Parotidectomy For Benign Tumors Research Articles

Late Prevalence of Typical and Atypical Symptoms of Frey's Syndrome after Parotidectomy for Benign Tumor.

The treatment of choice for tumors located in the parotid gland is surgery. Nevertheless, postoperative complications are not infrequent. Regardless of the type of surgical procedure, the most common complication is Frey's syndrome (FS). Traditionally, FS includes unilateral gustatory sweating and flushing of the facial skin lining the parotid compartment. Recent research describes atypical discomfort associated with FS. The aim of this study was to assess the late prevalence and severity of both usual and atypical symptoms after parotidectomy for benign tumors. We conducted a cross-sectional study involving 86 subjects who underwent superficial parotidectomy at least one year before the study. The questionnaire included the sweating-flushing-itch-paresthesia-pain (SFIPP) Frey scale supplemented by specific questions about symptoms. Sixty-seven out of eighty-six (77.9%) cases reported almost one symptom. The most frequent symptom was itch (36/67-53.7%), followed by pain (35/67-52.2%), while 28/67 (41.8%) subjects complained of atypical symptoms without flushing or sweating. A desire to treat the discomfort was reported by 50/67 (74.6%) subjects. Late postparotidectomy local discomfort is not infrequent and includes both usual and "unusual" symptoms almost equally. Our results suggest the importance of informing patients about the occurrence of the syndrome and the available treatment options during pre- and postoperative counseling.

Single-surgeon parotidectomy outcomes in an academic center experience during a 15-year period.

ObjectiveAs large single‐surgeon series in the literature are lacking, we sought to review a single‐surgeon's experience with parotidectomy in an academic center, with a focused analysis of pathology, technique, and facial nerve (FN) weakness. Benchmark values for complications and operative times with routine trainee involvement and without continuous FN monitoring are offered.Materials and MethodsAll patients who underwent parotidectomy, performed by D. G. D., for benign and malignant disease between January 2004 and December 2018 at an academic center were reviewed.ResultsA total of 924 parotidectomies, with adequate evaluatable data were identified. The majority of patients had benign tumors (70.9%). Partial/superficial parotidectomy was the most common approach (65.7%). Selective FN branch sacrifice was rare (12.3%), but significantly more common among patients with malignant pathology (33.8% vs 3.5% for benign, P < .0001). Among patients with intact FN, post‐operative short‐ and long‐term FN weaknesses were rare (6.5% and 1.7%, respectively). These rates were lower among patients with benign tumors (5.4% and 1.3%). Partial/superficial parotidectomy for benign tumors was associated with a low rate of short‐ and long‐term FN weaknesses (2.7% and 0.9%). Mean OR time was 185 minutes.ConclusionThis is the largest single‐surgeon series on parotidectomy, spanning 15 years. We demonstrate excellent long‐ and short‐term FN paresis rates with acceptable operative times without regular use of continuous FN monitoring and with routine trainee involvement. These findings may provide valuable insight into parotid tumor pathology, FN outcomes, and feasibility and expectations of performing parotidectomy in an academic setting.Level of Evidence4.

Parotidectomy combined with identification and preservation procedures of the great auricular nerve

Conclusions: We found that the great auricular nerve (GAN) passes at the median (m) point between the tips of the mandibular angle and mastoid process. We also established the GAN definitive line using this point for rapid identification of the trunk of the GAN and systematic parotidectomy combined with procedures for identification of the GAN, elevation of the skin flap, and exposure of the parotid capsule, which showed a high rate of preservation of the nerve and the lobular branch. Objective: The aim of this study was to improve parotidectomy and the rate of preservation of the GAN. Methods: This study comprised 74 consecutive patients who were scheduled to have parotidectomy for benign tumors at our department between November 2011 and April 2014. We examined whether our GAN definitive line including the m point was useful to identify the trunk of the GAN and whether anterograde dissection of the nerve could be performed simultaneously with skin flap elevation and exposure of the parotid capsule and contributed to preservation of the trunk to the lobular branch. Results: The trunk was identified under the GAN definitive line drawn preoperatively in 97.3% of cases (72/74). Combined surgery was successfully performed with a 95.9% (71/74) preservation rate of the GAN including the lobular branch.

Facial mimicry after conservative parotidectomy: a three-dimensional optoelectronic study

Facial nerve paralysis is one of several possible complications following conservative parotidectomy. To assess three-dimensional facial movements non-invasively in patients with unilateral facial palsy following parotidectomy for benign tumours, the three-dimensional coordinates of 21 soft-tissue facial landmarks were recorded in 32 patients (21 HB I, 5 HB II, 6 HB III-IV; 3 months post-surgery follow-up), and 40 control subjects, during the performance of facial movements (smile, ‘surprise’, eye closure, single eye closure). For all symmetric animations, control subjects had larger total mobility than patients; mobility progressively decreased in patients with larger clinical grades. For asymmetric eye closures, HB I patients and control subjects had similar total movements, while HB II patients had smaller movements, especially for the paretic side eye closure; smaller total movements were found in HB III-IV patients. The method allowed the quantitative detection of alterations in facial movements. Significant differences between patients and control subjects in the magnitude and asymmetry of movements were found.

耳下腺良性腫瘍の手術時間に影響を与える因子

Tumors of the parotid gland are fairly frequent among head and neck tumors. Parotidectomy for benign tumors is necessary for diagnosis and therapy. Furthermore, acquiring the skill for this operation is a significant step in the training course of an otolaryngologist Thus, it is useful to analyze the operation time and determine the factors affecting it to evaluate the progress in the operation skill. To measure the operation time and determine the factors affecting it, 71 cases, including 43 cases of pleomorphic adenomas and 28 cases Warthin's tumor, were retrospectively reviewed to the determine if the operation time depended on the age, sex, operated side, presence of complications, BMI, bleeding volume, tumor size, tumor location, exposure of branches of the facial nerve, and experience of the surgeon. Multivariate analysis was used to determine the factors correlated with the operation time. The results revealed that the bleeding volume, tumor size, tumor location and experience of the surgeon were significantly correlated with the operation time, whereas age, sex, operated side, presentation of complications and BMI showed no correlation with the operation time. Furthermore, surgeons with the experience of operating 20-39 cases took almost the same time for the operation as the surgeon with the experience of operating more than 40 cases. Taken together, to shorten the operation time, the inexperienced surgeon should start with smaller tumors and surgery in the superficial lobe in the initial training period, and supervision by well-experienced supervised surgeons is required until 30-40 are undertaken.

Parotid gland tumors

Summary One hundred cases of parotid tumors are presented and studied from a clinicopathologic viewpoint. The clinical features of the tumor had no definite bearing on the final histopathologic type of tumor and, therefore, were not reliable guides for the preoperative diagnosis and treatment of parotid tumors. The definite reduction in recurrence rate by subtotal parotidectomy for benign tumors should lead to the wider use of the procedure despite the higher rate of facial nerve dysfunction which in the great majority of cases is temporary.