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Indian Journal of Otolaryngology and... Dec 2022Traditional parotidectomy incision was devised by Blair (1912) which was modified by Bailey (1941). Over the years various approaches and techniques have evolved to...
Traditional parotidectomy incision was devised by Blair (1912) which was modified by Bailey (1941). Over the years various approaches and techniques have evolved to improve the aesthetic outcome and at the same time for complete disease clearance with reduced complications. In this study, we evaluated the feasibility of our mini-incision parotidectomy technique along with the surgical and quality of life (QOL) outcomes. This prospective case series was conducted at Apollo Hospitals, Bangalore over a period of 2 years (June 2018-August 2020) and includes 20 patients. The surgical outcomes were assessed in terms of feasibility of mini-incision technique with respect to levels of parotid involved and functional outcomes in terms of presence or absence of complications like facial palsy (temporary or permanent), seroma and Frey's syndrome. Patient related quality of life (QOL) outcomes were assessed in terms of post-operative pain score, patient comfort score and cosmetic score by using numerical rating scale-11 (NRS-11). The mini-incision parotidectomy technique is feasible for lesions in all the parotid levels and conversion or lengthening of incision was not needed in any of the cases. 2(10%) patients had temporary facial palsy (House-Brackman grade III) which was recovered within 3 weeks after surgery. One patient (5%) with adenoid cystic carcinoma had permanent facial palsy. Out of 20 patients 2(10%) had seroma and 1(5%) patient presented with Frey's syndrome. Mean post-operative pain score at 0, 6 and 24 h were 4.8, 3.4 and 1.8 out of 10 respectively. Mean comfort score was 9 out of 10 and mean cosmetic score was 9.5 out of 10. Mini-incision parotidectomy technique can render improved functional as well as aesthetic outcomes after parotidectomy without compromising the surgical clearance of the disease process.
PubMed: 36742673
DOI: 10.1007/s12070-021-02882-5 -
Healthcare (Basel, Switzerland) Apr 2022Surgery with parotidectomy is the preferable treatment for most parotid tumors. Our meta-analysis compared the differences between the use of the LigaSure (LS) device... (Review)
Review
Surgery with parotidectomy is the preferable treatment for most parotid tumors. Our meta-analysis compared the differences between the use of the LigaSure (LS) device and the conventional suture ligation technique (CT) in parotidectomies. A literature search in databases including EMBASE, MEDLINE, and the Cochrane Library was carried out. Studies including parotidectomy using LS and CT were included with the intraoperative and postoperative parameters collected. Continuous operative time data were measured by mean differences (MDs). Discrete data on postoperative complications, including facial palsy, postoperative bleeding, and salivary complications, were evaluated with risk differences (RDs). All values were reported with 95% confidence intervals (CIs). Five studies were included in our meta-analysis. The pooled analysis demonstrated a significant reduction in operative time in the LS group (MD: -21.92; 95% CI, -30.18 to -13.66). In addition, the analysis indicated that the incidence of postoperative complications, including permanent facial palsy (RD, -0.01; 95% CI, -0.06 to 0.05), temporary facial palsy (RD, 0.00; 95% CI, -0.03 to 0.04), salivary complications (RD, -0.01; 95% CI, -0.08 to 0.06), and postoperative bleeding (RD, -0.02; 95% CI, -0.07 to 0.04), were all similar between the LS group and the CT group. According to the results, the LS device appears to be a safe and useful tool and could shorten the operative time in patients needing parotidectomy.
PubMed: 35455883
DOI: 10.3390/healthcare10040706 -
European Annals of Otorhinolaryngology,... Nov 2022
Topics: Humans; Outpatients; Parotid Gland; Ambulatory Surgical Procedures; Salivary Glands; France; Parotid Neoplasms; Postoperative Complications; Retrospective Studies
PubMed: 34972645
DOI: 10.1016/j.anorl.2021.12.002 -
Otolaryngologic Clinics of North America Apr 2016Frey syndrome is a common sequela of parotidectomy, and although it is not frequently manifested clinically, it can cause significant morbidity for those affected. Frey... (Review)
Review
Frey syndrome is a common sequela of parotidectomy, and although it is not frequently manifested clinically, it can cause significant morbidity for those affected. Frey syndrome results from synkinetic autonomic reinnervation by transected postganglionic parasympathetic nerve fiber within the parotid gland to the overlying sweat glands of the skin. Many surgical techniques have been proposed to prevent the development of Frey syndrome. For those who develop clinical symptoms of Frey syndrome, objective testing can be performed with a Minor starch-iodine test. Some of the current methods to prevent and treat symptomatic Frey syndrome are reviewed.
Topics: Botulinum Toxins, Type A; Humans; Parotid Gland; Postoperative Complications; Sweat Glands; Sweating, Gustatory
PubMed: 26902982
DOI: 10.1016/j.otc.2015.10.010 -
Iranian Journal of Otorhinolaryngology Mar 2022Patotidectomy is the treatment of choice for superficial parotid gland lesions. The present study aimed to assess the facial nerve status, as well as peri-and...
INTRODUCTION
Patotidectomy is the treatment of choice for superficial parotid gland lesions. The present study aimed to assess the facial nerve status, as well as peri-and postsurgical complications, in two surgical techniques (antegrade and retrograde) for parotidectomy.
MATERIALS AND METHODS
This study was conducted on 56 patients diagnosed with parotid neoplasms from 2013-2015. The patients were randomly assigned to two groups of antegrade and retrograde. In the retrograde group, the dissection was performed initially to expose the facial nerve branches, while in the antegrade approach, the facial nerve trunk was exposed initially. Different values, such as intraoperative bleeding, mass characteristics, and the time for different sections of the surgery, were noted. The facial nerve was examined after the surgery; moreover, hospital stay and drain removal time was also noted. During the six-month postoperative period, complications and squeals were also noted.
RESULTS
Based on the results, antegrade nerve dissection was performed in 24 patients, while retrograde nerve dissection was carried out in 25 patients. The two groups were compared for intraoperative bleeding, drain output, and drain removal time. Hospital stay was found to be statistically higher in the retrograde group (P<0.05). Other complications and morbidities, such as facial nerve trauma, sialoceles, salivary fistulas, Frey's syndrome, skin sensory changes, and surgery time, were not statistically different (P≥0.05).
CONCLUSIONS
As evidenced by the obtained results, retrograde dissection had higher intraoperative bleeding and longer hospital stay. It seems that skin flap dissection is more extensive in retrograde dissection, leading to more bleeding in this approach. These differences, although statistically significant, are not clinically important; consequently, surgeons' experience and knowledge about the two approaches are of utmost importance.
PubMed: 35655768
DOI: 10.22038/IJORL.2022.51069.2717 -
Indian Journal of Otolaryngology and... Oct 2022To assess the parameters' setting of the microscope during parotidectomy and the impact of microscopic parotidectomy on facial nerve functional status. A prospective...
To assess the parameters' setting of the microscope during parotidectomy and the impact of microscopic parotidectomy on facial nerve functional status. A prospective study was conducted on 28 patients in a tertiary care center, who underwent microscopic parotidectomy. Microscope's settings' like magnification, focal length, diameter of the visualized field, and clock position were recorded. Facial nerve functional status was also recorded. All surgeries were performed by right-handed surgeons using Leica F 20 M525 microscope. Clock position of microscope for right parotidectomy ranged between 7 and 10 o clock and for left, it ranged between 7 and 12 o clock. Magnification ranged between 1.3 × and 3.2 ×; magnifications of 1.3 × and 1.8 × were preferred from incision to separation of parotid from sternocleidomastoid muscle, 1.8 × and 2 × for dissection of the facial nerve trunk, and 2 × and 3.2 × for individual branches of the facial nerve. Focal length ranged between 251 and 410 mm and the diameter of the visualized field ranged between 7 and 14.7 cm. Out of 24 cases of benign lesions, 2 (8.3%) developed facial paresis which resolved in 3 months. Two out of four cases of malignancy developed permanent palsy as nerve branches were sacrificed to achieve tumor clearance. Using a microscope for parotidectomy is advantageous for facial nerve dissection, reducing chances of facial paralysis. The microscope was also found to be useful for teaching. The use of appropriate microscopic parameters avoids the glitch of transition from open to microscopic approach.
PubMed: 36452574
DOI: 10.1007/s12070-020-02106-2 -
Otolaryngologic Clinics of North America Apr 2016Parotidectomy for parotid cancer includes management of primary salivary cancer, metastatic cancer to lymph nodes, and direct extension from surrounding structures or... (Review)
Review
Parotidectomy for parotid cancer includes management of primary salivary cancer, metastatic cancer to lymph nodes, and direct extension from surrounding structures or cutaneous malignancies. Preoperative evaluation should provide surgeons with enough information to plan a sound operation and adequately counsel patients. Facial nerve sacrifice is sometimes required; but in preoperative functioning nerves, function should be preserved. Although nerve involvement predicts poor outcome, survival of around 50% has been reported for primary parotid malignancy. Metastatic cutaneous squamous cell carcinoma is a high-grade aggressive histology whereby local control for palliation with extended parotidectomy can be achieved; however, overall survival remains poor.
Topics: Carcinoma, Squamous Cell; Facial Nerve; Humans; Lymph Nodes; Lymphatic Metastasis; Parotid Gland; Parotid Neoplasms; Skin Neoplasms; Treatment Outcome
PubMed: 26895698
DOI: 10.1016/j.otc.2015.10.007 -
International Archives of... Jan 2019chronic parotitis (CP) is a hindering, recurring inflammatory ailment that eventually leads to the destruction of the parotid gland. When conservative measures and...
chronic parotitis (CP) is a hindering, recurring inflammatory ailment that eventually leads to the destruction of the parotid gland. When conservative measures and sialendoscopy fail, parotidectomy can be indicated. to evaluate the efficacy and safety of parotidectomy as a treatment for CP unresponsive to conservative therapy, and to compare superficial and near-total parotidectomy (SP and NTP). retrospective consecutive case series of patients who underwent parotidectomy for CP between January 1999 and May 2012. The primary outcome variables were recurrence, patient contentment, transient and permanent facial nerve palsy and Frey syndrome. The categorical variables were analyzed using the two-sided Fisher exact test. Alongside, an elaborate review of the current literature was conducted. a total of 46 parotidectomies were performed on 37 patients with CP. Near-total parotidectomy was performed in 41 and SP in 5 cases. Eighty-four percent of patients was available for the telephone questionnaire (31 patients, 40 parotidectomies) with a mean follow-up period of 6,2 years. Treatment was successful in 40/46 parotidectomies (87%) and 95% of the patients were content with the result. The incidence of permanent and transient facial nerve palsy was 0 (0%) and 12 (26.1%), respectively. Frey syndrome manifested in 20 (43.5%) patients. Neither this study nor careful review of the current literature resulted in evident difference between SP and NTP regarding the primary outcome variables. parotidectomy is a safe and effective treatment for CP in case conservative therapy fails. There is no evidence of a distinct difference between SP and NTP regarding efficiency, facial nerve palsy or Frey syndrome.
PubMed: 30647789
DOI: 10.1055/s-0038-1667006