Functional outcomes after extracapsular dissection with partial facial nerve dissection for small and large parotid neoplasms

Auger, Samuel R.; Kramer, Dallas E.; Hardy, Brendan M.; Jandali, Danny; Stenson, Kerstin; Koçak, Mehmet; Al‐Khudari, Samer

doi:10.1016/j.amjoto.2020.102770

Cited by 15 publications

(11 citation statements)

References 17 publications

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“…The risk factors for facial nerve palsy reportedly include older age, tumor size ( 6 , 40 ), tumor in the deep lobe, long operation time, extensive bleeding, and lack of FNM ( 41 , 42 ). However, controversy exists, in that some researchers contend that there is no significant difference in complication rates relative to tumor size and tumor in the deep lobe ( 43 ), the length of the dissected facial nerve ( 44 ), and the extent of parotidectomy ( 45 ). We usually identify the trunk of the facial nerve using FNM and follow the branch to confirm nerve integrity.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of parotid gland tumors at a single institution

et al. 2022

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The aim of the present study was to analyze the clinical characteristics, surgical treatments and clinical outcome of patients with parotid gland tumors and to compare the results with those cited in the literature. A retrospective study was conducted in 140 patients (male, n=77; female, n=63) with parotid gland tumors who underwent parotidectomy at Hokuto Hospital Department of Otolaryngology-Head and Neck Surgery (Obihiro, Japan) between April 2007 and December 2021. Of the 140 patients enrolled, 118 (84.3%) patients had benign tumors, including 63 (45%) patients with pleomorphic adenomas and 43 (30.7%) patients with Warthin tumors, and 22 patients (15.7%) had parotid carcinoma. Comparison of the three groups of patients with parotid gland tumors indicated that pack years as an indicator of smoking status were significantly higher in patients with Warthin tumors than in those with parotid carcinomas (P=0.011) or pleomorphic adenoma (P<0.001). Fine-needle aspiration cytology (FNAC) was non-diagnostic for only 6 (4.3%) of 140 patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC by both conventional smear and liquid-based cytology (LBC) for parotid carcinomas were 70, 99, 93.3, 94.4 and 82.9%, respectively. Among the 22 patients with parotid carcinoma, extended total/total and superficial parotidectomy were performed in 10 (45%) and 11 (50%) cases, respectively. Total and selective neck dissection of the area from level II to I, II and III were performed in 6 (24%) and 7 (32%) patients, respectively. Postoperative radiotherapy (50 Gy) was performed in 15 (68%) patients. The overall survival (OS) and disease-free survival (DFS) rates at 5 years were 51.5 and 76.4%, respectively. Univariate analysis revealed that age >65 years was significantly associated with poorer 5-year OS (P<0.001) and DFS (P<0.001). Multivariate analysis revealed that an age of more than 65 years combined with high-grade histologic malignancy was associated with worse DFS (P=0.02; hazard ratio, 3.628; 95% confidence interval, 1.283-9.514). In conclusion, the clinical characteristics and treatment outcomes of parotid gland tumors were consistent with the results of previous reports. Smoking may be closely related to the pathogenesis of Warthin tumors. LBC potentially provides improved accuracy in FNAC.

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Section: Discussionmentioning

confidence: 99%

A retrospective study of parotid gland tumors at a single institution

et al. 2022

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“…Although the extension of the resection in the treatment of benign parotid tumors ranged from limited resections to total parotidectomy with preservation of the facial nerve [ 9 , 20 , 21 , 22 ], there is still a tendency to use limited surgeries, especially in small benign tumors [ 7 , 8 , 9 , 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Minimal Margin Surgery and Intraoperative Neuromonitoring in Benign Parotid Gland Tumors: Retrospective Clinical Study

Massimilla

Motta

Magaldi

et al. 2022

JPM

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Extracapsular dissection (ECD) was introduced for the removal of superficial and small benign parotid tumors. According to a recent proposal, ECD is reserved for tumors that are 3 cm or less, mobile, and close to the parotid borders in cases of pleomorphic adenoma. The aim of the study is to evaluate the effectiveness of ECD for treatment of benign parotid tumors also in cases of tumors that were larger than 3 cm and deeper. All ECD for benign parotid neoplasms conducted between 2007 and 2017 were reviewed. The lesions included were limited to primary parotid tumors and categorized by Quer proposal. Facial nerve monitoring was used in all cases. Facial nerve palsy and local recurrences were assessed. The 88 ECD performed met inclusion criteria. The mean lesion size was 4.26 cm. Of the tumors, 68 were less than 3 cm in diameter and 20 were larger, 64 were superficial, and 24 were deep. The most common lesion types were pleomorphic adenoma (88.6%). There was no significant difference in complication rates between the size of tumor (p = 0.9) and location (p = 0.91). Our results suggest that extracapsular dissection could be considered an option for first-time diagnosed benign parotid tumors, even in cases of large dimensions and deep lobe involvement.

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“…Higher ESGS category was associated with an increased risk of temporary/permanent weakness and Frey's syndrome, but not recurrence 17 . Auger et al 20 studied 51 tumors treated by ECD with limited dissection of encountered nerve branches; 77.1% of tumors were category I/II and ESGS category was not associated with the incidence of sialocele, seroma, or nerve palsy. The variability in technique performed for each category is likely multifactorial and based on surgeon experience and preference as well as tumor‐nerve proximity.…”

Section: Discussionmentioning

confidence: 99%

Patient safety and quality improvements in parotid surgery

Talati

Brown

Losenegger

et al. 2022

World j. otorhinolaryngol.-head neck surg.

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Parotidectomy is the mainstay treatment for tumors of the parotid gland. In an effort to improve clinical outcomes, several modern surgical techniques and perioperative interventions have been evaluated and refined. This review discusses current and actively debated perioperative interventions aimed at improving patient safety and the quality of parotidectomy. Relevant high‐impact literature pertaining to preoperative diagnostic modalities, intraoperative surgical techniques, and postoperative care will be described.

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Functional outcomes after extracapsular dissection with partial facial nerve dissection for small and large parotid neoplasms

Cited by 15 publications

References 17 publications

A retrospective study of parotid gland tumors at a single institution

A retrospective study of parotid gland tumors at a single institution

Minimal Margin Surgery and Intraoperative Neuromonitoring in Benign Parotid Gland Tumors: Retrospective Clinical Study

Patient safety and quality improvements in parotid surgery

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