Extracapsular dissection and limited parotidectomy

Abstract

Parotid surgery has evolved over the last century. Many of the long-held principles have been questioned and consequently modified. The basic tenets of parotid surgery for benign disease have been identifying and preserving the facial nerve and complete excision of the tumor with an adequate cuff of normal tissue. This can be safely accomplished by extracapsular dissection or limited and/or partial parotidectomy. Extracapsular dissection implies no attempt at finding the facial nerve, while limited or partial parotidectomy includes finding one (or more) branch of the facial nerve and then dissecting that branch in a retrograde fashion. Indications for extracapsular dissection or limited parotidectomy are similar to superficial parotidectomy. There is some evidence that this technique can be used safely without compromising oncological principles with low-grade cancers. Extracapsular dissection or limited parotidectomy should not be performed for large tumors, anatomically difficult to reach tumors, and high-grade cancers. When compared to superficial parotidectomy, extracapsular dissection had similar recurrence rates. Extracapsular dissection had lower transient and permanent facial paralysis rates. Frey syndrome was also reported less frequently following extracapsular dissection. Sialoceles may be more frequent postoperatively but are easily treated and rarely last longer than 3 weeks. Parotid surgery has evolved over the last century. Many of the long-held principles have been questioned and consequently modified. The basic tenets of parotid surgery for benign disease have been identifying and preserving the facial nerve and complete excision of the tumor with an adequate cuff of normal tissue. This can be safely accomplished by extracapsular dissection or limited and/or partial parotidectomy. Extracapsular dissection implies no attempt at finding the facial nerve, while limited or partial parotidectomy includes finding one (or more) branch of the facial nerve and then dissecting that branch in a retrograde fashion. Indications for extracapsular dissection or limited parotidectomy are similar to superficial parotidectomy. There is some evidence that this technique can be used safely without compromising oncological principles with low-grade cancers. Extracapsular dissection or limited parotidectomy should not be performed for large tumors, anatomically difficult to reach tumors, and high-grade cancers. When compared to superficial parotidectomy, extracapsular dissection had similar recurrence rates. Extracapsular dissection had lower transient and permanent facial paralysis rates. Frey syndrome was also reported less frequently following extracapsular dissection. Sialoceles may be more frequent postoperatively but are easily treated and rarely last longer than 3 weeks.