of facial nerve injury or Frey syndrome between the two groups, but overall, fewer miscellaneous complications were observed in the endoscopic cohorts. Endoscopic parotid surgery reported a shorter duration of hospital stay, and tumour recurrence was similar in both treatment arms. Endoscopic parotid gland surgery is an effective alternative to conventional approaches with comparable operating times, reduced blood loss and fewer complications, as well as shorter inpatient stay and improved cosmesis. Further studies are, however, required with longer follow-up periods to assess outcomes between different subtypes of parotid tumour.
Topics: Endoscopy; Humans; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms
PubMed: 33280943
DOI: 10.1016/j.bjoms.2020.08.103 -
Journal of Oral and Maxillofacial... Feb 2013To detect the effect and safety of different types of grafts for the prevention of Frey syndrome after parotidectomy. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To detect the effect and safety of different types of grafts for the prevention of Frey syndrome after parotidectomy.
MATERIALS AND METHODS
The following data bases were searched electronically: MEDLINE (using OVID, from 1948 to July 2011), Cochrane Central Register of Controlled Trials (CENTRAL, issue 2, 2011), EMBASE (available from: http://embase.com, 1984 to July 2011), World Health Organization International Clinical Trials Registry Platform (July 2011), Chinese BioMedical Literature Database (1978 to July 2011), and the China National Knowledge Infrastructure (1994 to July 2011). The relevant journals and reference lists of the included studies were manually searched for randomized controlled trials studying the effect and safety of different types of grafts for preventing Frey syndrome after parotidectomy. The risk of bias assessment using Cochrane Collaboration's tool and data extraction was independently performed by 2 reviewers. The meta-analysis was performed using Review Manager, version 5.1.
RESULTS
A total of 14 randomized clinical trials and 1,098 participants were included. All had an unclear risk of bias. The meta-analysis results showed that the use of an acellular dermis matrix can reduce by 82% the risk of Frey syndrome compared with the no-graft group using an objective assessment (relative risk [RR] 0.18, 95% confidence interval [CI] 0.12 to 0.26; P < .00001; Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] quality of evidence: high). The acellular dermis matrix can also reduce by 90% the risk of Frey syndrome compared with the no-graft group using a subjective assessment (RR 0.10, 95% CI 0.05 to 0.22; P < .00001; GRADE quality of evidence: high). The muscle flaps can reduce by 81% the risk of Frey syndrome compared with the no-graft group (RR 0.19, 95% CI 0.13 to 0.27; P < .00001; GRADE quality of evidence: high). No statistically significant difference was found between the acellular dermal matrix and muscle flap groups (RR 0.73, 95% CI 0.15 to 3.53, P = .70; GRADE quality of evidence: low). No serious adverse events were reported.
CONCLUSIONS
The present clinical evidence suggests that grafts are effective in preventing Frey syndrome after parotidectomy. More randomized clinical trials are needed to confirm our conclusions and prove the safety of the grafts.
Topics: Acellular Dermis; Bias; Humans; Muscle, Skeletal; Parotid Gland; Postoperative Complications; Randomized Controlled Trials as Topic; Risk Factors; Skin Transplantation; Surgical Flaps; Sweating, Gustatory
PubMed: 22884117
DOI: 10.1016/j.joms.2012.06.007 -
American Journal of Otolaryngology 2020To evaluate surgical approaches and outcomes associated with accessory parotid gland neoplasms.
OBJECTIVE
To evaluate surgical approaches and outcomes associated with accessory parotid gland neoplasms.
DATA SOURCES
MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials.
REVIEW METHODS
A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed. Studies were included if they reported surgical management and outcomes of patients with accessory parotid gland neoplasms.
RESULTS
After screening 3532 records, 15 studies were included with a total of 187 patients. Benign tumors consisted of 61.5% of cases. External open, transoral, and preauricular endoscopic approaches were used for 82.3%, 11.3%, and 6.5% of cases, respectively. Accessory lobe resection alone, concurrent with partial parotidectomy, and concurrent with total parotidectomy were used in 54.8%, 43.0%, and 2.2% of cases, respectively. Complication rates were similar between histology groups (7.8% benign vs. 8.3% malignant, p = 0.82). Accessory lobe resection with concurrent partial parotidectomy had the lowest overall complication rate (6.3%). Resections limited to the accessory lobe were found to have an overall complication rate of 8.7%.
CONCLUSION
The results offer an overview of the surgical management and complications for accessory parotid gland tumors. Overall surgical complication rates found in these case series may be lower for management of accessory gland tumors than rates available in the literature for tumors within the main parotid gland.
Topics: Adult; Aged; Aged, 80 and over; Endoscopy; Humans; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Treatment Outcome; Young Adult
PubMed: 32580067
DOI: 10.1016/j.amjoto.2020.102610 -
Otolaryngology--head and Neck Surgery :... Jun 2023To compare outcomes of facial nerve repair or grafting following facial nerve-sacrificing procedures among patients treated with and without postoperative radiotherapy... (Review)
Review
OBJECTIVE
To compare outcomes of facial nerve repair or grafting following facial nerve-sacrificing procedures among patients treated with and without postoperative radiotherapy (RT).
DATA SOURCES
PubMed, OVID, Conference Papers Index, Cochrane Library, ClinicalTrials.gov.
REVIEW METHODS
Databases were searched using terms including "facial nerve," "graft," "repair," and "radiotherapy." Abstracts mentioning facial nerve repair and evaluation of facial nerve function were included for full-text review. Studies that utilized the House-Brackmann or similar validated scale for evaluation of postoperative facial nerve function were selected for review. All identified studies were included in a pooled t test analysis.
RESULTS
Twelve studies with 142 patients were included in the systematic review. All 12 studies individually demonstrated no significant difference in facial nerve outcomes between patients who received postoperative radiation and patients who did not. A pooled t test of data from all studies also demonstrated no significant difference in postoperative facial nerve function between the postoperative RT and non-RT groups (t stat = 0.92, p = .36).
CONCLUSION
This analysis, including 12 studies, demonstrated that among patients undergoing facial nerve grafting or repair, there was no significant difference in postoperative facial nerve function between postoperative RT and non-RT patients. Due to the small sample size and variability in study methods, further studies directly comparing outcomes between patients with and without postoperative RT would be beneficial.
Topics: Humans; Facial Nerve; Treatment Outcome; Facial Nerve Injuries; Face; Neurosurgical Procedures
PubMed: 36939391
DOI: 10.1002/ohn.224 -
Clinical Otolaryngology : Official... Dec 2017Fibrin sealants (FS) are commercially available products used in surgical wounds as adjuncts to haemostasis and closure of dead space. The role of FS in soft tissue head... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fibrin sealants (FS) are commercially available products used in surgical wounds as adjuncts to haemostasis and closure of dead space. The role of FS in soft tissue head and neck surgery has not been established.
OBJECTIVES
To assess whether FS improves wound-related outcomes in patients undergoing soft tissue surgery of the head and neck anatomical region that would commonly require a drain.
TYPE OF REVIEW
Systematic review and meta-analysis of randomised controlled trials (RCTs).
SEARCH STRATEGY
MEDLINE (1946-2016), EMBASE (1974-2016), PubMed (2016), CENTRAL (2016), ClinicalTrials.gov (2016), WHO International Clinical Trials Registry and Platform (2016), Research Gate (2016).
EVALUATION METHOD
Two independent reviewers screened and selected studies. Included studies were assessed for risk of bias and data extracted using a predetermined data collection form.
RESULTS
Of the 421 studies that were screened, 11 RCTs met the inclusion criteria. There were two RCTs on thyroidectomy, three on "surgery involving neck dissection" (central or lateral), five on rhytidectomy and one on parotidectomy. There was a tendency for FS to reduce "mean total drainage volume" (mean difference -26.86 mL, 95% CI -43.41 to -10.31, I =97%, P=.001). Subgroup analysis of thyroidectomy (mean difference -36.36 mL, 95% CI -72.82 to 0.10, I =79%, P=.05), "surgery involving neck dissection" (mean difference -33.21 mL, 95% CI -70.01 to 3.59, I =94%, P=.08) and rhytidectomy (mean difference -13.79 mL, 95% CI -17.57 to -10.01, I =0%, P < .00001) concurred with the overall analysis. There was a suggestion that FS may reduce "mean retention time of drains" by 1.24 days (95% CI -3.32 to 0.85, I =99%, P=.25) and "hospital length of stay" by 2.09 days (95% CI -5.18 to 0.99, I =97%, P=.18), but this was not statistically significant. There was also a suggestion that FS may protect against adverse events (RR 0.69, 95% CI 0.35 to 1.38, I =0%, P=.29) and haematoma/seroma formation (RR 0.49, 95% CI 0.22 to 1.07, I =0%, P=0.07).
CONCLUSIONS
There was considerable heterogeneity within the RCTs included in this study, thus restricting definitive conclusions. FS has however shown a definite benefit in rhytidectomy and potential benefit in other soft tissue head and neck surgical procedures. Further pragmatic trials are required particularly in the field of lateral neck dissection.
Topics: Drainage; Fibrin Tissue Adhesive; Humans; Neck Dissection; Parotid Gland; Postoperative Complications; Randomized Controlled Trials as Topic; Rhytidoplasty; Thyroidectomy
PubMed: 28130927
DOI: 10.1111/coa.12837 -
Indian Journal of Otolaryngology and... Dec 2022To evaluate the clinico-epidemiological aspects, pathological features, diagnostic methods, management protocol and functional outcome of the intra-parotid facial nerve...
To evaluate the clinico-epidemiological aspects, pathological features, diagnostic methods, management protocol and functional outcome of the intra-parotid facial nerve schwannoma (IFNS) and to present a case report on intra parotid facial nerve schwannoma. PubMed, ProQuest, Google scholar, Science direct and Scopus were screened for studies. Article selection and data extraction was done by one investigator and other investigator confirmed its accuracy. After abstract and text screening a total of 69 articles were finally selected for the study with the inclusion and exclusion criteria of the systematic review as per PRISMA guidelines. With addition of one case reported to our department. The mean age of diagnosis was 43 ± 16 years with a slight female predominance. The mean duration of the tumour was 29.5 months and the mean size of the tumour on initial diagnosis was 3.6 ± 1.67 cm. Pleomorphic adenoma was the primary diagnosis in 44 cases. Superficial parotidectomy was done in 64 cases followed by resection in 47 cases. Reconstructive treatment was carried out by an end-to-end anastomosis in 3 patients and by facial-hypoglossal anastomosis in 16 patients, GAN cable grafting in 5 patients, a greater auricular nerve graft was done in18 patients and end-to-side interposed sural nerve graft in 8 patients. The type D tumours are treated by extended resection of the facial nerve, which is difficult to reconstruct and also employs a nerve graft that does not often give acceptable recovery of facial function. Facial nerve schwannomas being a rare entity poses a dilemma in diagnosis and management. Managing the lesions is also difficult as intraoperative adherence to the nerve makes a tumour free margin difficult without sacrificing the nerve. At present there is no consensus regarding the management of various types of intra-parotid facial nerve shwannoma.
PubMed: 36742919
DOI: 10.1007/s12070-021-03013-w -
Head & Neck Apr 2014Our objectives were to assess the evidence of preservation of the greater auricular nerve in parotidectomy with regard to morbidity and quality of life. (Review)
Review
BACKGROUND
Our objectives were to assess the evidence of preservation of the greater auricular nerve in parotidectomy with regard to morbidity and quality of life.
METHODS
This was a systematic review. Inclusion criteria were: English literature, prospective and retrospective studies. Exclusion criteria were: single case reports, "teaching" reviews. Outcome measures were: tactile sensation, pain, thermal sensitivity, and quality of life.
RESULTS
Although quality of life does not seem to be adversely affected when the greater auricular nerve is sacrificed, preservation of the posterior branch was recommended in 8 studies. When preserving the nerve, the incremental operative time increase is no more than 10 to 5 minutes after a rapid learning curve.
CONCLUSIONS
There is level Ib evidence that preservation of the greater auricular nerve minimizes the postoperative sensory disturbance and should be considered whenever tumor clearance is not compromised. There is no evidence that overall quality of life is affected when the greater auricular nerve is sacrificed.
Topics: Cervical Plexus; Ear, External; Humans; Parotid Gland; Postoperative Complications; Quality of Life; Sensation Disorders; Touch
PubMed: 23766239
DOI: 10.1002/hed.23292 -
The British Journal of Oral &... May 2022
Meta-Analysis
Topics: Endoscopes; Feasibility Studies; Humans; Parotid Gland
PubMed: 35120784
DOI: 10.1016/j.bjoms.2021.10.012