Parotid Tumor Surgery Research Articles

Research progress in accessory parotid gland tumor surgery

In salivary gland disease, accessory parotid gland (APG) lesions are relatively low, and tumor is the most common manifestation. Currently, surgery is the primary treatment method for APG tumors. Although numerous surgical procedures are available, there is no standard protocol. Due to the location of the APG in the midcheek area, the complications and aesthetic concerns connected with conventional surgery for treating APG tumors sometimes cause significant distress to patients. With the progress of medical technology as well as improving patients' aesthetic and functional requirements, surgical excision methods and incision design are constantly improving. More beautiful and minimally invasive treatments, such as concealed transoral approach and endoscopically aided extracapsular dissection of APG, have been gradually developed. This review focuses on surgical techniques, benefits, and drawbacks of APG tumor surgery that have been carried out and provides an outlook based on the preliminary application of endoscopically assisted accessory parotid tumor resection.

Quality of Life Outcomes for Parotid Malignancies.

This study describes patient-reported outcome measures (PROMs) and associated factors in patients who underwent surgery for malignant parotid tumors (MPT). This is a retrospective study of all surgically treated MPT patients in a multidisciplinary head and neck cancer (HNC) survivorship clinic (2017-2023). PROMs included University of Washington Quality of Life Questionnaire (UW-QOL), Eating Assessment Tool (EAT-10), Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Neck Disability Index (NDI), and Insomnia Severity Index. Multivariable regression analysis was used to investigate clinical predictors associated with PROMs. In 62 MPT patients, the prevalence of clinically relevant dysphagia symptoms (EAT-10), elevated symptoms of depression (PHQ-8), moderate/severe symptoms of anxiety (GAD-7), moderate/severe neck pain with activities of daily living (NDI), and moderate/severe symptoms of insomnia at last follow-up was 32.3%, 15.5%, 7.1%, 17.7%, and 7.2%, respectively. Nonparametric one-sided test revealed that patients treated with adjuvant CRT had significantly worse physical QOL, social-emotional QOL, and swallowing scores than patients treated with surgery alone (p = 0.01, p = 0.02, p = 0.03, respectively); that patients treated with surgery and adjuvant RT had significantly worse physical QOL and social-emotional QOL than patients treated with surgery alone (p < 0.01, p = 0.01, respectively) and that patients treated with surgery and adjuvant CRT had significantly worse swallowing and neck pain than patients treated with surgery and adjuvant RT (p = 0.03, p = 0.05, respectively). In patients with surgically treated MPT, adjuvant CRT and RT were associated with worse PROMs. 4 Laryngoscope, 134:4549-4556, 2024.

Long-term follow-up and prognostic analysis of parotid tumors in children and adolescents.

The objective of this study is to summarize the clinical characteristics, treatment, and prognosis of parotid tumors in children and adolescents. Fifty-three children and adolescents diagnosed with parotid gland tumors were included. Survival was evaluated using the Kaplan-Meier method. Log-rank test and multivariate analysis were used to analyze the association between clinical factors and recurrence. Of the 53 patients, 30 cases were benign and 23 cases were malignant. All patients underwent surgery. Patients with malignant tumors with high-risk factors received radiotherapy or chemotherapy. The median follow-up time was 61 months. Of these, 1 patient with benign tumor and 5 patients with malignant tumors recurred. Of the patients with malignant tumors, 2 developed distant metastases and 2 died. The 5-year overall survival (OS) and 5-year locoregional recurrence-free survival (LRFS) rates for benign tumors were 100.0% and 92.9%, respectively, whereas the 5-year OS and 5-year LRFS rates for malignant tumors were 94.4% and 72.5%, respectively. The log-rank univariate test showed that tumor size >3.5 cm (p = .056), distant metastasis (p = .056), and stage III and IV (p = .032) were associated with recurrence. However, multivariate analysis did not show the above factors to be independent prognostic factors for LRFS. Surgery for benign tumors depends on the location and size. Surgery for malignant parotid tumors depends mainly on the stage, grade, pathological type, and recurrence. Prophylactic lymph node dissection is required for high-grade tumors. Radiotherapy or chemotherapy for children needs more research. Both benign and malignant tumors have high survival rates after active treatment. Level 2.

MR-Neurography of the facial nerve in parotid tumors: intra-parotid nerve visualization and surgical correlation.

One of the most severe complications in surgery of parotid tumors is facial palsy. Imaging of the intra-parotid facial nerve is challenging due to small dimensions. Our aim was to assess, in patients with parotid tumors, the ability of high-resolution 3D double-echo steady-state sequence with water excitation (DE3D-WE) (1) to visualize the extracranial facial nerve and its tracts, (2) to evaluate their relationship to the parotid lesion and (3) to compare MRI and surgical findings. A retrospective study was conducted including all patients with parotid tumors, who underwent MRI from April 2022 to December 2023.Two radiologists independently reviewed DE3D-WE images, assessing quality of visualization of the facial nerve bilaterally and localizing the nerve's divisions in relation to the tumor. MRI data were compared with surgical findings. Forty consecutive patients were included (M:F = 22:18; mean age 56.3 ± 17.4years). DE3D-WE could excellently visualize the nerve main trunk and the temporofacial division in all cases. The cervicofacial branch was visible in 99% of cases and visibility was good. Distal divisions were displayed in 34% of cases with a higher visibility on the tumor side (p < 0.05). Interrater agreement was high (weighted kappa 0.94 ± 0.01 [95% CI 0.92-0.97]). Compared to surgery accuracy of MRI in localizing the nerve was 100% for the main trunk, 96% for the temporofacial and 89% for the cervicofacial branches. Facial nerve MR-neurography represents a reliable tool. DE3D-WE can play an important role in surgical planning of patients with parotid tumors, reducing the risk of nerve injury.

Gland preservation with postauricular sulcus approach for benign parotid tumors

An observational longitudinal investigation encompassed 46 patients undergoing gland-preserving surgery for benign parotid tumors via the postauricular sulcus incision approach. Patient assessments included cosmetic contentment, functional repercussions, and disease management throughout the follow-up. Predominantly, tumors were situated in the superficial lobe, with successful application observed in 8 instances (17%) within the deep lobe. Notably, no tumor recurrences were detected during the follow-up period. Postoperative pain remained minimal, accentuated by high patient satisfaction regarding the incision scar and facial symmetry. Furthermore, preservation of facial nerve functionality and salivary secretion was observed. Gland-preserving surgery via the postauricular sulcus incision technique exemplifies advantageous functional and cosmetic outcomes when addressing benign parotid tumors. This approach presents a secure and efficient alternative, facilitating effective local management.

The extracapsular dissection technique in the management of benign tumours of the parotid gland: our experience in 194 patients.

The indications for and approaches to extracapsular dissection for parotid gland benign tumours are debated in the literature. This study retrospectively evaluates a single site's short- and long-term results with a standardised extracapsular dissection approach to benign parotid tumours. A retrospective review of a single institution's records identified cases with extracapsular dissection as the primary surgery for non-recurrent benign parotid tumours. A total of 194 eligible patients were identified (124 women and 70 men, age 47.75 ± 15.62 years). Pre-, intra- and post-surgical data were reviewed for complications and recurrences. Histology reported pleomorphic adenoma in 165 patients, Warthin's tumour in 28 patients and both in one patient. Mean follow up was 36 ± 16 months (range, 12-84 months). The incidences of complications following extracapsular dissection were temporary (n = 13) and permanent (n = 0) facial nerve dysfunction, Frey's syndrome (n = 1)) and recurrences (n = 5). These rates align with prior literature. This case series shows how a standardised approach to extracapsular dissection for benign parotid tumours yields favourable results, supporting a progressive change of strategy towards reduced invasiveness.

Tumor localization is the important factor for recovery time of postoperative facial nerve paralysis in benign parotid surgery

ObjectiveFacial nerve paralysis is the most problematic complication of surgery for parotid tumors. This study aimed to examine the progress of recovery from postoperative transient facial nerve paralysis (POFNP). MethodsParticipants were 203 patients who developed POFNP after benign parotid surgery. A Kaplan-Meier showed the progress of recovery from paralysis. Factors involved in recovery were examined. For factors for which a significant difference was found, recovery from paralysis was examined over time. ResultsRates of recovery from paralysis were as follows: 28.6% of patients at 1 month, 58.3% at 3 months, 85.9% at 6 months, and 95.1% at 12 months after surgery. Deep lobe tumors were shown to be significantly associated with delayed recovery from paralysis. The relationship between tumor location and the time of recovery from was that deep lobe tumors had a significantly worse recovery from paralysis at 4 and 5 months after surgery. ConclusionPatients who develop POFNP must be informed about the progress of recovery and factors involved in recovery from paralysis. We believe that the results of the present study are a useful reference to that end.

The use of bipolar pure cut mode technology in dissection of parotid tumors: A novel technique

Background The basic concern in parotid surgery is facial nerve preservation. Various methods of dissection have been used to excise the parotid tissue and spare the facial nerve and its branches. Combined (blunt, mosquito tip, monopolar, and bipolar electrocautery, and scissor dissection) procedures are the most widely used techniques. Further new methods were used as an alternative for hemostasis and dissection such as ligasure and ultrasonic devices. New emerging technology of bipolar energy with high voltage and low current gave a benefit of deep coagulation and powerful cutting with less spread of heat to the surrounding tissue. In this study, we tried a new dissection technique with the pure auto-cut bipolar electrodissection with the new versions of bipolar technology to report its effect in parotid tumor surgery. The primary objective of the study was to evaluate the safety and efficacy of new bipolar pure cut electrodissection and weighing its benefits in the preservation of the facial nerve branches and reducing the postoperative complications. The secondary objective of the study was to compare the result of the new technique with the results of the conventional technique that was previously performed in our department and the complication of this new technique if any. Patients and methods This prospective and retrospective study was held in Menoufia University Hospital. Our study included 30 patients with parotid tumors, where 15 retrospective patients underwent conventional parotidectomy (superficial and/or total parotidectomy) and were referred as group B, and 15 prospective patients underwent parotidectomy (superficial or total parotidectomy) and were referred as group A, using the bipolar pure auto-cut electrodissection technique by advanced bipolar technology. Results The mean operative time was significantly lower in group A patients than in group B, where the time for superficial parotidectomy was 100±14 min in group A and 117±11 min in group B and for total parotidectomy was 118±12 min in group A and 139±18 min in group B (P=0.001). Regarding postoperative complications, in group A, we reported one case with temporary nerve affection. However, in group B, we reported two cases of wound infection, one case with salivary fistula, two cases with seroma, two cases of temporary nerve affection, two cases of permanent nerve branch affection, and one case of Frey syndrome. Regarding tumor recurrence, we reported only one case in group B. Conclusions Using the new bipolar pure cut technique in various types of parotid tumors is technically easier for meticulous fast dissection around the facial nerve branches, showing significantly shorter operative time and less incidence of seroma, wound infection, salivary fistula, and facial nerve injury.

Surgical management and side effects of parotid gland surgery for benign lesions: a retrospective analysis of our experience from 2012 to 2021

Surgery is the treatment of choice for tumours in the parotid gland. We evaluated complications following parotid surgery. We conducted a retrospective study on 554 patients undergoing parotid surgery for benign parotid tumours from 2012 to 2021. We analysed complication rates between extracapsular dissection (ECD) and superficial parotidectomy (SP). We found 19 capsular ruptures in patients undergoing ECD (5.34%) and five among those undergoing SP (2.52%) [p < 0,05]; 16 cases of temporary facial paralysis among those undergoing ECD (4.49%) and 35 in patients undergoing SP (17.67%) [p < 0,05]; and eight instances of permanent facial nerve paralysis in patients undergoing ECD (2.25%) [p > 0,05] and 13 in patients undergoing SP (6.56%). Among the mid-term complications described were: 22 salivary fistulas among patients operated with ECD (6.18%) [p > 0,05] and 17 in patients with SP (8.58%) 17 sialoceles in those who underwent ECD (4.77%) and seven with SP (3.53%) [p > 0,05]. Regarding late complications, we found: surgical wound dehiscence, pathological scarring (keloid), Frey's syndrome, and recurrence, which affected 45 patients with ECD (12.64%) and 21 with SP for dehiscence (10.6%) [p < 0,05]; 28 keloids in patients with ECD (7.86%) and 15 in patients with SP (7.57%) [p > 0,05]; 12 cases of Frey's syndrome in patients with ECD (3.37%) and 36 with SP (18.18%) [p < 0,05]; and finally 22 recurrences in patients who underwent ECD (6.18%) and 13 in patients who underwent SP (6.56%) [p > 0,05], including 30 in the 273 patients with pleomorphic adenoma and five in the 214 patients with Warthin’s tumour. We can conclude that the onset of the different complications after parotid gland surgery are related to the surgery performed. Our data confirm that there is a tight relationship between type of surgery performed and type of complication.

Prospective Assessment of Risk Factors Influencing Facial Nerve Paresis in Patients after Surgery for Parotid Gland Tumors.

Background and objectives: Facial weakness is the most important complication of parotid gland tumor surgery. The aims of this study are as follows: (1) assessment of the prevalence of postparotidectomy facial nerve dysfunction; (2) clinical and electrophysiological assessment of the facial nerve function before parotidectomy and at 1 and 6 months postoperatively; (3) assessment of the association of postoperative facial palsy with selected risk factors; and (4) assessment of the correlation between the results of clinical and neurophysiological assessments of facial nerve function. Materials and Methods: This study comprised 50 patients (aged 24-75 years) who underwent parotidectomy at the Department of Otolaryngology and Laryngological Oncology in Zabrze, Poland between 2015 and 2017. The evaluation included neurological, clinical and electrophysiological assessments of the facial nerve prior to surgery and at 1 and 6 months postoperatively. Results: No facial palsy was found preoperatively or 6 months postoperatively. Facial nerve dysfunction was found in 74% of patients 1 month postoperatively. In most cases (54%), paresis was mild or moderate (House-Brackmann grades II and III). The results of electrophysiological tests before parotidectomy were either normal or showed some mild abnormalities. We found a statistically significant correlation between the clinical assessment of the facial nerve function (based on the House-Brackmann scale) one month postoperatively and the latency of the CMAP response from the orbicularis oculi and orbicularis oris muscles. In all three studies, a statistically significant correlation was found between the amplitude of the compound muscle action potential (CMAP) of the orbicularis oris muscle and the degree of facial nerve weakness. Conclusions: The factors that may influence the risk of postoperative facial nerve paralysis (prolonged surgical time and the size and location of the tumor other than in the superficial lobe only) may indirectly suggest that surgery-related difficulties and/or surgeon experience could be crucial to surgery safety.

Evaluating the results of the surgery of benign parotid tumors

Background: Benign tumors account for 80% of parotid salivary gland tumors, early diagnosis and effective treatment will contribute to reducing complications of surgery. Objective: To evalutate surgical results of benign parotid tumors on facial paralysis and other complications. Research Methodology: including 51 patients with benign parotid salivary gland tumors at Hue University of Medicine and Pharmacy Hospital from June 2019 to October 2021 were operated on and monitored for facial paralysis after 1 week, 1 month, 3 months, and 6 months according to the House-Brackmann facial nerve grading system and noted other complications. Results: Pleomorphic adenoma and Warthin tumors are the two most common types of benign tumors. The rate of facial paralysis at the time points after 1 week, 1 month, 3 months, and 6 months gradually decreased by 56.9%, 35.3%, 19.6%, 0%, respectively. Most temporary facial paralysis grade II (mild) and grade III (moderate) (classification of House - Brackmann). The surgical method was significantly related to facial paralysis (p &lt; 0.05). Other complications such as numbness around the ear, hemorrhage, sialocele, salivary fistula, depression of facial contour, bad scars. Nevertheless, no cases of tumor recurrence and Frey’s syndrome were recorded after 6 months. Conclusion: Surgery is an effective and safe treatment for benign parotid salivary gland tumors. Facial paralysis accounts for a high incidence after surgery, but it will fully recover after 6 months. Choosing the appropriate treatment method helps to minimize complications and recurrence after surgery of parotid salivary gland tumors. Key words: benign parotid tumors, facial paralysis, parotidectomy.

Prospective Assessment of Intraoperative Facial Nerve Monitoring in Patients Undergoing Partial Parotidectomy.

The most significant complication of parotid gland tumor surgery is facial weakness. This study compares the occurrence of transient facial palsy in patients with parotid gland tumors who underwent surgery without monitoring to those who underwent surgery with monitoring. The study's aim was to investigate facial nerve function in patients undergoing parotidectomy as well as the effect of intraoperative facial nerve monitoring and the effect of certain risk factors on the surgery and onset of postoperative facial palsy. This prospective study included 100 patients who underwent parotidectomy. The study cohort was divided into two groups. Group I included 50 patients who underwent surgery without neuromonitoring and group II included 50 patients who underwent surgery with neuromonitoring. The neurological assessment was conducted using the House–Brackmann scale. Preoperatively and one month postoperatively, electroneuronography (ENoG) and blink reflex tests were done. The analyses showed a significant reduction of the compound muscle action potential (CMAP) amplitude of the orbicularis oculi and orbicularis oris muscles and prolonged R1 and R2 blink reflex latencies 1 month after surgery. On neurological and electrophysiological studies, the rate of postoperative transient facial nerve dysfunction was significantly different between the groups. Significantly more patients, operated with use of facial nerve monitoring, presented postoperatively normal nerve function (i.e., House–Brackmann grade I) compared to those who underwent surgery without monitoring (78% and 26%, respectively; p < 0.001). Monitoring had a statistically significant impact on the prevalence of facial nerve conduction disorders in patients who underwent surgery, according to the blink reflex and ENoG studies. The duration of the surgical procedure was not affected by monitoring in any way. The clinical evaluation of facial nerve function (House–Brackmann scale) and some ENoG results 1 month after surgery were found to have a significant correlation. To summarize, using monitoring considerably reduced the negative impact of local factors and the prevalence of transient facial nerve palsy.

Two-Lines-Four-Regions: A New Concept in Endoscopic-Assisted Surgery of Parotid Gland Tumors

Endoscopic-assisted surgery of parotid gland tumor is challenging due to the complex anatomic structures. This study compared an innovative endoscopic-assisted operation called the two-lines-four-regions method to a traditional endoscopic-assisted surgery in the treatment of parotid gland tumors. In this retrospective cohort study, patients were assigned to the traditional endoscopic group (Trad-En group) and the two-lines-four-regions endoscopic group (Tlfr-En group) according to whether two-lines-four-regions concept was used before the surgery. The primary outcomes are operation time (minutes) and postoperative complications present or absent. Other outcomes including intraoperative blood loss (milliliter), whether to increase auxiliary incision (yes/no), postoperative drainage (milliliter), and retention time (day) are the secondary outcomes. χ2 analysis or Fisher exact test was used to compare the statistical differences of those variables in 2 groups, and a P value of less than .05 was considered to indicate statistical significance. A total of 121 patients with parotid gland tumors underwent endoscopic-assisted surgery; 59 patients were assigned to the Trad-En group, and 62 patients were assigned to the Tlfr-En group. The mean operation times (65.24±14.82min), blood loss (9.85±3.38mL), and the amount of drainage (10.52±3.17mL) in the Tlfr-En group were shorter than the values in the Trad-En group (75.75±14.16min, 10.52±3.17mL, and 16.54±3.21mL, respectively; P<.05). The median follow-up time was 34months (range 4 to 70months). No tumor recurrence was found in all patients. This study demonstrated that the new concept of two-lines-four-regions of parotid gland makes the endoscopic-assisted surgery of parotid gland tumors more simplified, efficient, and minimally invasive.

Kabat Rehabilitation in Facial Nerve Palsy after Parotid Gland Tumor Surgery: A Case-Control Study.

Temporary facial nerve palsy after parotid tumor surgery ranges from 14 to 65%, depending on surgery, tumor type, and subsite. The study aimed to evaluate the role of Kabat physical rehabilitation in the outcomes of patients affected by severe facial nerve palsy following parotid gland surgery. The results and clinical data of two groups, Kabat and non-Kabat (control), were statistically compared. Descriptive statistics, the multiple linear regression model, difference in difference approach, and the generalized linear model were used. F-Test, Chi-square test, McFadden R-squared, and adjusted R-squared were used to assess the significance. The results showed that the House–Brackmann (HB) stage of patients who had physiotherapy performed were lower than the control group. The decrease of HB staging in the Kabat group at 3 months was −0.71 on average, thus the probability of having a high HB stage decreased by about 13% using Kabat therapy. The results are statistically significant, and indicated that when the Kabat rehabilitation protocol is performed, mainly in the cases of a high-grade HB score, the patients showed a better and faster improvement in postoperative facial nerve palsy.

THE RESULTS OF PAROTID GLAND TUMOR TREATMENT AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Background: Salivary gland tumors are the most complex and diverse of any organ in the body. Surgery is the mainstay of treatment for salivary gland tumor. Assessing the results of parotid gland tumor treatment is the aim of the study. Objective: To evaluate the results of parotid gland tumor surgery. Materials and Methods: 31 patients with parotid gland tumor who were examined at Hue University of Medicine and Pharmacy Hospital from June 2019 to June 2020 were recorded about clinical, paraclinical and evaluated results at 1 week, 1 month and 3 months after surgery. Results: Histopathological study of parotid salivary gland tumors: pleomorphic adenoma (64.5%), warthin tumour (32.3%), oncocytoma (3.2%). After parotid surgery, cervicofacial branches being the most commonly affected (29%). The most common complication was numbness around the earlope (77.4%), facial paralysis (41.9%), hemorrhage (29.1%), seroma (3.2%) and salivary fistula (3.2%). Conclusion: After performing parotid surgery, facial nerve injury was temporary Key words: Parotid gland, parotidectomy, facial paralysis

CLINICAL AND PARACLINICAL STUDY OF PAROTID SALIVARY GLAND TUMORS AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Background: Parotid gland tumors account for 80% of all salivary gland neoplasms, but 80% of parotid tumors are benign. In the presence of a parotid mass, a physical examination is the first diagnostic tool and, in most cases, it guides the clinician in the appropriate direction. A fine needle aspiration biopsy (FNA) has been indicated by several authors for the diagnostic work-up. Ultrasonography, computed tomography, and/ or magnetic resonance imaging are useful complementary studies for proper surgical planning. Objective: Study clinical, paraclinical features of parotid gland tumor surgery. Materials and Methods: 31 patients with parotid gland tumor who were examined at Hue University of Medicine and Pharmacy Hospital from June 2019 to June 2020 were recorded about clinical, paraclinical of tumour. Results: Parotid salivary gland tumors in men account for 54.8, the mean age of patients was 53.7±12.3. Majority of the parotid gland tumor size in ultrasound were between 2 and 4 cm (67.7%), homogenous (67.7%). Majority of the parotid gland tumor size in CT scanner encountered were between 2 and 4 cm (67.7%), homogenous (61.3%) and in the superficial lobe (96.8). Preoperative fine needle aspiration biopsy (FNA) results showed 35.5% pleomorphic adenoma. Conclusion: FNA - Fine Needle Aspiration, Ultrasound and CT scanner were very valuable for diagnosis. Key words: salivary gland neoplasms, tumors

An Experience of Superficial Parotidectomy in Tertiary Care Teaching Hospitals

Background: Superficial parotidectomy is associated with a decreased incidence of transient facial nerve paralysis compared with that of total parotidectomy. Aim: To analyze the clinical presentation, histopathology and complications following superficial parotidectomy performed for benign parotid tumors. Methods: Two center study data was collected from the Surgical Unit I, Department of Surgery AIMC/Jinnah Hospital Lahore (1st January 2012 to October 2018) and Surgical Unit II, Department of Surgery, Sir Ganga Ram Hospital Lahore (November 2018 to 31st December 2020). All patients who underwent superficial Parotidectomy surgery for benign parotid tumors, from 1st January 2012 to 31st December 2020 were assessed for intra-operative and post-operative complications. Demographic data, intraoperative details, and postoperative outcomes of all patients who underwent superficial parotidectomy were collected. Patients with benign parotid tumors on FNAC were included while patients with malignant cells on histopathology were excluded. Results: A total of 50 patients having benign parotid tumors on FNAC underwent superficial parotidectomy during this study period. There were 35 female patients (70%) and 15 male (30%), with female to male ratio of 2.3:1. The age range was 23-70 years with mean age of patients 35.6 years (5.65±SD). In 48% cases the tumor was on left side of face and in 52% cases it was on right side. Amongst 50 cases, on postoperative histopathology, 2 patients had malignant change. Key words: Superficial parotidectomy, pleomorphic adenoma, facial nerve paralysis.

Augmented Reality with HoloLens® in Parotid Tumor Surgery: A Prospective Feasibility Study

Introduction: Augmented reality can improve planning and execution of surgical procedures. Head-mounted devices such as the HoloLens® (Microsoft, Redmond, WA, USA) are particularly suitable to achieve these aims because they are controlled by hand gestures and enable contactless handling in a sterile environment. Objectives: So far, these systems have not yet found their way into the operating room for surgery of the parotid gland. This study explored the feasibility and accuracy of augmented reality-assisted parotid surgery. Methods: 2D MRI holographic images were created, and 3D holograms were reconstructed from MRI DICOM files and made visible via the HoloLens. 2D MRI slices were scrolled through, 3D images were rotated, and 3D structures were shown and hidden only using hand gestures. The 3D model and the patient were aligned manually. Results: The use of augmented reality with the HoloLens in parotic surgery was feasible. Gestures were recognized correctly. Mean accuracy of superimposition of the holographic model and patient’s anatomy was 1.3 cm. Highly significant differences were seen in position error of registration between central and peripheral structures (p = 0.0059), with a least deviation of 10.9 mm (centrally) and highest deviation for the peripheral parts (19.6-mm deviation). Conclusion: This pilot study offers a first proof of concept of the clinical feasibility of the HoloLens for parotid tumor surgery. Workflow is not affected, but additional information is provided. The surgical performance could become safer through the navigation-like application of reality-fused 3D holograms, and it improves ergonomics without compromising sterility. Superimposition of the 3D holograms with the surgical field was possible, but further invention is necessary to improve the accuracy.

Feasibility and efficacy of partial superficial parotidectomy with V-shaped incision

Objective: To evaluate the feasibility and efficacy of partial superficial parotidectomy with V-shaped incision by comparing with the Blair incision and hairline N-shaped incision. Methods: From January 2015 to January 2016, 60 patients (47 males and 13 females, with an age range of 25- 63 years) required for superficial partial parotid gland resection were randomly divided into three groups: V-shaped incision (VI) group, Blair incision (BI) group and hairline N-shaped incision (NI) group, with 20 cases in each group.Intraoperative, postoperative and follow-up indexes were compared between three groups. Operative time and drainage volume in the surgery of tumors at different sites in VI group were compared. SPSS18.0 software was used for statistic analysis. Results: There were no statistically significant differences among the three groups in operative time, drainage volume, postoperative hospital stay, periauricular numbness, fistulas, pain score, facial palsy, and scar score at the 3rd month after surgery (P>0.05). For appearance satisfaction score at the 6th month after surgery, VI group was better than BI group or NI group, with significant differences(VI group vs. BI group: 9.00[8.00, 9.00] vs. 5.00[4.00, 5.25], χ(2)=6.629, P<0.001; VI group vs. NI group: 9.00[8.00, 9.00] vs. 7.00[6.00, 8.00], χ(2)=2.942, P=0.010; BI group vs. NI group: 5.00[4.00, 5.25] vs. 7.00[6.00, 8.00], χ(2)=-3.687, P=0.001). For tumors located in the front, upper and middle of parotid gland, there were no statistically significant differences in operative time and drainage volume between the three groups (P>0.05). For tumors located at the lower part of parotid gland, the difference in operative time between the three groups was statistically significant (F=7.278, P=0.01). With pairwise comparison, operative time in VI group was longer than that in BI group or NI group, but there was no significant difference between BI group and NI group (VI group vs. BI group: (181.00±22.89) min vs. (132.50±9.01) min, t=3.694, P=0.004; VI group vs. NI group:(181.00±22.89) min vs. (149.00±15.94) min, t=2.585, P=0.025; BIgroup vs. NI group, (132.50±9.01) min vs. (149.00±15.94) min, t=1.257, P=0.235). For tumors located at the lower part of parotid gland, the differences in intraoperative drainage volume were not statistically significant between three groups (P>0.05). There were no statistically significant differences in operative time and drainage volume in the surgery of tumors at different sites in VI group (P>0.05). Conclusions: By use of V-shaped incision for the surgery of benign parotid gland tumors, the operation time of tumors located only in the lower part of the parotid gland will be prolonged. For tumors in different sites without increasing surgical complications, this modality can get good cosmetic effect.

Drain fluid amylase as a predictor of postoperative salivary fistula in cases with benign parotid tumours

BackgroundLate diagnosis of a salivary fistula increases the risk of wound infection and scarring. The purpose of the present study was to identify a quantitative predictor of postoperative salivary fistula for cases treated with surgery.MethodsDemographic, intraoperative and postoperative parameters for 57 cases that received surgery for benign parotid tumours were recorded from June 2017 to June 2018, of which 18 cases developed salivary fistulas. These data were analysed using univariate and binary logistic regression analyses as well as receiver operating curve analysis.ResultsDrain fluid amylase concentration was positively correlated with salivary fistula development (p < 0.001), with an odds ratio of 1.14 for a 1 KU/L increase in concentration and an optimal receiver operating curve cut-off value of 51,100 U/L for predicting salivary fistula development. Cases wherein the parotid–masseteric fascia remained intact were associated with a lower risk of salivary fistula development (p = 0.006).ConclusionDrain fluid amylase concentration may be a valuable predictor of postoperative salivary fistula in cases with benign parotid tumours.