Extracapsular dissection versus superficial parotidectomy in pleomorphic adenomas of the parotid gland

Abstract

Objectives:We aimed to compare the results of extracapsullary dissection (ED) with superficial parotidectomy (SP) in the surgical treatment of benign parotid tumors. Patients and Methods:Forty-one patients who were diagnosed with pleomorphic adenoma of the parotid gland and underwent surgery between January 1992 and June 2000 were enrolled in this study. The patients were divided into two groups: the ED group (6 males, 15 females; mean age 47.2 years; range 32 to 57 years) and the SP group (7 males, 13 females; mean age 47.7 years; range 29 to 61 years). ED was performed on 21 patients and SP was performed on 20 patients. All patients were followed-up postoperatively and the mean follow-up time was 194 (range 117 to 264) months. Results:Although no complications developed in the ED group patients during the follow-up period, there were several cases in the SP group: three cases of salivary fistula, one of Frey's syndrome, three case of temporary facial paresis and 13 of cosmetic deformity. The cosmetic deformities were as minimal depressions in the parotid region. There have been no recurrences in either group. There was a statistically significant difference between the two groups regarding cosmetic deformity (p=0.000 and X 2 =19.27). There was also a statistically significant difference between the two groups regarding general complications (p=0.001 and X 2 Y: 8.32). Conclusion:Extracapsullary dissection is a safe and reliable surgical procedure compared to superficial parotidectomy with a lower complication rate and a similiar recurrence rate.

Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience

“…One of the most devastating complications in parotid surgery is recurrent disease. Especially pleomorphic adenomas that harbor a significant risk for recurrent disease with a slightly higher recurrence rates after extracapsular dissection (0% to 10%) compared with SP (0% to 6.7%; Table ) . In accordance with the literature, we found a significantly higher rate of recurrent disease after extracapsular dissection compared with SP.…”

“…Because our department had a considerable large number of patients treated between the 1960s and 1990s, it was obvious to compare the clinical outcome and time of surgery between these 2 surgical techniques. To the best of our knowledge, this study includes the largest collective of performed SPs and the second largest collective of conducted SPs and extracapsular dissections in total (Table ) …”

“…Another challenging factor in parotid surgery is the function of the facial nerve. The rate of permanent facial palsy varies between 0% and 13.3% after extracapsular dissection and 0% and 8.9% after SP (Table ) . In their large cohort study, Mantsopoulos et al showed that 1.9% of patients developed permanent facial palsy after extracapsular dissection and 9.8% of patients after nonextracapsular dissection cases.…”

Review of Salivary Gland Neoplasms

“…Studies in the past have found enucleation of benign tumours to be associated with an unacceptably high chance of tumour recurrence especially for pleomorphic adenomas [22]. However, several recent studies have suggested that a more limited resection in the form of extracapsular dissection where the pleomorphic adenoma is resected only with a cuff of normal glandular tissue offers better postoperative cosmetic result and lower incidence of Frey's syndrome without an increase in the incidence of tumour recurrence and facial nerve injury [23–25]. Recurrence rates with either approach are in the order of 1–3% in the literature [26].…”

A Case of Sebaceous Carcinoma of the Submandibular Gland

“…Studies in the past have found enucleation of benign tumours to be associated with an unacceptably high chance of tumour recurrence especially for pleomorphic adenomas [22]. However, several recent studies have suggested that a more limited resection in the form of extracapsular dissection where the pleomorphic adenoma is resected only with a cuff of normal glandular tissue offers better postoperative cosmetic result and lower incidence of Frey's syndrome without an increase in the incidence of tumour recurrence and facial nerve injury [23][24][25]. Recurrence rates with either approach are in the order of 1-3% in the literature [26].…”