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Head & Neck Nov 2021The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis... (Meta-Analysis)
Meta-Analysis Review
The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis (NMA) is to answer the following questions: (1) Does the extent of surgical resection of benign parotid tumors increase the risk of postoperative complications? (2) What is the best surgical intervention for treatment of benign parotid tumors that can provide an acceptable balance between tumor recurrence rate and other postoperative complications? A comprehensive search on PubMed, Embase, Scopus, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of tumor recurrence, facial nerve weakness (temporary [TFW] or permanent [PFP]), Frey's syndrome (FS), sialocele, and salivary fistula. The Bayesian network meta-analysis (NMA) accompanied by a random effect model and 95% credible intervals (CrI) were calculated using the GeMTC R package. Forty-four studies with a total of 7841 participants were included in the current NMA comparing five surgical interventions, namely enucleation, extracapsular dissection (ECD), partial superficial parotidectomy (PSP), superficial parotidectomy (SP), and total parotidectomy (TP). Enucleation showed the highest recurrence rate compared to ECD, SPS, SP, and TP. No statistical differences were observed concerning the recurrence rate when ECD, PSP, SP, and TP were compared together. There was an increased incidence of TFW and FS with the increase in the extent of parotid resection, while no significant difference was found when comparing enucleation with ECD and PSP. SP showed the highest incidence of PFP, and salivary fistula compared to ECD, PSP, and TP. The tumor recurrence rates in enucleation, ECD, PSP, SP, and TP were 14.3%, 3.6%, 3.7%, 2.8%, and 1.4%, respectively. The current NMA demonstrated that the risk of TFW and FS increases with the increase in the extent of parotid resection and that ECD and PSP can be considered the treatment of choice for benign parotid tumors, as both provide an acceptable balance between the incidence of tumor recurrence and facial nerve dysfunction.
Topics: Bayes Theorem; Humans; Neoplasm Recurrence, Local; Network Meta-Analysis; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies
PubMed: 34288212
DOI: 10.1002/hed.26813 -
Journal of Otolaryngology - Head & Neck... Dec 2023To quantify the results of superficial parotidectomy (SP) and partial SP (PSP) for benign parotid tumours using a systematic evaluation method. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To quantify the results of superficial parotidectomy (SP) and partial SP (PSP) for benign parotid tumours using a systematic evaluation method.
METHODS
A systematic search of English and Chinese databases (PubMed, Web of Science, Cochrane Library, China Knowledge Network, Wanfang and Vipshop) was conducted to include studies comparing the treatment outcomes of SP with PSP.
RESULTS
Twenty-three qualified, high-quality studies involving 2844 patients were included in this study. The results of this study showed that compared to the SP surgical approach, the PSP surgical approach reduced the occurrence of temporary facial palsy (OR = 0.33; 95% confidence interval [CI] 0.26-0.41), permanent facial palsy (OR = 0.28; 95% CI 0.16-0.52) and Frey syndrome (OR = 0.36; 95% CI 0.23-0.56) in patients after surgery, and the surgery operative time was reduced by approximately 27.35 min (95% CI - 39.66, - 15.04). However, the effects of PSP versus SP on salivary fistula (OR = 0.70; 95% CI 0.40-1.24), sialocele (OR = 1.48; 95% CI 0.78-2.83), haematoma (OR = 0.34; 95% CI 0.11-1.01) and tumour recurrence rate (OR = 1.41; 95% CI 0.48-4.20) were not statistically significant.
CONCLUSION
Compared with SP, PSP has a lower postoperative complication rate and significantly shorter operative time, suggesting that it could be used as an alternative to SP in the treatment of benign parotid tumours with the right indications.
Topics: Humans; Facial Paralysis; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 38135871
DOI: 10.1186/s40463-023-00679-w -
Frontiers in Surgery 2017The recurrence of pleomorphic adenoma (PA) has been extensively debated, mostly in relation to the extent of parotidectomy. (Review)
Review
BACKGROUND
The recurrence of pleomorphic adenoma (PA) has been extensively debated, mostly in relation to the extent of parotidectomy.
METHODS
A systematic review was undertaken to clarify the surgical and pathological variables related to PA recurrence. Inclusion criteria were as follows: English literature, and prospective or retrospective studies. Exclusion criteria were as follows: single case reports, reviews, and lack of PA recurrence data.
RESULTS
Pathology-related variables associated with recurrence include the histological subtype, the thickness and incompleteness of the tumor capsule, pseudopodia, and satellite nodules. Surgery-related variables associated with recurrence are the presence of intact margins and tumor puncture or spillage. Other factors are the size of the tumor and the age of patient. Myxoid subtypes of PA tend to have incomplete and thinner capsules and to recur more frequently. Surgical variables related to recurrence include positive margins and tumor spillage.
CONCLUSION
Myxoid and/or large PA, especially in young patients, should be approached more cautiously to avoid recurrences.
PubMed: 28555187
DOI: 10.3389/fsurg.2017.00026 -
Head & Neck Apr 2012Parotidectomy is a common procedure and Frey's syndrome (gustatory sweating) is a common side effect. The current literature was assessed concerning the effectiveness of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Parotidectomy is a common procedure and Frey's syndrome (gustatory sweating) is a common side effect. The current literature was assessed concerning the effectiveness of the sternocleidomastoid muscle (SCM) flap to prevent Frey's syndrome after parotidectomy.
METHODS
A bibliography search was conducted for studies published between 1966 and 2010 and included randomized controlled trials (RCTs) or cohort studies with patients undergoing parotidectomy with facial nerve preservation. The outcome measures of particular interest were the incidence of Frey's syndrome and cosmetic impairment.
RESULTS
In all, 12 studies were selected (1 meta-analysis of all interventions to prevent Frey's syndrome, 2 RCTs, and 9 cohort studies). The trials were too heterogeneous to perform a meta-analysis on the effect of the SCM flap. The results reported by the authors of each study suggest an objective decrease in Frey's syndrome when the SCM flap was used, but there was no difference in the patients' subjective reporting of symptoms. However, this conclusion is prone to the biases inherent in these studies, and thus overall it is impossible to make any recommendation.
CONCLUSION
Current reported evidence is inconclusive as to the use of SCM muscle flap as an intervention to prevent Frey's syndrome following parotid surgery.
Topics: Controlled Clinical Trials as Topic; Female; Follow-Up Studies; Humans; Male; Muscle, Skeletal; Parotid Gland; Postoperative Complications; Primary Prevention; Randomized Controlled Trials as Topic; Risk Assessment; Surgical Flaps; Surgical Procedures, Operative; Sweating, Gustatory; Treatment Outcome
PubMed: 21472880
DOI: 10.1002/hed.21722 -
The Journal of Laryngology and Otology Sep 2021Parotid incidentalomas on fluorodeoxyglucose positron emission tomography/computed tomography imaging are rare. A systematic review was performed to assess their...
OBJECTIVE
Parotid incidentalomas on fluorodeoxyglucose positron emission tomography/computed tomography imaging are rare. A systematic review was performed to assess their aetiology and association with scanning indication, and to develop an evidence-based algorithm for their management.
METHODS
A literature search was performed on 25 August 2020 using the keywords 'incidentaloma', 'incidental finding', 'parotid', 'parotid gland', 'salivary gland' and 'head and neck'. Articles were reviewed by two authors before their inclusion.
RESULTS
Forty articles were included, totalling 558 incidentalomas. The mean incidence was 0.74 per cent. Lung cancer was the most common imaging indication. The most common aetiologies were cystadenolymphoma, pleomorphic salivary adenoma and metastases. Only cystadenolymphoma (p = 0.015) and pleomorphic salivary adenoma (p = 0.011) were significantly associated with a primary malignancy (lung). The most common further investigations were aspiration cytology, ultrasound imaging and core biopsy, usually prior to parotidectomy.
CONCLUSION
If appropriate, parotid incidentalomas should be followed up with flexible endoscopy, skin examinations, and head and neck examinations. Ultrasound-guided core biopsy provides higher accuracy, avoiding repeat sampling and excision biopsy.
Topics: Fluorodeoxyglucose F18; Humans; Incidence; Incidental Findings; Parotid Gland; Parotid Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals
PubMed: 34308809
DOI: 10.1017/S0022215121002036 -
Cancers Oct 2022The aim of this study was to systematically review the literature of sarcoma of the parotid gland in order to analyze the main factors affecting survival rate. A... (Review)
Review
Systematic Review of Parotid Gland Sarcomas: Multi-Variate Analysis of Clinicopathologic Findings, Therapeutic Approaches and Oncological Outcomes That Affect Survival Rate.
The aim of this study was to systematically review the literature of sarcoma of the parotid gland in order to analyze the main factors affecting survival rate. A systematic literature review was performed between January 1990 to November 2021, and 88 patients affected by parotid gland sarcomas were included. The most common histological types were Rhabdomyosarcoma and Synovial Sarcoma. From our review, it emerges that primary sarcomas of the parotid glands are locally aggressive but show low tendency to metastasize to the lymph nodes of the neck and that surgery (i.e., total or radical parotidectomy) is the main approach for their treatment. The global overall survival (OS) is 52% at 5 years and 34.1% at 10 years. The OS for T1, T2, T3, T4 tumor at 5 years of follow up is 80.0%, 66.5%, 56.7% and 33.3%, respectively. Size/extension at the diagnosis and the sarcoma's histotype are the most important prognostic factors. Multivariate analysis showed that surgery (total or radical parotidectomy) performed on the tumor ( = 0.0008) was the only parameter that significantly affected the OS. Among the other variables, age (younger), use of adjuvant therapy and lymph node metastasis showed borderline significative values ( = 0.05). Our analysis suggests that, when a primitive parotid sarcoma is diagnosed, total or radical parotidectomy should be performed at any age independent of tumor histology. Because regional lymph node metastases from parotid sarcomas are uncommon, alternative strategies (e.g., close follow-up by imaging and evaluation of sentinel lymph nodes) should be pursued before lymph node (selective/radical) dissection.
PubMed: 36230786
DOI: 10.3390/cancers14194862 -
Indian Journal of Otolaryngology and... Sep 2023Lateral skull base involvement from parotid cancers is a rare condition and is considered a poor prognostic indicator. The aim of this study was to systematically review...
Lateral skull base involvement from parotid cancers is a rare condition and is considered a poor prognostic indicator. The aim of this study was to systematically review the literature of parotid tumors with temporal bone invasion to analyze the survival outcome. A systematic literature review was performed in August 2022, without time limits, and 289 patients affected by parotid gland cancers and lateral skull base involvement were included. The most common symptoms in parotid tumors at the onset were indolent mass, facial weakness, pain, and hearing loss; the chi-square value is 23.1063, with a statistically significance (p = < 0.000121). The five most common histologies were adenoid cystic carcinoma, acinic cell carcinoma, mucoepidermoid carcinoma, adenocarcinoma, and squamous cell carcinoma. The facial nerve function after surgery showed statistically significance (functional vs. non-functional; chi-square was 91.7698, p = < 0.00001). Mean follow-up was 36.2 months (range 0.3-192). At the last follow-up, more patients died of disease (DOD; 60/289, 21%) than other causes (DOOC; 5/289, 2%). There is a statistically significant correlation between patients died for tumor (DOD) and patients died for other causes (DOOC) (p = < 0.0001), suggesting that the lateral skull base invasion negatively impacts on survival. Basing on the results of our systematic review, lateral skull base involvement from parotid recurrent/advance tumors should be considered a poor prognostic factor, as the majority of patients die due to this condition. It also would be necessary to have "clear"works, with full data (demographic, clinical, surgical data), and with a longer follow up, in order to assess the best treatment modality of these patients.
PubMed: 37636674
DOI: 10.1007/s12070-023-03787-1 -
The Cochrane Database of Systematic... Mar 2015Frey's syndrome is a rare disorder, the symptoms of which include sweating, flushing and warming over the preauricular and temporal areas following a gustatory stimulus.... (Review)
Review
BACKGROUND
Frey's syndrome is a rare disorder, the symptoms of which include sweating, flushing and warming over the preauricular and temporal areas following a gustatory stimulus. It often occurs in patients who have undergone parotidectomy, submandibular gland surgery, radical neck dissection, infection and traumatic injury in the parotid region, and is caused by the aberrant regrowth of facial autonomic nerve fibres. Currently there are several options used to treat patients with Frey's syndrome; for example, the topical application of anticholinergics and antiperspirants, and the intradermal injection of botulinum toxin. It is uncertain which treatment is most effective and safe.
OBJECTIVES
To assess the efficacy and safety of different interventions for the treatment of Frey's syndrome.
SEARCH METHODS
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; ICTRP and additional sources for published and unpublished trials. The date of the search was 28 April 2014.
SELECTION CRITERIA
We included randomised or quasi-randomised controlled trials (RCTs) in participants diagnosed with Frey's syndrome using a clinical standard such as Minor's starch-iodine test. We planned to include trials in which participants received any intervention versus no treatment (observation) or an alternative intervention, with or without a second active treatment. Our primary outcome measures were success rate (as assessed clinically by Minor's starch-iodine test, the iodine-sublimated paper histogram method, blotting paper technique or another method) and adverse events. Our secondary outcome measure was success rate as assessed by patients (disappearance or improvement of symptoms).
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures expected by The Cochrane Collaboration.
MAIN RESULTS
We identified no RCTs or quasi-RCTs that fulfilled the inclusion criteria. Our searches retrieved eight potentially relevant studies, but after assessment of the full-text reports we excluded all of them due to the absence of randomisation or because the patients did not have Frey's syndrome. We excluded one randomised controlled trial that compared two different doses of botulinum toxin in patients with Frey's syndrome because the comparator was not an alternative treatment.
AUTHORS' CONCLUSIONS
We are unable to establish the efficacy and safety of the different methods used for the treatment of Frey's syndrome.RCTs are urgently needed to assess the effectiveness of interventions for the treatment of Frey's syndrome. Future RCTs should include patients with Frey's syndrome of different ranges of severity and report these patients separately. Studies should investigate all possibly effective treatments (such as anticholinergics, antiperspirants and botulinum toxin) compared to control groups using different treatments or placebo. Subjective assessment of Frey's syndrome should be considered as one of the outcome measures.
Topics: Humans; Sweating, Gustatory
PubMed: 25781421
DOI: 10.1002/14651858.CD009959.pub2 -
Cureus Nov 2023The facial nerve is the seventh of 12 cranial nerves found in the head and neck region that facilitates several nerve fibers and pathways to perform various functions.... (Review)
Review
The facial nerve is the seventh of 12 cranial nerves found in the head and neck region that facilitates several nerve fibers and pathways to perform various functions. Iatrogenic facial nerve injury during surgeries of the head and neck is common, ranging from 4-6%, particularly in procedures that involve mobilization or resection of associated anatomical structures. Any injury to the facial nerve or its branches impacts the quality of life and patient satisfaction as the degree of iatrogenic injury may result in partial or complete facial nerve paralysis. Of the various implementable techniques available to avoid injury, electromyography (EMG) has recently been widely used to monitor facial nerve function intraoperatively to determine the degree of injury and predict postoperative weakness. The purpose of this study was to analyze and review existing scientific literature in determining the role of intraoperative facial nerve monitoring (IFNM) with EMG in decreasing the incidence and degree of intraoperative facial nerve injury among commonly performed surgeries involving the facial nerve. A systematic review was conducted from articles published between September 2006 and December 2022. Suitable articles were identified from the MEDLINE/PubMed databases using relevant terms to meet the inclusion criteria. Articles were subsequently coded based on the inclusion/exclusion criteria as well as the type of surgery performed with concurrent use of EMG and the results from intraoperative monitoring. A total of 47 articles were found in relation to the use of IFNM, including studies to reduce the incidence and determine preventative measures to decrease nerve injury. Eleven articles were used to evaluate the use of EMG during various head and neck surgeries in decreasing the incidence of intraoperative facial nerve injury. Sources found were primarily divided based on the type of surgery performed when determining the use of EMG. Four sources tested the efficacy of EMG during parotidectomy, four sources during vestibular schwannoma resection, two sources during cochlear implant surgeries, and one during a lymphatic malformation surgery. IFNM also decreased the duration of surgery, the severity of facial nerve palsy, and the average time of facial nerve paralysis recovery. IFNM was found to not significantly predict facial nerve injury in the setting of intraoperative nerve injury but tended to preserve potential facial nerve function in vestibular schwannoma cases. The surgical setting determined the efficacy and use of IFNM in decreasing the incidence of facial nerve weakness and paralysis. IFNM had the best preventative and prognostic value when used in vestibular schwannoma resection, and the least in cochlear implants, with mixed evidence seen in the setting of parotidectomy. Overall, IFNM using EMG as an adjunct during surgery may reduce the risk of iatrogenic injury; however, additional studies must be performed to determine the degree of long-term patient satisfaction and quality of life achieved in the setting of IFNM.
PubMed: 38060739
DOI: 10.7759/cureus.48367 -
Oncology Letters Apr 2013Approximately 34-86% of neoplasms of the salivary glands are located in the parotid gland and parotidectomy is the first-line treatment for parotid gland tumors. Frey...
Approximately 34-86% of neoplasms of the salivary glands are located in the parotid gland and parotidectomy is the first-line treatment for parotid gland tumors. Frey syndrome and cosmetic deformity are common complications experienced by patients following parotidectomy and the sternocleidomastoid muscle flap (SCMF) is used to prevent them. Numerous studies have been performed to examine the effectiveness of the SCMF for the prevention of cosmetic deformity and Frey syndrome, however, they provide contradictory results and possess small sample sizes with consequently low statistical power. In order to evaluate the effectiveness of the SCMF for the prevention of Frey syndrome and cosmetic deformity following parotidectomy, we performed a systematic review and meta-analysis based on published randomized controlled trials (RCTs), which were identified using PubMed and CNKI databases, and references of studies up to August 2012 were included. Using these criteria, we yielded 11 RCTs. Following an independent assessment of the methodological quality of these studies and the extraction of data, a systematic review and meta-analysis was conducted. The results of the meta-analysis demonstrated that there was a significant trend towards a lower risk of objective incidence [67%; risk ratio (RR), 0.33; 95% confidence interval (CI), 0.16-0.67; P<0.01] and subjective incidence (66%; RR, 0.34; 95% CI, 0.16-0.75; P= 0.01) of Frey syndrome in the SCMF group. The sensitivity analysis also indicated that this result was significant. Due to the considerable variation between the included studies, a meta-analysis was not applicable to assess cosmetic deformity. Two RCTs demonstrated that the difference between the SCMF and no SCMF group was not statistically significant, while the other seven RCTs detected a statistically significant difference between the two groups. Publication bias was detected. In conclusion, based on currently available evidence, the use of the SCMF is benefical for the prevention of Frey syndrome, however, whether it is also benefical for cosmetic deformity remains inconclusive.
PubMed: 23599790
DOI: 10.3892/ol.2013.1179