Facial nerve dysfunction after superficial parotidectomy with or without continuous intraoperative electromyographic neuromonitoring: a prospective randomized pilot study

Graciano, Agnaldo José; Fischer, Carlos Augusto; Coelho, Guilherme Vianna; Steck, José Higino; Paschoal, Jorge Rizzato; Chone, Carlos Takahiro

doi:10.1007/s00405-018-5130-1

Cited by 37 publications

(34 citation statements)

References 37 publications

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“…Two prospective trials have found no benefit in reducing the incidence of postoperative facial weakness. 20 , 21 This is in line with our finding. Nevertheless, in the recent randomized trial carried out by Graciano et al, non-monitored patients had significantly more severe weakness.…”

Section: Discussionsupporting

confidence: 93%

“…Nevertheless, in the recent randomized trial carried out by Graciano et al, non-moni-tored patients had significantly more severe weakness. 21 Furthermore, a meta-analysis of 546 patients by Sood et al concluded that IFNM decreases the risk of temporary weakness but does not appear to influence the incidence of permanent facial nerve weakness. 22 In revision surgery, where the facial nerve is more difficult to identify and dissect due to scarring and fibrosis, the use of IFNM may be more useful.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with facial weakness following surgery for benign parotid disease: a retrospective multicenter study

et al. 2020

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BACKGROUND: Facial nerve weakness is the most common and most concerning complication after parotidectomy. Risk factors for this complication following surgery for benign diseases remain controversial. OBJECTIVE: Review the frequency and prognosis of facial nerve weakness after parotidectomy and analyze potential risk factors. DESIGN: Retrospective review of medical records. SETTINGS: Two tertiary care centers. PATIENTS AND METHODS: We included all parotidectomies performed for benign diseases from January 2006 to December 2018. Details about the development and recovery of postoperative facial weakness were recorded. Patient, disease and surgery-related variables were analyzed using bivariate and multivariate analyses to identify risk factors. MAIN OUTCOME MEASURES: Frequency, recovery rates and risk factors for facial nerve weakness SAMPLE SIZE: 191 parotidectomies, 183 patients, 61 patients with facial weakness. RESULTS: The frequency of postoperative facial weakness was 31.9% (61/191 parotidectomies). Among patients with temporary weakness, 90% regained normal facial movement within 6 months. Steroid therapy was not associated with a faster recovery. Postoperative weakness was not associated with age, diabetes, smoking, disease location, use of an intraoperative facial nerve monitor or direction of facial nerve dissection. Risk factors for temporary weakness were total parotidectomy and surgical specimens larger than 60 cubic centimeters. Revision surgery was the only identified risk factor for permanent weakness. CONCLUSION: Larger parotid resections increase the risk of temporary facial nerve weakness while permanent weakness is mainly influenced by previous surgeries. LIMITATIONS: Retrospective nature, underpowered sample size, selection bias associated with tertiary care cases. CONFLICT OF INTEREST: None.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Factors associated with facial weakness following surgery for benign parotid disease: a retrospective multicenter study

et al. 2020

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“…Only seven (14%) patients in the current study developed temporary facial paralysis. This is in the lower range compared to rates previously demonstrated in the literature, where temporary facial paralysis following superficial parotidectomy has been found to range between 10 and 80% [4,22,23]. One possible explanation for this is that in most studies, a surgical drain was placed at the end of surgery.…”

Section: Discussionmentioning

confidence: 56%

Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction

Melong

Rigby

Corsten

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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Background Patients undergoing superficial parotidectomy for benign parotid lesions are at risk of postoperative complications, most notably cosmetic complications such as facial paralysis and contour defects, and functional complications including Frey’s syndrome. Traditionally, surgical drains have been placed at the end of surgery to prevent hematoma and sialocele formation. However, this can increase the risk of postoperative complications and contribute to a prolonged course in hospital. To try and prevent these risks and complications, we introduced a novel technique of a drainless parotidectomy by reconstructing the resulting parotid bed defect with a superiorly based sternocleidomastoid (SCM) rotational flap and by placement of gelfoam into the wound bed and a facelift dressing postoperatively to provide additional hemostasis and avoid drain placement. Methods All patients with benign parotid disease undergoing a drainless superficial parotidectomy and reconstruction with a superiorly based SCM rotational flap at our center were identified within a prospective cohort database between July 2010–2018. Primary outcomes included postoperative cosmetic and functional outcomes, complications and length of hospital stay. A secondary cost analysis was done to compare this novel technique to traditional superficial parotidectomy with surgical drain placement. Results Fifty patients were identified within the database and were included in the final analysis. The average length of hospital stay was 1.02 days. All patients were satisfied with their aesthetic outcome at 1 year. During long term follow-up, 63% of patients reported normal appearance of the operated side. Seven patient’s (14%) developed temporary facial paresis following surgery. All patients had resultant normal facial function at follow-up in 1 year. No patients developed subjective Frey’s Syndrome. Two patients (4%) developed a postoperative sialocele requiring drainage and one patient (2%) developed a hematoma on extubation requiring evacuation and drain placement. Cost analysis demonstrated a cost savings of approximately $975 per person following surgery. Conclusion In the current study, we introduced a novel approach of a drainless superficial parotidectomy using a superiorly based SCM flap, gelfoam and placement of a post-operative facelift dressing. This drainless approach was associated with good long-term cosmetic and functional outcomes with few postoperative complications. This new technique may also offer the potential for long-term savings to the health care system.

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“…Eine weitere von der Arbeitsgemeinschaft Speicheldrüsen-und Schilddrüsenerkrankungen unterstützte prospektive Studie an 100 Parotidektomien wies nach, dass Fazialismonitoring die Operationszeit in einer Ausbildungsklinik ohne Zunahme von Komplikation vermindert [101]. Eine Meta-Analyse hat darüber hinaus herausgearbeitet, dass das Fazialismonitoring bei Parotidektomie das Risiko zumindest von temporären Fazialisparesen verringert [102] Dies bestätigt auch noch einmal eine aktuelle randomisierte Studie ( ± Monitoring) [103]. Es wird dennoch sicher nicht flächendeckend in Deutschland mit Fazialismonitoring gearbeitet.…”

Section: Evidenz-basierte Daten Zum Fazialismanagementunclassified

Qualität der Therapie von Speicheldrüsenerkrankungen

Guntinas‐Lichius

2020

Laryngo-Rhino-Otol

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ZusammenfassungDie Behandlung von Speicheldrüsenerkrankungen stellt ein wichtiges Segment der HNO-Heilkunde dar. Von der Vielzahl von Speicheldrüsenerkrankungen sieht der einzelne HNO-Arzt allerdings möglicherweise nur wenige Fälle pro Jahr und chirurgische oder endoskopisch minimal-invasive Therapiekonzepte spielen eine wichtige Rolle. Daher kann der Erkenntnisgewinn nicht nur von prospektiven klinischen Studien getragen werden, sondern heute im Wesentlichen durch Meta-Analysen und potentiell auch von Registerdaten. Während eine Vielzahl guter Indikatoren vorhanden ist, um die Funktion der erkrankten Speicheldrüse und deren Besserung unter Therapie zu messen, sind Patient-reported outcome measures (PROMs) bislang nicht ausreichend entwickelt worden. Es ist zu fordern, dass diese Indikatoren auch konsequent in klinischen Studien eingesetzt werden. Perspektivisch könnten dieselben Indikatoren auch für Qualitätskontrollen in der ambulanten und stationären Routine angewandt werden. Die Rahmenbedingungen für einen qualitativ hochwertigen Wissenserwerb sind durch die HNO-Facharzt-Ausbildung, die Verpflichtung der Weiterbildung und durch zertifizierte Speicheldrüsen-Kurse prinzipiell sehr gut, die Vorgaben für spezifische Qualitätsstandards für die Behandlung von Patienten sind jedoch wenig ausgearbeitet. In Abgrenzung zu anderen Fachgebieten, die sich mit Speicheldrüsenerkrankungen beschäftigen, sollte die HNO-Heilkunde Standards mit hoher Qualitätsforderung für die Behandlung von Patienten mit Speicheldrüsenerkrankungen entwickeln.

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Facial nerve dysfunction after superficial parotidectomy with or without continuous intraoperative electromyographic neuromonitoring: a prospective randomized pilot study

Cited by 37 publications

References 37 publications

Factors associated with facial weakness following surgery for benign parotid disease: a retrospective multicenter study

Factors associated with facial weakness following surgery for benign parotid disease: a retrospective multicenter study

Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction

Qualität der Therapie von Speicheldrüsenerkrankungen

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