Extracapsular Dissection Research Articles

Completion surgery after extracapsular dissection of low-grade parotid gland malignant tumors.

The aim of the study was to compare the oncological and functional outcome between extracapsular dissection and completion surgery on the one hand and sole extracapsular dissection on the other hand in small low-grade malignant parotid tumors. The records of all patients treated for T1-T2 low-grade malignant tumors of the parotid gland primarily by means of extracapsular dissection between 2006 and 2015 were studied retrospectively. Forty patients with T1-T2 low-grade parotid malignancies were detected. Our study showed outstanding oncological outcomes in both patient groups, the facial nerve function being significantly better after sole extracapsular dissection in the direct postoperative phase, with no differences between the groups in the long term. Our study showed very encouraging preliminary results following primary extracapsular dissection as the sole surgical therapy for carefully selected low-stage, low-grade, inferiorly located lesions in patients with high compliance.

Parotid pleomorphic adenomas: Factors influencing surgical techniques, morbidity, and long-term outcome relative to the new ESGS classification in a retrospective study

PurposeTo assess long-term results after treatment of parotid pleomorphic adenomas (PPAs) with different surgical techniques, standardized according to the European Salivary Gland Society (ESGS) classification system. MethodsWe analyzed ESGS categories, occurrence of facial nerve paresis (FNP), Frey's syndrome, histopathology, and recurrences. Surgical modalities were compared, differentiating techniques with and without facial nerve dissection. A strict protocol ensured a postoperative follow-up-period of more than 7 years. Results205 patients were included. A complete follow-up was possible in 138 patients, 77 of whom underwent extracapsular dissection (ED) and 61 of whom had other surgical modalities (OSMs). ESGS categories correlated with the extent of surgery, significantly with the risk for FNP and Frey's syndrome, but not with recurrences. Recurrences did not differ significantly between ED and OSMs, whereas the risks for FNP (p < 0.001 each) and Frey's syndrome (p = 0.000) were significantly higher after OSMs in comparison with ED. Young women with a stroma-rich (myxoid) tumor subtype appear to have the greatest risk for recurrences. ConclusionED is the treatment of choice for PPAs, if possible, resulting in similar recurrence rates but significantly fewer comorbidities in comparison with more extensive surgery. After the treatment of PPAs, a long-term follow-up is needed, including imaging.

Conservative Surgical Treatment of Benign Parotid Tumors: Extracapsular Dissection

Parotid tumor resection, parotidectomy, is a surgical procedure that requires considerable experience from surgeons in most of the cases because of the risk of facial nerve damage. In addition, it is often times difficult to identify and preserve the facial nerve during the procedure, because it requires removal of a considerable amount of normal parotid tissue even when it is not related to the location of the tumor itself. Post-operative cosmetic problems and complications associated with inevitable removal of the normal parotid gland tissue cannot be ignored. For these reasons, parotidectomy has been evolved over the years to ensure the oncological safety, avoid complications, and improve functional and cosmetic results. Recently, the use and importance of extracapsular dissection (ECD) has become more recognized because it is a more conservative surgical method than partial superficial parotidectomy with preservation of facial nerve function, minimization of functional and cosmetic complications, and limited removal of unnecessary normal parotid gland tissue. Herein, we review the literatures related to ECD for benign parotid tumors and explain the efficacy of this emerging procedure based on the previous study results reported by the authors.

Does increasing the incidence of extracapsular dissection for benign tumors of the parotid correlate with an increased need for revision surgery?

ObjectivesThe aim of this study was to investigate the hypothesis of whether extracapsular dissection (ED) of the parotid gland increases the need for revision surgery for benign tumours in comparison to traditional surgical modalities. A further aim of this study was to evaluate and compare the functional outcome of revision procedures after primary ED with other modalities involving the parotid gland in our department. Materials and methodsAll patients who underwent revision parotid surgery after a primary surgical procedure at a tertiary care hospital (University of Erlangen-Nürnberg) between 2000 and 2016 were included in our study. Data concerning the indication for revision surgery as well as the functional postsurgical outcome were obtained. Results2465 cases formed our study sample. In total, revision surgery was necessary in 30/2465 cases (1.2%). 1532 patients underwent primary ED, with 17 cases requiring revision (1.1%), whereas 933 cases were managed by means of other facial nerve dissecting surgical modalities, with the indication for revision surgery in 13 cases (1.4%). Our analysis did not reveal a statistically significantly higher need for revision surgery or a higher rate of facial nerve palsies after revision surgery in the group of patients after primary ED. ConclusionThe argument in favour of a greater need for revision surgery after primary parenchyma-sparing modalities was not sustained from our data. Due to the low revision rate and the acceptable functional results after revision surgery, we believe that extracapsular dissection is justified in cases where a benign lesion is suspected preoperatively.

Recurrence of pleomorphic adenoma in parotid gland

Background: The pleomorphic adenoma (PA) is the most common salivary gland tumour. The standard of care remains the surgical approach, with superficial parotidectomy and extracapsular dissection as the techniques of choice, with low recurrence rates (2–5%).

Translabyrinthine Approach for Resection of Large Cystic Acoustic Neuroma: Operative Video and Technical Nuances of Subperineural Dissection for Facial Nerve Preservation.

The translabyrinthine approach is advantageous for the resection of large acoustic neuromas compressing the brainstem when hearing loss is nonserviceable. This approach provides wide access through the presigmoid corridor without prolonged cerebellar retraction. Early identification of the facial nerve at the fundus is also achieved. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a large cystic acoustic neuroma via a translabyrinthine approach. The nuances of microsurgical and skull base technique are illustrated including performing extracapsular dissection of the tumor while maintaining a subperineural plane of dissection to preserve the facial nerve. This strategy maximizes the extent of removal while preserving facial nerve function. A microscopic remnant of tumor was left adherent to the perineurium. A near-total resection of the tumor was achieved and the facial nerve stimulated briskly at low thresholds. Other than preexisting hearing loss, the patient was neurologically intact with normal facial nerve function postoperatively. In summary, the translabyrinthine approach and the use of subperineural dissection are important strategies in the armamentarium for surgical management of large acoustic neuromas while preserving facial nerve function. The link to the video can be found at: https://youtu.be/zld2cSP8fb8 .

Extracapsular dissection via sternocleidomastoid muscle-parotid space approach-a new operative technique for treating clinically benign tumor in the parotid tail.

The aim of this study was to introduce extracapsular dissection via the sternocleidomastoid muscle-parotid space approach (ECD-SMPSA) as a modified operative technique for removal of clinically benign tumors from the parotid tail. The study included 52 patients with clinically benign tumors in the parotid tail, and the patients were divided into 2 groups: one group was treated with ECD-SMPSA and the other with extracapsular dissection (ECD). All of the patients were followed up for at least 2 years. The ECD-SMPSA group had lower incidence of subjective Frey syndrome (P = .03) and higher satisfaction with the cosmetic result after the surgery (P = .023) compared with the ECD group. All of the patients were free of salivary fistulae. Facial palsy (P = .234) and earlobe numbness (P = .291) were not significantly different between the groups (P < .05). With careful preoperative assessment, ECD-SMPSA may be a more suitable approach for the treatment of clinically benign tumors in the parotid tail.

Extracapsular dissection versus partial superficial parotidectomy for the treatment of benign parotid tumours

The purpose of this study was to compare the complications of patients treated for a benign parotid tumour (BPT) by extracapsular dissection (ECD) vs. partial superficial parotidectomy (PSP). A comprehensive literature investigation was conducted by searching electronic databases. A systematic review and meta-analysis of comparative studies were performed to assess ECD and PSP for the treatment of BPTs with fixed-effects models. The outcomes analysed were transient or permanent facial nerve injury, Frey syndrome, recurrence rate, infection, and salivary fistula/sialocele. A total of 1641 patients from seven studies (1120 ECD-treated and 521 PSP-treated patients) were included in this meta-analysis. Transient facial nerve injury (odds ratio (OR)=0.28, 95% confidence interval (CI): 0.11–0.71; p=0.008) and Frey syndrome (OR=0.12, 95% CI: 0.03–0.48; p=0.003) were less prevalent in the ECD group. The rates of permanent facial nerve injury (OR=0.77, 95% CI: 0.35–1.70; p=0.520), recurrence rate (OR=0.17, 95% CI: 0.02–1.75; p=0.14), infection (OR=0.70, 95% CI: 0.07–6.67; p=0.76), and salivary fistula/sialocele (OR=0.40, 95% CI: 0.06–2.66; p=0.350) were similar in both groups. Although there was a trend that ECD showed a reduced risk for complications, the present results are not sufficient to conclude that ECD is more beneficial than PSP.

Going beyond extracapsular dissection in cystadenolymphomas of the parotid gland

BackgroundThe aim of this study was to evaluate the potential for reducing surgical invasiveness in parotid cystadenolymphomas by means of capsular dissection based on the experience made in our department and on various aspects of these lesions gained from the relevant literature. MethodsAll patients treated for cystadenolymphomas with extracapsular or capsular dissection at a tertiary referral center between 2000 and 2017 were examined retrospectively. A literature review of various aspects and of different treatment strategies for this lesion was also performed. Results629 patients were included in the study. 499 had solitary tumors (79.3%) and 130 had unilateral multicentric lesions (20.7%). 595 patients were managed by means of ED, while 34 patients underwent a CD. Our analysis detected an overall occurrence rate of ipsilateral metachronous tumors of 2.06% (13/629), all after extracapsular dissection, with a mean follow-up of 104.1 months. No statistical difference could be found between ED and CD in the overall occurrence rate of ipsilateral metachronous tumors or in the complication rate. No cases of a malignancy arising from a preexisting Warthin tumor could be detected in our study sample. ConclusionA clear potential for reducing surgical invasiveness could be shown. A reliable imaging diagnosis, appropriate patient counseling and high compliance with close follow-up are the basic prerequisites for an acceptable outcome.

Fibrous Pituitary Macroadenomas: Predictive Role of Preoperative Radiologic Investigations for Proper Surgical Planning in a Cohort of 66 Patients

The endoscopic technique is in many cases the technique of choice for the removal of pituitary adenomas. Extended endoscopic approaches make it possible to remove lesions with suprasellar and parasellar extension and fibrous consistency. We identify some characteristics that might point to the adoption of an expanded approach in the preoperative phase. We considered 66 consecutive cases treated for pituitary macroadenomas. All patients underwent preoperative magnetic resonance imaging and computed tomography, as well as postoperative magnetic resonance imaging. From the analysis of surgical reports and preoperative radiologic investigations, we extracted data related to size, extension, morphologic characteristics, consistency, and type of approach used (sellar or expanded). The degree of removal was judged to be total, near total, subtotal, or partial. The data showed that in some cases it is possible to assume in advance that there is a need for an expanded endoscopic approach. The features that led to an extended approach for extracapsular dissection of the lesion were the size of the tumor; an hourglass/dumbbell shape; lateral extension to the suprasellar carotid artery; Knosp degree 3 or 4; contrast enhancement heterogeneity; intratumoral hemorrhage, erosion, or discontinuity of the sellar floor; and increased sellar depth, which predicts increased thickness. The ability to predict the consistency of pituitary adenomas allows the surgeon to design a surgical procedure tailored to the patient. This approach has advantages concerning the extent of resection and allows a radical strategy with a single surgical procedure to be pursued.

Comparison of surgical techniques for benign parotid tumours: a multicentre retrospective study

This study aimed to compare the outcomes of three surgical techniques for the treatment of patients with benign parotid tumours: superficial parotidectomy (SP; group 1), partial superficial parotidectomy (PSP; group 2), and ultrasonic scalpel-assisted minimal extracapsular dissection (US-MECD; group 3). Groups 1 and 2 received the conventional surgical technique, while group 3 underwent surgery with an ultrasonic scalpel. A total of 281 patients treated during 2012–2016 were included: 98 in group 1, 91 in group 2, and 92 in group 3. The mean surgical time and blood loss during surgery, as well as drainage time and amount, were significantly lower for US-MECD (P<0.01). The great auricular nerve and parotid fascia were both preserved with US-MECD (P<0.01), while the rate of capsule rupture with US-MECD was slightly higher than in the other groups (P>0.05). There was less transient facial nerve paralysis and Frey syndrome with US-MECD (P<0.01). No significant difference in wound infection, sialocele, or permanent facial nerve paralysis was observed among the three groups. Patients enrolled during 2012–2013 were selected to evaluate the recurrence rates, and no statistically significant differences were found among the groups. In conclusion, US-MECD showed similar effectiveness and fewer side effects than SP and PSP. The long-term effects of the new technique require further study.

The bacterial community and local lymphocyte response are markedly different in patients with recurrent tonsillitis compared to obstructive sleep apnoea

IntroductionObstructive sleep apnea (OSA) is now a more common indication for tonsillectomy than recurrent tonsillitis (RT) [1,2]. Few studies have addressed possible differences in pathogenesis between these two conditions. Children with RT and OSA are often being treated in the community with multiple courses of antibiotics before surgery. Current understanding of the role of bacteria in disorders of the tonsils is mainly based on the culture of tonsil swabs. Swab cultures reflect only a very small fraction of the bacteria present on the mucosal surface and may not represent the bacterial communities within the tonsil crypts [3,4]. This study aimed to evaluate the local lymphocyte response and associations with bacterial community composition using molecular techniques of the tonsils removed from children for RT or OSA. MethodThe palatine tonsils were removed by extracapsular dissection from 24 patients with age range one to ten years, 14 of whom had RT and 10 had OSA. The fixed tonsil tissues were evaluated for bacteria by Gram-staining and presence of connective tissue by safranin staining. B lymphocytes and T lymphocytes were also measured immunohistochemically. Finally, previously published bacterial community data for this cohort were reassessed for associations with RT and OSA, and with the observed lymphocyte patterns. ResultsIn tonsils from patients with RT, large micro-colonies of bacteria were observed in the tonsil crypts, and a large number of B and T lymphocytes were noted immediately adjacent to the tonsil crypt itself. In marked contrast, the tonsils from patients with OSA had no bacteria identified, and no significant skewing of lymphocytes based on site (such as follicles or crypts). We observed that the majority of lymphocytes surrounding the bacterial micro-colonies were B lymphocytes with a mean ratio of 109:55 (B lymphocytes: T lymphocytes). Bacterial community diversity was not different between the two cohorts; however, there were significant differences in bacterial community composition. Children with RT had a higher relative abundance of members from the genera Parvimonas, Prevotella, and Treponema. While children with OSA had a higher relative abundance of Haemophilus, and Capnocytophaga. ConclusionThese results demonstrate significant differences in the local lymphocyte response and bacterial community composition in tonsil tissue between RT and OSA patients. It suggests that the response to antibiotics used in the treatment of these two conditions may be different. Furthermore, the presence of lymphocytes in RT within the tonsil crypt outside the tonsil epithelium is a unique observation of the location of these cells.

Extracapsular dissection and limited parotidectomy

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.

Investigation of the surgical strategies for unilateral multifocal cystadenolymphomas of the parotid gland

ObjectivesThe aim of the study was to compare multifocal extracapsular dissection with complete parotidectomy in the treatment of unilateral multifocal cystadenolymphomas of the parotid gland. Materials and methodsThe records from all patients treated for unilateral multifocal cystadenolymphomas of the parotid gland at a tertiary referral center between 2000 and 2016 were retrospectively analyzed. Results203 patients were included in the study. 96 patients were managed by multifocal extracapsular dissection, 107 patients underwent complete parotidectomy. Metachronous tumors were detected in 7 cases (3.4%) with a significant difference in the occurrence rate between multifocal extracapsular dissection (7/96, 7.3%) and complete parotidectomy (0/107, 0%) (p = 0.004). Permanent facial palsy was significantly more common after complete parotidectomy (21/107, 19.6%) than multifocal extracapsular dissection (2/96, 2.1%) (p = 0.000). ConclusionsThe functional benefit of multifocal extracapsular dissection was counterbalanced by the advantage of complete parotidectomy, in terms of recurrences. Extracapsular dissection is at its limit in cases of multifocal cystadenolymphomas and the indication for it should be thoroughly verified in each and every case.

Preservation of Salivary Function Following Extracapsular Dissection for Tumors of the Parotid Gland

This study evaluated salivary function after extracapsular dissection (ECD) compared with partial superficial parotidectomy (PSP) and classic superficial parotidectomy (CSP) of benign parotid gland tumors. The authors hypothesized that ECD would be superior to PSP and CSP in preserving postoperative salivary function. Retrospective analyses were performed for 43 consecutive patients who underwent parotidectomies of benign parotid tumors performed by a single experienced surgeon. Clinical data and pre- and postoperative whole salivary flow rates were compared among the operative procedures. Pearson χ2 and Fisher exact tests were used to compare categorical variables. Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests were used to compare means. A P value less than .05 was considered significant throughout the study. Tumor sizes did not differ among groups. Operative times, amounts of drainage, and hospital days for ECD were markedly decreased compared with CSP and tended to be decreased compared with PSP. Resection margins were exposed in 0, 12.5, and 6.7% of patients who underwent ECD, PSP, and CSP, respectively. Postoperative complications occurred less often (but not meaningfully) after ECD. Postoperative basal salivary flow rates in the ECD, PSP, and CSP groups were 0.39, 0.32, and 0.14mL/minute, respectively (P=.05). Stimulated salivary flow rates remained stable for the ECD and PSP groups but decreased in the CSP group. ECD is a safe and time-efficient surgical approach, offering early recovery from parotid tumors and better preservation of salivary function. ECD should be considered a surgical approach for parotid tumors, especially those in the parotid tail region, such as Warthin tumors.

Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma with Fascia Lata Button and Nasoseptal Flap Reconstruction.

Surgery for craniopharyngiomas can be challenging due to the involvement of multiple critical neurovascular structures. The expanded endoscopic endonasal approach can provide superior access to suprasellar craniopharyngiomas, particularly with retrochiasmatic extension and significant hypothalamic involvement. We describe the surgical technique used to treat a 30-year-old patient who presented with 4 weeks of worsening vision, fatigue, and memory loss. His vision was counting fingers at 1 feet on the right and 20/800 on the left with a temporal hemianopsia. Laboratory evaluation demonstrated central hypoadrenalism, hypothyroidism, and hypogonadism. Imaging showed a large solid and cystic suprasellar mass. The transtubercular approach with removal of the lateral tubercular strut can provide wide bilateral access to the opticocarotid region. The superior intercavernous sinus must be coagulated and ligated. Initial arachnoid dissection is centered at the midline, mobilizing the superior hypophyseal branches to the optic apparatus laterally. The cyst capsule is opened and care is taken to minimize spillage of cyst fluid into the subarachnoid space. Central debulking and then extracapsular dissection is performed under direct visualization using sharp dissection. Reconstruction of the dura is performed with an inlay/onlay fascia lata button that is held together with four sutures that hold the graft edges against the native dural edges. This is followed by vascularized nasoseptal flap reconstruction. No lumbar drain or nonabsorbable packing is required. The patient's vision had dramatic improvement and by 1 week postoperatively was 20/20 with full visual fields. Postoperative diabetes insipidus was managed with nasal desmopressin. Postoperative MRI demonstrated complete removal. The link to the video can be found at: https://youtu.be/QQxCNUcq1qg .

The extent of surgery for benign parotid pathology and its influence on complications: A prospective cohort analysis

BackgroundThe surgical management of benign parotid tumors is aimed at complete extirpation of the mass with preservation of facial nerve function. There is a relative paucity of literature pertaining to complications after benign parotid surgery and related risk factors. We aim to critically review the outcomes following treatment of benign parotid pathology when surgery entailed either complete superficial parotidectomy (CSP), partial superficial parotidectomy (PSP) or extracapsular dissection (ECD). Material and methodsThis is a review of prospectively collected data of all parotidectomies performed between June 2006 to June 2016 for histologically-proven benign pathology of the parotid. Median follow-up time was 31.6weeks. ResultsA total of 101 parotidectomies were carried out on 97 patients (40 CSP, 56 PSP and 5 ECD). Pleomorphic adenoma (48.4%) and Warthin's tumors (32.7%) were the most common pathologies. Temporary facial weakness occurred after 7 operations (6.9%). Facial weakness was permanent in 4 cases (3.9%). The rates of sialocele and salivary fistula were 4.9% and 0.9%, respectively. Only one patient (0.9%) developed Frey Syndrome postoperatively. No significant associations between extent of parotid surgery and postoperative facial nerve dysfunction (p=0.674) or wound complications (p=0.433) were observed. Univariate analyses for potential contributing factors such as advanced age, smoking status, tumor location or histology did not demonstrate any increased risk with developing postoperative complications. ConclusionPartial superficial parotidectomy was associated with low rates of morbidity to the facial nerve and surgical wound. The results were comparable to complete superficial parotidectomy. We recommend offering patient partial superficial parotidectomy where appropriate and this is in line with the current trend of minimising surgical dissection, thereby potentially decreasing the risk of short-term and long-term complications.

Extra-pseudocapsule dissection technique in endoscopic endonasal transsphenoidal surgery for pituitary adenomas

Objective To investigate the significance of the concept of the pseudocapsule-based extra-capsular dissection technique in endoscopic transsphenoidal surgery for pituitary adenomas. Methods We performed a retrospective analysis on clinical data of 287 patients with pituitary adenomas who underwent endoscopic endonasal transsphenoidal surgeries at Neurosurgery Department of Zhongshan Hospital, Fudan University from October 2011 to December 2015. Patients were divided into two groups: pseudocapsule-based extra-capsular dissection group (157 cases) and intra-capsular resection group (130 cases). We compared their surgical and endocrinological outcomes and complications. Results The total resection rate in pseudocapsule-based extra-capsular dissection group was 89.8% (141/157) while that in intra-capsular resection group was 81.5% (106/130) (P=0.044). Furthermore, the recurrence rates in the extra-capsular and intra-capsular resection groups were 1.9% (3/157) and 6.9% (9/130), respectively (P= 0.035). Besides, with the application of extra-capsular dissection technique, the remission rate of functional adenoma in terms of biochemical parameters increased [56.5% (26/46) vs. 86.2% (50/58), P=0.001]. In addition, there was no difference in the rate of hypopituitarism, CSF leakage, intracranial infection or temporary polyuria (P>0.05). Conclusions The application of pseudocapsule-based dissection technique in endoscopic transsphenoidal surgery for pituitary adenomas could lead to a high rate of gross total tumor resection and endocrinological remission. Extra-pseudocapsular resection does not seem to cause additional postoperative complications. Key words: Pituitary neoplasms; Neuroendoscopy; Extra-pseudocapsule dissection technique; Endonasal transsphenoidal approach

Assessment of the extracapsular dissection of the benign parotid tumors, extending the literature

ObjectiveTo remove a superficial benign tumor of the parotid, the surgeon has two options; superficial parotidectomy, with well-known morbidity and practiced for decades, and extracapsular dissection with less surgical evidence. The aim of the study was to evaluate the extracapsular dissection technique and extending the present literature. MethodsSixteen cases were selected according to certain criteria and monitored for complications. ResultsOne complication encountered with no long-term morbidity. ConclusionsExtracapsular dissection is a safe, reliable and recommended technique to manage the small benign superficial parotid tumors if the case is selected properly.

Extracapsular Dissection vs Superficial Parotidectomy of Benign Parotid Lesions

The clinical implications of extracapsular dissection over superficial parotidectomy are controversial and limited in data on cost-effectiveness. To compare extracapsular dissection with superficial parotidectomy for benign parotid tumors with respect to surgical outcomes and cost-effectiveness. This was a retrospective medical record review and cost-effectiveness analysis performed from August 2012 to November 2015 at a tertiary care institution. Adult patients (age ≥18 years) who underwent parotidectomy for benign parotid lesions were included. Treatment by extracapsular dissection or superficial parotidectomy. Differences in postoperative complication rates and health services outcomes, including procedure time, anesthesia time, length of stay, and charges for surgeon, anesthesia, operating room, and hospital. A total of 46 parotidectomies consisting of 26 extracapsular dissections and 20 superficial parotidectomies met criteria. Of the 46 patients, 33 were women. Patient ages ranged from 18 to 83 years. Lesion features were similar between groups with most being pleomorphic adenoma. Procedure time (effect size, -1.31; 95% CI, -1.93 to -0.65), anesthesia time (effect size, -1.37; 95% CI, -1.99 to -0.70), and length of stay (effect size, -0.66; 95% CI, -1.25 to -0.05) were significantly shorter for extracapsular dissection compared with superficial parotidectomy. Moreover, anesthesia (effect size, -1.55; 95% CI, -2.19 to -0.86), operating room (effect size, -1.09; 95% CI, -1.69 to -0.45), and total hospital charges (effect size, -1.13; 95% CI, -1.74 to -0.49) were significantly less for extracapsular dissection while remaining charges, including surgeon, showed no difference. Finally, facial nerve weakness, great auricular nerve dysesthesia, and other relevant postoperative complications were comparable between groups. In the hands of an experienced surgeon, extracapsular dissection is a shorter, less costly, and equally safe alternative to traditional superficial parotidectomy when treating benign parotid lesions. Further follow-up is needed to ensure these perceived advantages are maintained over time.