Comparative outcomes of extracapsular dissection and superficial parotidectomy

Öztürk, Kerem; Öztürk, Arın; Turhal, Göksel; Kaya, İsa; Akyıldız, Serdar; Uluöz, Ümit

doi:10.1080/00016489.2019.1669821

Cited by 16 publications

(29 citation statements)

References 19 publications

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“…One RCT 31 was assessed as a low risk of bias. Twenty-five studies 12,14,19,32,35,36,[38][39][40]42,44,47,49,[51][52][53][56][57][58]60,[63][64][65]68,69,71 were assessed as having moderate risk of bias, whereas the other 18 studies 14,[33][34]41,43,45,46,48,50,54,55,59,61,62,66,67,70,72 were assessed as having high risk of bias (Table S4). [32][33][34]36,40,44,…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

“…versus ECD was reported in 18 studies, 32,36,39,40,44,47,48,50,52,53,[57][58][59]62,64,65,68,71 of them 3 studies 64,65,71 reported 0 event in both groups and were excluded from the meta-analysis. The pairwise metaanalysis of the remaining 15 studies with a total of 3211 participants showed a significant higher incidence in FS T A B L E 2 Summary of incidence rates of postoperative complication of different surgical intervention of parotid gland when SP was compared to ECD and PSP (p = 0.002 and p = 0.004) (Table 1 and Figure S1).…”

Section: Spmentioning

confidence: 99%

“…The network diagram of TFW of 37 studies with a total of 6064 patients is presented in Figure S2. 12,19,14,31,32,35,37,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][54][55][56][57][58][59][60][61][62][63][64][65]67,68,70,71 Eight studies 19,31,35,40,42,53,63,69 used House-Brackmann scale for postoperative evaluation of facial nerve function, while others did not report any method for nerve function assessment. The results of NMA showed no significant differences when comparing enucleation with ECD and PSP concerning TFW (OR 0.34, CrI [0.011, 3.66]) and (OR 5.720, CrI [0.552, 180.008]), respectively.…”

Section: Temporary Facial Nerve Weaknessmentioning

confidence: 99%

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Surgical interventions for management of benign parotid tumors: Systematic review and network meta‐analysis

et al. 2021

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The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis (NMA) is to answer the following questions: (1) Does the extent of surgical resection of benign parotid tumors increase the risk of postoperative complications? (2) What is the best surgical intervention for treatment of benign parotid tumors that can provide an acceptable balance between tumor recurrence rate and other postoperative complications? A comprehensive search on PubMed, Embase, Scopus, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of tumor recurrence, facial nerve weakness (temporary [TFW] or permanent [PFP]), Frey's syndrome (FS), sialocele, and salivary fistula. The Bayesian network meta-analysis (NMA) accompanied by a random effect model and 95% credible intervals (CrI) were calculated using the GeMTC R package. Forty-four studies with a total of 7841 participants were included in the current NMA comparing five surgical interventions, namely enucleation, extracapsular dissection (ECD), partial superficial parotidectomy (PSP), superficial parotidectomy (SP), and total parotidectomy (TP). Enucleation showed the highest recurrence rate compared to ECD, SPS, SP, and TP. No statistical differences were observed concerning the recurrence rate when ECD, PSP, SP, and TP were compared together. There was an increased incidence of TFW and FS with the increase in the extent of parotid resection, while no significant difference was found when comparing enucleation with ECD and PSP. SP showed the highest incidence of PFP, and salivary fistula compared to ECD, PSP, and TP. The tumor recurrence rates in enucleation, ECD, PSP, SP, and TP were 14.3%, 3.6%, 3.7%, 2.8%, and 1.4%, respectively. The current NMA demonstrated that the risk of TFW and FS increases with the increase in the extent of parotid resection and that ECD and PSP can be considered the treatment of choice for benign parotid tumors, as both provide an acceptable balance between the incidence of tumor recurrence and facial nerve dysfunction.

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Section: Risk Of Bias Assessmentmentioning

confidence: 99%

Section: Spmentioning

confidence: 99%

Section: Temporary Facial Nerve Weaknessmentioning

confidence: 99%

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Surgical interventions for management of benign parotid tumors: Systematic review and network meta‐analysis

et al. 2021

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“…4 Currently, extracapsular dissection and superficial parotidectomy are preferred over previous surgical procedures. 5 Ozturk et al 5 have illustrated that both, extracapsular dissection and superficial parotidectomy, have similar results in terms of recurrence rate. Authors of a study conducted in Medical University of Vienna reported a higher recurrence rate (7.3%) in patients undergoing extracapsular dissection as compared to superficial parotidectomy (2.2%).…”

Section: Discussionmentioning

confidence: 97%

“…4 In search of a less invasive surgical procedure which would have the benefits of all previous techniques together with fewer complications, Anderson 4 introduced extracapsular dissection of the parotid in 1975 which involves excision of the tumor with clear margins without dissecting the facial nerve. According to some recent studies 5,6 extracapsular dissection has similar success rate in terms of recurrence as superficial parotidectomy, but fewer complications. On the contrary, some evidence suggests a higher rate of recurrence in patients undergoing extracapsular dissection as https://doi.org/10.29309/TPMJ/2021.28.07.5918 compared to superficial parotidectomy.…”

Section: Introductionmentioning

confidence: 98%

Frequency of surgical complications and recurrence rate after extracapsular dissection of benign tumors of the parotid.

Arham

Khan

Arish

et al. 2021

TPMJ

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Objective: To determine surgical complications and recurrence rate in patients with benign lesions of the parotid undergoing extracapsular dissection. Study Design: Case Series. Setting: Department of Surgery, Rawalpindi Medical University, Rawalpindi. Period: January 2010 and December 2018. Material & Methods: The hospital records of all 50 patients who underwent extracapsular dissection with a diagnosis of either Pleomorphic adenoma or War thin tumor between reviewed retrospectively. Data regarding demographics, tumor, complications and recurrence was collected. Results: Out of 50 patients, 40 were males and 10 were females with age ranging from 26 to 52 years and mean age of 42 years. 44 of 50 parotid lumps were diagnosed as Pleomorphic adenoma and 6 were cases of Warthin tumor. The range of lesion size was 1.5 to 3 cm. 15 (30%) patients suffered from transient facial nerve weakness, whereas only 1 (2%) sustained a facial nerve injury which required repair. There was no case of Frey syndrome, sialocele and hematoma, however, salivary fistula was seen in 1 (2%) patient. Capsule rupture during surgery occurred in 15 (30%) patients and recurrence was seen in only 1 patient (2%). Conclusion: Extracapsular dissection has low recurrence rate, very few complications and is a safe and effective treatment for Pleomorphic adenoma and Warthin tumor.

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Selective Deep Lobe Parotidectomy vs Total Parotidectomy for Patients With Benign Deep Lobe Parotid Tumors

Wallerius,

Xie,

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceLimited literature exists on surgical outcomes after selective deep lobe parotidectomy (SDLP) with preservation of superficial lobe for patients with benign deep lobe tumors.ObjectiveTo compare the following factors for SDLP vs total parotidectomy for patients with benign tumors in the deep lobe: postoperative complications, including facial nerve paresis or paralysis, Frey syndrome, first bite syndrome, cosmetic defect, sialocele formation, and wound infection; and tumor control and recurrence.Design, Setting, and ParticipantsThis case series included 273 adults who underwent SDLP (n = 177) or total parotidectomy (n = 96) at a single tertiary care institution for benign parotid tumors located in the deep lobe or deep lobe and parapharynx from January 1, 2000, to December 31, 2020.ExposureSelective deep lobe parotidectomy vs total parotidectomy.Main Outcomes and MeasuresIncidence of postoperative complications and tumor recurrence.ResultsAmong 273 patients (SDLP, 177 [65%]; 122 women [69%]; median age at surgery, 58 years [IQR, 46-67 years]; total parotidectomy, 96 [35%]; 57 women [59%]; median age at surgery, 59 years [IQR, 40-68 years]), the most common tumor was pleomorphic adenoma (SDLP, 128 of 177 [72%]; total parotidectomy, 62 of 96 [65%]). An abdominal dermal fat graft was less commonly performed for patients who underwent SDLP than those who underwent total parotidectomy (2 of 177 [1%] vs 20 of 96 [21%]; difference, −20% [95% CI, −28% to −11%]). The rate of great auricular nerve preservation was higher in the SDLP group than in the total parotidectomy group (84 of 102 [82%] vs 20 of 34 [59%]; difference, 24% [95% CI, 5%-42%]). No meaningful difference in length of hospital stay was found. The percentage of patients with House-Brackmann grade I immediately after surgery was 48% (85 of 177) in the SDLP group and 21% (20 of 96) in the total parotidectomy group (difference, 28% [95% CI, 16%-40%]). There were no clinically meaningful differences in rates of hematoma, sialocele, seroma, ear numbness, wound infection, or unplanned return to emergency department or operating room. The SDLP group reported a lower rate of Frey syndrome than the total parotidectomy group (1 of 137 [1%] vs 12 of 78 [15%]; difference, −15% [95% CI, −23% to −7%]), as well as a lower rate of facial contour defect (28 of 162 [17%] vs 25 of 84 [30%]; difference, −13% [95% CI, −24% to −1%]) and a higher rate of first bite syndrome (34 of 148 [23%] vs 7 of 78 [9%]; difference, 14% [95% CI, 5%-23%]). The percentage of patients with House-Brackmann grade I at their first follow-up visit was 67% (118 of 177) in the SDLP group compared with 49% (47 of 96) in the total parotidectomy group (difference, 17% [95% CI, 4%-30%]). There was no clinically meaningful difference in House-Brackmann grade after 1 year.Conclusions and RelevanceFindings of this case series study suggest that SDLP can be considered an effective and even superior technique for management of benign tumors in the deep parotid lobe. Advantages associated with SDLP include reduction in need for reconstruction for facial contour defect and reduction in complications, such as immediate facial nerve weakness and Frey syndrome. The incidence of first bite syndrome was higher in the SDLP group. Tumor control was not compromised by SLDP.

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Comparative outcomes of extracapsular dissection and superficial parotidectomy

Cited by 16 publications

References 19 publications

Surgical interventions for management of benign parotid tumors: Systematic review and network meta‐analysis

Surgical interventions for management of benign parotid tumors: Systematic review and network meta‐analysis

Frequency of surgical complications and recurrence rate after extracapsular dissection of benign tumors of the parotid.

Selective Deep Lobe Parotidectomy vs Total Parotidectomy for Patients With Benign Deep Lobe Parotid Tumors

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