-
European Archives of... Oct 2021To establish if day case superficial parotidectomy is feasible, safe and does not result in excess readmissions.
PURPOSE
To establish if day case superficial parotidectomy is feasible, safe and does not result in excess readmissions.
METHOD
A retrospective review was carried out of all patients listed for superficial parotidectomy with day case intent by a single surgeon between January 2016 and December 2019 inclusively. The reasons for failure of same day discharge were established. Postoperative complications and readmissions were recorded. Our approach for a superficial parotidectomy typically includes the use of a 10Fr suction drain which is removed at 4 h postoperatively if the output is less than 30 ml.
RESULTS
Ninety-one consecutive superficial parotidectomies listed for day case surgery were eligible for inclusion. Seventeen patients failed to be discharged on the same day and were admitted giving a day case success rate of 81%. Most of these (n = 9) occurred in the first year of adopting day case surgery. The most common reason to admit patients was a late finish (n = 8, 47%). Six patients (25%) were admitted due to anaesthetic complications. One patient had a surgical complication requiring admission.
CONCLUSION
Our series demonstrates that day case superficial parotidectomy using a surgical drain is feasible, safe and does not result in an unacceptable readmission rate. In our experience, surgical complications are an uncommon cause for day case failure. The most common cause for day case failure was a late finish. Postoperative complications including bleeding, seroma/salivary collection and facial nerve palsy were in keeping with or better than those quoted in the literature.
Topics: Ambulatory Surgical Procedures; Facial Paralysis; Humans; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Seroma
PubMed: 33555439
DOI: 10.1007/s00405-021-06642-7 -
Plastic and Reconstructive Surgery.... Jun 2019The authors seek to highlight some of the ongoing challenges related to complex oncologic reconstruction and the current solutions to these problems.
OBJECTIVES
The authors seek to highlight some of the ongoing challenges related to complex oncologic reconstruction and the current solutions to these problems.
SUMMARY
The standard of care in reconstruction following oncologic resection is continually evolving. Current frontiers in breast reconstruction include addressing animation deformity through prepectoral reconstruction, offering autologous reconstruction to patients with limited donor sites, and improving postoperative sensation with innervation of free tissue transfer. Facial nerve reconstruction and contour defects pose an ongoing challenge in patients undergoing parotidectomy requiring complex nerve transfers and autologous reconstruction. Lymphedema is not a monolithic disease, and as our understanding of the pathophysiology improves, our surgical algorithms continue to evolve.
PubMed: 31624664
DOI: 10.1097/GOX.0000000000002181 -
Medical Archives (Sarajevo, Bosnia and... Jun 2022While salivary gland tumors constitute 5-6% of all head and neck tumors, they constitute 2-3% of all trunk tumors. About 3.8 per 100,000 of parotid tumors are diagnosed...
BACKGROUND
While salivary gland tumors constitute 5-6% of all head and neck tumors, they constitute 2-3% of all trunk tumors. About 3.8 per 100,000 of parotid tumors are diagnosed in the US each year, about 1300 to 1600 cases. The salivary gland cancer rate is 0.9 per 10000. The frequency of salivary gland tumors varies according to localization.
OBJECTIVE
In our study, we aimed to evaluate retrospectively the histopathological results, incidence, surgical treatment modalities and complications of parotid tumors operated in our clinic.
METHODS
We examined the patients who were operated for parotid gland tumor. The files of 136 patients who were admitted to the Otorhinolaryngology department of Dicle University Medical Faculty Hospital between January 2010 and April 2020 due to a parotid mass and underwent parotidectomy and whose pathology results were reported as benign or malignant parotid tumors were retrospectively scanned and included in the study. Patients' age, gender, FNAB cytology result, type of surgery, histopathological results after surgery and complications after surgical treatment were recorded.
RESULTS
A total of 136 patients, 73 (53.7%) male and 63 (46.3%) female, were included in the study. The mean age of the patients was 48.26±17.37 (min=14, max=83) years. Superficial parotidectomy was performed in 108 (79.4%) patients and total parotidectomy was performed in 28 (20.6%) patients. According to the histopathological results after surgery, 108 (79.4%) benign tumors and 28 (20.6%) malignant tumors were diagnosed. Accordingly, pleomorphic adenoma (47.8%) was the second most common with 65 patients, followed by Whartin tumor (25.7%) with 35 patients. The sensitivity (sensitivity) of FNAB was 85.2%, and the specificity (specificity) was 96.2%. The accuracy of FNAB was found to be 94.0%.
CONCLUSION
Good identification of the parotid mass preoperatively, together with both FNAB and radiological imaging methods, gains much more value in differentiating malignant and benign pathologies. While superficial parotidectomy is mostly sufficient in benign tumors, total parotidectomy-radical parotidectomy in malignant tumors and neck dissection should be considered in high-grade tumors even if there is no neck metastasis. Patients should be evaluated for RT and CT according to the tumor type after surgery.
Topics: Adenoma, Pleomorphic; Aged, 80 and over; Female; Humans; Male; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Salivary Gland Neoplasms
PubMed: 36200113
DOI: 10.5455/medarh.2022.76.170-174 -
International Journal of Clinical and... 2017Parotid metastases (PMs) that originate from thyroid carcinomas (TCs) are extremely rare, and many questions about their diagnosis and management remain unanswered. Of...
Parotid metastases (PMs) that originate from thyroid carcinomas (TCs) are extremely rare, and many questions about their diagnosis and management remain unanswered. Of the 15,780 patients with TC that we had prospectively recorded in our institutional databases between 1996 and 2015, we retrospectively retrieved only three patients (0.019%) with PM. Patient characteristics, histological findings on initial thyroidectomy and parotidectomy specimens, treatments, and times of recurrence and death were reviewed. In addition, we searched PubMed, Embase, and ISI Web of Science databases (1996-2015) for articles published in the English language using the key words "parotid" and "thyroid", and reviewed almost all reports that described PM that were derived from TC. These rare cases of thyroid carcinoma presenting as metastasis in the parotid gland highlight the importance of maintaining close communication between clinicians, radiologists, and histopathologists to ensure that such rare cases are not missed.
PubMed: 31966384
DOI: No ID Found -
The Annals of Otology, Rhinology, and... Oct 2021Frey's syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been...
BACKGROUND
Frey's syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, and prevent Frey's syndrome. Free dermal-fat-fascial graft (DFFG) is one such technique; however, its use is largely undocumented in the literature. In this case series, we investigate the efficacy of free DFFG in reconstructing parotidectomy defects at 2 tertiary care centers.
MATERIALS AND METHODS
Medical records of 54 patients who underwent primary parotidectomy and immediate reconstruction with autologous abdominal free DFFG by 2 surgeons in George Washington University Hospital and McGill University Health Centre between 2007 and 2019 were collected prospectively. Patients responded to 2 questionnaires addressing postoperative outcomes.
RESULTS
Fifty-four patients were included; 32 superficial parotidectomies and 22 total parotidectomies were performed for 39 benign and 15 malignant tumors. Thirty-seven patients could be reached. Out of 37 patients who responded to the first questionnaire, 59% (22) reported complete facial symmetry, 27% (10) reported mild hollowness, and 14% (5) reported mild fullness. None declared noticeable hollowness or fullness. While 81% (30) did not experience Frey's syndrome, 5.4% (2) experienced mild symptoms without disability, and 13.5% (5) experienced debilitating symptoms. Out of 37 patients, 8 patients responded to a second questionnaire addressing the outcome of the abdominal graft donor site. In regard to the donor site, 87.5% (7) were satisfied or very satisfied from its cosmetic appearance, 75% (6) were not bothered by its cosmetic appearance, and 87.5% (7) had no discomfort at the graft donor site. Patients did not report any other symptom at the graft donor site.
CONCLUSION
In this large series of total parotidectomies including malignant pathologies, autologous abdominal free DFFG effectively prevented Frey's syndrome and preserved facial cosmesis in most patients.
Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Prospective Studies; Skin Transplantation; Surgical Flaps; Transplantation, Autologous; Young Adult
PubMed: 33657862
DOI: 10.1177/0003489421999542 -
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 Surgeon : Journal of the Royal... Aug 2022Sialocele and salivary fistula are recognised complications of parotid surgery and have been reported to be more common with less extensive parotidectomy. We...
PURPOSE
Sialocele and salivary fistula are recognised complications of parotid surgery and have been reported to be more common with less extensive parotidectomy. We investigated the efficacy of tissue sealant(Cunniffe et al., 2019) as an alternative to surgical drainage in terms of length of hospital stay (LOS), cost, and incidence of wound complications.
METHODS
The study comprised a retrospective review of a prospectively maintained parotidectomy database at a single tertiary Head and Neck referral centre between 2009 and 2020. Cases undergoing concomitant neck dissection or major skin resection were excluded. Patients were divided into Group 1 (without tissue sealant), and Group 2 (with tissue sealant). Patients were also divided based on extent of surgery 1) Extracapsular dissection/Partial superficial parotidectomy 2) Superficial/total parotidectomy.
RESULTS
Of 202 included patients, there were 146 in Group 1 (143 with drain), and 56 in Group 2 (7 with drain). Compared to Group 1, Group 2 had a significantly shorter LOS (mean 1.4 ± 0.98 versus 3.1 ± 1.29 days, p < 0.05) and estimated cost (€1386 versus €2736). There was no significant difference in the complication rates (15.8% Group 1 versus 10.7% Group 2, p = 0.50). Group 1 showed a higher incidence of complications in patients undergoing less extensive parotidectomy (19/70 versus 4/76, p = 0.02), whereas in Group 2, the difference was not significant (5/30 versus 1/26, p = 0.20).
CONCLUSION
The use of tissue sealant as an alternative to surgical drains after parotidectomy facilitates reduced LOS and cost savings without increase in morbidity.
Topics: Drainage; Humans; Length of Stay; Parotid Gland; Postoperative Complications; Retrospective Studies
PubMed: 34103269
DOI: 10.1016/j.surge.2021.05.001 -
Ear, Nose, & Throat Journal Dec 2022First bite syndrome (FBS) is a rare but potentially debilitating complication observed after surgery involving the upper cervical region. Patients classically complain... (Review)
Review
INTRODUCTION
First bite syndrome (FBS) is a rare but potentially debilitating complication observed after surgery involving the upper cervical region. Patients classically complain of severe facial pain in the ipsilateral parotid region with the first few bites of a meal.
OBJECTIVE
The aim of this study is to shed light on the incidence and potential risk factors of FBS, including a series of cases depicting FBS observed after parotidectomy.
METHODS
Retrospective review of 419 patients who underwent parotidectomy at a single tertiary care facility between December 2016 and June 2020.
RESULTS
With a mean follow-up time of 16.5 months, 8 (2%) patients were documented to have symptoms of FBS after parotid gland surgery. Six of these patients underwent partial parotidectomy by dissection of the deep lobe of the parotid (DLP).
CONCLUSION
Patients undergoing dissection of the DLP are particularly at risk for the development of FBS. All patients should be appropriately counseled during informed consent discussions, especially in high-risk cases.
Topics: Humans; Mastication; Parotid Gland; Parotid Region; Syndrome; Retrospective Studies; Facial Pain; Parotid Neoplasms; Postoperative Complications
PubMed: 33314982
DOI: 10.1177/0145561320980179 -
Cureus Feb 2023The sternocleidomastoid (SCM) flap has been used for a long time in protective coverage of major vessels, reconstruction of intraoral pharyngeal, closure of... (Review)
Review
The sternocleidomastoid (SCM) flap has been used for a long time in protective coverage of major vessels, reconstruction of intraoral pharyngeal, closure of pharyngo-cutaneous fistulas, and augmentation of soft tissue defects in the oral and maxillofacial region. However, this flap is not yet commonly used due to doubtful blood supply to the flap. This flap offers favorable esthetic results, combined flap, rich vascularization, and the possibility of shifting the two heads of the muscle. Thus, this flap has been used broadly in the maxillofacial region to reconstruct the defects of the post-parotidectomy, mandible, pharynx, and floor of the mouth defects. Previous studies discussed the use of a SCM flap following parotidectomy. However, few studies explained the use of SCMs in facial reconstruction. This study aims to review published articles discussing the use of SCMs for facial reconstruction.
PubMed: 36883082
DOI: 10.7759/cureus.34575 -
Molecular Medicine Reports Apr 2012Although Frey syndrome is not life-threatening, it is identified as the most serious and widely recognized sequela of parotidectomy and has significant potential... (Meta-Analysis)
Meta-Analysis Review
Although Frey syndrome is not life-threatening, it is identified as the most serious and widely recognized sequela of parotidectomy and has significant potential negative social and psychological implications. Several studies have investigated whether AlloDerm® implants prevent Frey syndrome effectively and safely, however, the conclusions are inconsistent. We aimed to evaluate the precise effectiveness of AlloDerm implants for preventing Frey syndrome after parotidectomy, using a systematic review and meta-analysis. We searched randomized and quis-randomized controlled trials in which AlloDerm implants were compared to blank controls for preventing Frey syndrome after parotidectomy, from the PubMed, Embase, the Cochrane Library and the ISI Web of Knowledge databases, without any language restriction. Two reviewers independently searched, identified, extracted data and assessed methodological quality. Relative risks with 95% confidence intervals were calculated and pooled. Five articles involving 409 patients met the inclusion criteria. Meta-analyses showed a significant 85% relative risk reduction in objective incidence (RR=0.15, 95% CI 0.08-0.30; P<0.00001) and 68% in subjective incidence (RR=0.32, 95% CI 0.19-0.57; P<0.00001) of Frey syndrome with AlloDerm implants; there was a significant 91% relative risk reduction in salivary fistula (RR=0.09, 95% CI 0.01-0.66; P=0.02); there was no statistical significance for the incidence of facial nerve paralysis (RR=0.96, 95% CI 0.84-1.09; P=0.51); there was no statistical significance for the incidence of seroma/sialocele (RR=1.36, 95% CI 0.66-2.80; P=0.40); there was a trend for a small effect in improving facial contour. Adverse events related to AlloDerm implants were not found. There is evidence that AlloDerm reduces the incidence of Frey syndrome effectively and safely, and also has the potential to improve facial contour and decrease salivary fistula. However, it is unclear whether AlloDerm implants improve facial contour and decrease other complications. Thus, further controlled evaluative studies incorporating more precise measures are required.
Topics: Collagen; Humans; Parotid Gland; Prostheses and Implants; Sweating, Gustatory
PubMed: 22266670
DOI: 10.3892/mmr.2012.762