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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 -
Journal of Oral and Maxillofacial... May 2017We sought to evaluate clinical-epidemiologic aspects, pathologic characteristics, and treatment of sclerosing polycystic adenosis (SPA) of the parotid gland and to... (Review)
Review
PURPOSE
We sought to evaluate clinical-epidemiologic aspects, pathologic characteristics, and treatment of sclerosing polycystic adenosis (SPA) of the parotid gland and to report 2 new cases.
MATERIALS AND METHODS
We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies published in or before June 2016. The inclusion criteria were as follows: final diagnosis of SPA affecting the parotid gland and articles published in Spanish or English. The exclusion criteria were as follows: unclear diagnosis after pathologic analysis and patients affected by other conditions in the major salivary glands. We added 2 new cases.
RESULTS
Our review ultimately included 21 articles and 45 cases. The mean patient age was 41 years (range, 7-84 years). The female-to-male ratio was 2:1. In all patients the tumor showed progressive growth. The evolution range was 7 days to 11 years. In 17.7% of cases, the tumor was associated with pain. The average tumor size was 30.3 mm (range, 12-60 mm). Fine needle aspiration biopsy (FNAB) was unable to diagnose 30 cases. Benign tumors comprised 58% of tumors (18), whereas malignancy was present in 25.8% (8). Thirty-five tumors were well circumscribed. There were 8 multinodular or lobed cases. The tumor was described as encapsulated in 1 case, partially encapsulated or pseudo-encapsulated in 16, and not encapsulated in 12. Five cases showed different degrees of degenerative changes, ranging from dysplasia to invasive carcinoma. All cases underwent surgical treatment. Superficial parotidectomy with preservation of the facial nerve was performed in 22 cases (61.1%), total parotidectomy in 8 (22.2%), and tumor enucleation in 6 (16.6%). The mean follow-up period was 51.5 months (range, 5-276 months). Of documented cases, 74.2% had 2 or more years of follow-up. Recurrences occurred in 6 cases (16.6%).
CONCLUSIONS
We consider SPA a benign tumor with progressive growth, which is occasionally painful. It occurs around age 40 years and occurs more often in female patients. Fine needle aspiration biopsy does not provide an adequate preoperative diagnosis. Recurrences are infrequent. Follow-up should be customized according to the pathologic findings. Malignant transformation may occur. Superficial parotidectomy with facial nerve preservation is the treatment of choice.
Topics: Aged; Female; Humans; Middle Aged; Parotid Gland; Salivary Gland Diseases; Sclerosis
PubMed: 27888671
DOI: 10.1016/j.joms.2016.10.031 -
Journal of Cranio-maxillo-facial... Jul 2015Different types of surgical management of pleomorphic adenoma of the parotid gland are associated with different recurrence rates. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Different types of surgical management of pleomorphic adenoma of the parotid gland are associated with different recurrence rates.
MATERIAL AND METHODS
A systematic review of literature until 2014 with meta-analysis was conducted. Inclusion criteria were original studies of patients with surgical management for pleomorphic adenoma of the parotid gland and recurrence rates, with a median follow-up period of 5 years. The Newcastle-Ottawa Quality Assessment Scale (NOQAS) was used to assess the quality.
RESULTS
Sixteen studies were included. Four studies show a low recurrence rate (0.01, 95% confidence interval [CI] = 0.00-0.02) after total parotidectomy. Twelve studies show a low recurrence rate (0.02, 95% CI = 0.01-0.03) after superficial parotidectomy. Six studies show a low recurrence rate (0.02, 95% CI = 0.01-0.04) after limited parotidectomy. Six studies demonstrate a low recurrence rate (0.01, 95% CI = 0.00-0.04) after extracapsular dissection. Five studies report a low-to-medium recurrence rate (0.08, 95% CI = 0.03-0.14) after extracapsular enucleation.
CONCLUSION
Information about recurrence rates, times of recurrence in relation to type of surgical treatment, and significance of capsule rupture is very poor. With regard to recurrence rates and surgical approaches, the types of operations that show the lowest recurrence rate are total parotidectomy and extracapsular dissection. Controversies over surgical treatment of PA of parotid gland remain, and the safest surgical method for the removal of this tumors has not been identified.
Topics: Adenoma, Pleomorphic; Dissection; Follow-Up Studies; Humans; Neoplasm Recurrence, Local; Parotid Gland; Parotid Neoplasms
PubMed: 25982213
DOI: 10.1016/j.jcms.2015.03.017 -
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 -
Journal of Cranio-maxillo-facial... Jan 2015Since of the 1940s, there has been wide controversy about the most effective surgical treatment for the primary benign parotid tumor. This review investigates the...
PURPOSE
Since of the 1940s, there has been wide controversy about the most effective surgical treatment for the primary benign parotid tumor. This review investigates the effectiveness and associated complications of superficial parotidectomy versus total conservative parotidectomy in the management of primary benign parotid tumors.
MATERIAL AND METHODS
An electronic search with restricted dates (1920-2014) and restricted language was performed in August 2014. Thirteen studies were included. In total, 2477 patients were enrolled in the 13 studies, with 1317 patients undergoing superficial parotidectomy and 391 patients undergoing total conservative parotidectomy; 769 patients treated with other surgical techniques were excluded. The maximum follow-up period varied between 2 and 24 years (mean 2.8 years).
RESULTS
The incidence of recurrence in the superficial parotidectomy patients ranged from 0% to 15% (mean 5.7%), whereas, in the total conservative parotidectomy patients it ranged from 0% to 16% (mean 3.03%). The incidence of the facial nerve paresis according to collected data in the superficial parotidectomy group ranged from 0% to 23% (mean 6.75%), whereas in the total conservative parotidectomy group it was 0%-45% (mean 15%). The incidence of facial nerve paralysis in the superficial parotidectomy group ranged from 0% to 3% (mean 0.8%), whereas in the total conservative parotidectomy group it was 0%-17 % (mean 4.4%).
CONCLUSION
The results of this review suggest that superficial parotidectomy is superior to total conservative parotidectomy in the management of primary benign tumor in superficial lobes. In addition, superficial parotidectomy showed a minimal recurrence rate for benign tumor in superficial lobes.
PubMed: 25769678
DOI: 10.1016/j.jcms.2015.01.002 -
World Journal of Clinical Cases Feb 2015To systematically review the literature to assess the efficacy of corticosteroids in treating post-parotidectomy facial nerve palsy (FNP).
AIM
To systematically review the literature to assess the efficacy of corticosteroids in treating post-parotidectomy facial nerve palsy (FNP).
METHODS
We searched the Cochrane library, EMBASE and MEDLINE (from inception to 2014) for studies assessing the use of corticosteroids in post-parotidectomy FNP. Studies were assessed for inclusion and quality. Data was extracted from included studies.
RESULTS
Two randomised controlled trials met the inclusion criteria. One study assessed the use of dexamethasone and the other prednisolone. None of the studies demonstrated a significant difference in the outcome of FNP post-parotidectomy with the use of corticosteroids vs no therapy. The majority of FNP post-parotidectomy is transient. Preoperative factors (size of tumour and malignancy), intraoperative factors (extent of parotidectomy and integrity of facial nerve at the end of the operation) are important in determining prognosis of FNP if it does occur.
CONCLUSION
Corticosteroids do not appear to improve FNP prognosis post-parotidectomy. Further studies assessing patients by cohort and with long term follow-up are required to increase scientific evidence.
PubMed: 25685765
DOI: 10.12998/wjcc.v3.i2.180 -
Otolaryngology--head and Neck Surgery :... Apr 2015To determine the effectiveness of intraoperative facial nerve monitoring (FNM) in preventing immediate and permanent postoperative facial nerve weakness in patients... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To determine the effectiveness of intraoperative facial nerve monitoring (FNM) in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy.
DATA SOURCES
PubMed-NCBI database from 1970 to 2014.
REVIEW METHODS
A systematic review and meta-analysis of the literature was conducted. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without FNM (intraoperative nerve monitor vs control). Primary and secondary end points were defined as immediate postoperative and permanent facial nerve weakness (House-Brackmann score, ≥2), respectively.
RESULTS
After a review of 1414 potential publications, 7 articles met inclusion criteria, with a total of 546 patients included in the final meta-analysis. The incidence of immediate postoperative weakness following parotidectomy was significantly lower in the FNM group compared to the unmonitored group (22.5% vs 34.9%; P = .001). The incidence of permanent weakness was not statistically different in the long term (3.9% vs 7.1%; P = .18). The number of monitored cases needed to prevent 1 incidence of immediate postoperative facial nerve weakness was 9, given an absolute risk reduction of 11.7% This corresponded to a 47% decrease in the incidence of immediate facial nerve dysfunction (odds ratio, 0.53; 95% CI, 0.35 to 0.79; P = .002).
CONCLUSION
In primary cases of parotidectomy, intraoperative FNM decreases the risk of immediate postoperative facial nerve weakness but does not appear to influence the final outcome of permanent facial nerve weakness.
Topics: Facial Nerve; Facial Nerve Injuries; Humans; Intraoperative Neurophysiological Monitoring; Parotid Diseases; Parotid Gland; Parotid Neoplasms
PubMed: 25628369
DOI: 10.1177/0194599814568779 -
Shanghai Kou Qiang Yi Xue = Shanghai... Jun 2014To evaluate the efficacy and safety of closed suction drainage for prevention of postoperative complications after parotidectomy. (Review)
Review
PURPOSE
To evaluate the efficacy and safety of closed suction drainage for prevention of postoperative complications after parotidectomy.
METHODS
Pubmed, Cochrane Controlled Trials Register, Embase, Open Sigle, CBM, VIP and Wanfang database were searched electronically from the date of their establishment to May 10,2013. Hand-searching covering 19 relevant Chinese journals were also performed, and the literature of randomized controlled trials comparing closed suction drainage and open drainage for prevention of postoperative complications after parotidectomy were included. Risk of bias assessment, which was suggested by Cochrane handbook for systematic reviewers of intervention review, and data extraction of included studies were delivered by two reviewers in duplicate; and meta analysis was performed with Revman 5.2 software.
RESULTS
Ten randomized controlled trials were included. All studies had unclear risk of bias. When compared with open drainage, closed suction drainage showed a significant advantage on reducing postoperative complications (salivary fistula/effusion, edema) after parotidectomy; it also improved clinical comprehensive effect and patients' quality of life (P<0.05).
CONCLUSIONS
To a certain extent, closed suction drainage has better efficacy and safety than controls in preventing postoperative complications after parotidectomy. However, as the quality of some included studies is limited, more randomized controlled trials are needed to reinforce the conclusion.
Topics: Drainage; Humans; Parotid Gland; Postoperative Complications; Quality of Life; Randomized Controlled Trials as Topic; Suction
PubMed: 25102886
DOI: No ID Found -
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 -
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