Parotidectomy For Benign Disease Research Articles

Long-term outcomes and quality of life following parotidectomy for benign disease.

SUMMARYObjectiveParotidectomy worsens quality of life (QoL) in the short-term, but the long-term impact is unknown. In this study, we analysed the long-term effects of parotidectomy on QoL.MethodsIn this prospective long-term follow-up study, participants were divided into three groups: short-term (ST) follow-up of six weeks, long-term (LT) follow-up of 13 years and short- and long-term (SLT) follow-up. QoL was assessed using the Parotidectomy Outcome Inventory (POI-8). Parotidectomies were classified based on whether the great auricular nerve (GAN) had been preserved or sacrificed.ResultsIn total, 164 observations were analysed, 74 in the LT group, 57 in the ST group and 33 in the SLT group. Hypoaesthesia was a major problem and facial palsy was a minor problem. Pain (p < 0.01) and hypoaesthesia (p < 0.001) were significantly lower after 13 years compared with after six weeks, and QoL was higher after 13 years compared with after six weeks (p = 0.04). The disease-specific impairment rate decreased from 70% at short-term follow-up to 30% at long-term follow-up. Removal of the GAN was associated with hypoaesthesia in the ST group (p = 0.028).ConclusionsHypoaesthesia has a long-term impact on the QoL, and this should be emphasised during preoperative discussions.

Assessment of Intraoperative Nerve Monitoring Parameters Associated With Facial Nerve Outcome in Parotidectomy for Benign Disease

Prior studies suggest that the use of facial nerve monitoring decreases the rate of immediate postoperative facial nerve weakness in parotid surgery, but published data are lacking on normative values for these parameters or cutoff values to prognosticate facial nerve outcomes. To identify intraoperative facial nerve monitoring parameters associated with postoperative weakness and to evaluate cutoff values for these parameters under which normal nerve function is more likely. This retrospective case series of 222 adult patients undergoing parotid surgery for benign disease performed with intraoperative nerve monitoring was conducted at an academic medical institution from September 13, 2004, to October 30, 2014. The data analysis was conducted from May 2018 to January 2019. The main outcome measure was facial nerve weakness. Receiver operating characteristic curves were generated to define optimal cut point to maximize the sensitivity and specificity of the stimulation threshold, mechanical events, and spasm events associated with facial nerve weakness. Of 222 participants, 121 were women and 101 were men, with a mean (SD) age of 51 (16) years. The rate of temporary facial nerve paresis of any nerve branch was 45%, and the rate of permanent paralysis was 1.3%. The mean predissection threshold was 0.22 milliamperes (mA) (range, 0.1-0.6 mA) and the mean postdissection threshold was 0.24 mA (range, 0.08-1.0 mA). The average number of mechanical events was 9 (range, 0-66), and mean number of spontaneous spasm events was 1 (range, 0-12). Both the postdissection threshold (area under the curve [AUC], 0.69; 95% CI, 0.62-0.77) and the number of mechanical events (AUC, 0.58; 95% CI, 0.50-0.66) were associated with early postoperative facial nerve outcome. The number of spasm events was not associated with facial nerve outcome. The optimal cutoff value for the threshold was 0.25 mA, and the optimal cutoff for number of mechanical events was 8. If a threshold of greater than 0.25 mA was paired with more than 8 mechanical events, there was a 77% chance of postoperative nerve weakness. Conversely, if a threshold was 0.25 mA or less and there were 8 mechanical events or less, there was 69% chance of normal postoperative nerve function. No parameters were associated with permanent facial nerve injury. Postdissection threshold and the number of mechanical events are associated with immediate postoperative facial nerve function. Accurate prediction of facial nerve function may provide anticipatory guidance to patients and may provide surgeons with intraoperative feedback allowing adjustment in operative techniques and perioperative management.

Comparative Study between Antegrade and Retrograde Facial Nerve Dissection in Superficial Parotidectomy

Introduction: Facial nerve injury is the most dreaded and most feared complication in parotid surgery, many techniques were used for its proper identification and safeguarding.  Aim: Is to compare both antegrade and retrograde facial nerve dissection regarding complications mainly facial nerve injury.  Patients and methods: We had 2 randomly divided equal groups, 18 patients each.  Group A had antegrade parotidectomy and group B had retrograde parotidectomy. Patients were followed up for 1 year.  Results: Group B had shorter operative time 121±31.8 vs. 148± 22.27 min in group A. Also group B had a slight shorter hospital stay. Early facial nerve affection was less in group B 27% vs 33% in group A, and late affection was much more in group A 11% vs 0% in group B.  Conclusion: Retrograde parotidectomy is a safe and easy technique with a high safety profile in parotidectomy for benign disease.

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AN ANALYSIS OF COMPLICATIONS FOLLOWING SURGICAL TREATMENT OF BENIGN PAROTID DISEASE

The purpose of this study was to review the incidence of and risk factors for, developing complications following parotidectomy for benign disease. In an 11 year period, 162 parotidectomies were performed for benign disease, the commonest being PSA (43%), Warthin’s (30%) and sialadenitis (22%). There were 71 males/91 females, mean age was 58 years and 79% presented with a painless mass of 26 months. 134 patients underwent a superficial parotidectomy and the mean follow‐up was 23 months. Post‐operatively 40% developed a temporary facial palsy, 11% had Frey’s syndrome and 10% developed a salivary fistula. Sialadenitis was a significant risk factor for the development of facial nerve palsy (p &lt; 0.01) and increased the risk of salivary fistulae. Parotid duct ligation increased the risk of nerve palsy in the distribution of the zygomatic and buccal branches. Operations for Warthin’s tumour were associated with an elevated risk of dysfunction of the cervical branch of the facial nerve. Half of the patients had intra‐operative facial nerve stimulation and this uninfluenced the liklehood of facial paresis. The recovery of facial nerve function showed a biphasic distribution, with 90% of patients having normal function within 12 months, followed by a slower recovery rate for up to two years. In conclusion, the incidence of post‐operative complications was influenced by the pathology, with inflammatory lesions significantly increasing the risk of facial nerve dysfunction and other complications, but also by variations in surgical practice, such as parotid duct ligation. Overall, the incidence of permanent facial palsy was under 2%, but a temporary nerve palsy was common at 40%, with most patients regaining normal function within one year of surgery.

Facial nerve morbidity after retrograde nerve dissection in parotid surgery for benign disease: A 10-year prospective observational study of 136 cases

We evaluated the facial nerve function in 136 patients who had had retrograde nerve dissection during parotidectomy for benign disease. One week after the operation 90 patients (66%) had some weakness of the facial nerve. After 1 month 52 (38%) had facial nerve paresis. After 3 months 114 (84%) had recovered fully and 21 (16%) had minor nerve paresis. After 6 months 135 (99%) had normal nerve function. One patient had persistent marginal mandibular nerve paresis.