Abstract
We investigated whether a fibrinogen-thrombin collagen sponge patch reduces postoperative complications of parotid gland surgery. This single-blinded, randomized controlled study included 165 patients who underwent parotid surgery for benign tumors (2018–2019) at a tertiary center. Primary outcomes were postoperative drain amount, days until drain removal, and discharge. Patients were scheduled for follow-up at 1 and 4 weeks, and 3 months after surgery. Complications including surgical site infection, pain, seroma, sialocele, salivary fistula, facial nerve palsy, Frey’s syndrome with subjective symptoms, and facial asymmetry were analyzed. After identifying confounding variables, multivariate approaches were used. Histologic analysis was performed in a mouse model of salivary gland surgery. In total, 162 patients (77, fibrinogen-thrombin collagen patch group; 85, controls) were included, with no significant between-group differences other than resected tissue. Among postoperative total drain amount and days until drain removal and discharge, the only postoperative total drain was significantly lower in the patch group than in the control group in the adjusted model. Additionally, although validation through robust trials with longer follow-up is needed, we found the potential benefit of the fibrinogen patch on Frey’s syndrome and facial asymmetry. In conclusion, fibrinogen-thrombin-impregnated collagen patches in parotidectomy can reduce postoperative drainage and improve outcomes.
Highlights
IntroductionSurgery for major salivary gland tumors, including parotidectomy, is routinely performed by head and neck surgeons [1]
Among 165 patients, one was excluded from the study because of having Sjogren’s syndrome and two patients did not consent to participate in the study; a total of 162 patients were enrolled with informed consent and randomly assigned to the fibrinogenthrombin-impregnated collagen patch (n = 77) and control groups (n = 85); three and two patients were lost during follow-up in each group, respectively
We further evaluated the effect of the patch on the facial asymmetry using 3D photogrammetry
Summary
Surgery for major salivary gland tumors, including parotidectomy, is routinely performed by head and neck surgeons [1]. Postoperative complications, such as facial palsy, wound complications, and facial asymmetry, due to tissue removal can be challenging. Facial palsy has been significantly reduced through procedural standardization and developments in surgical instrumentation [2,3,4]. To decrease serious facial nerve complications or facial contour asymmetry, adequate or superficial parotidectomy is preferred over total parotidectomy, when possible [4]
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