Retrograde Parotidectomy and facial nerve outcomes: A case series of 44 patients

Kligerman, Maxwell P.; Song, Yuyan; Schoppy, David W.; Divi, Vasu; Megwalu, Uchechukwu C.; Haughey, Bruce H.; Sirjani, Davud

doi:10.1016/j.amjoto.2017.05.003

Cited by 16 publications

(39 citation statements)

References 16 publications

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“…The incidence of bleeding in retrograde approach is much less and landmarks for marginal mandibular nerve identification are considerably superficial. 9 O' Regan et al studied 138 patients undergoing retrograde superficial parotidectomy and reported that 66% of the patients exhibited facial weakness for the first week and 38% had it for the first month. But by the end of first six months, 99% of the patients had fully recovered.…”

Section: Discussionmentioning

confidence: 99%

“…8 The other known complications after Superficial Parotidectomy include Frey's syndrome, salivary fistula, and wound infection. 9 There are two principal approaches to identify and dissect the facial nerve. 10 Firstly, the more commonly used technique is anterograde dissection where the main trunk of nerve is identified first and it is traced to its division into terminal branches.…”

Section: Original Articlementioning

confidence: 99%

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Superficial Parotidectomy by Retrograde approach through Marginal Mandibular Nerve Dissection

Hussain

Farid

Uddin

2019

JIMDC

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A B S T R A C TBackground: Parotid gland is most commonly involved in tumors, comprising about 80% of the salivary gland neoplasms. Majority of parotid tumors are benign in nature, the most common being pleomorphic adenoma. Superficial Parotidectomy is the preferred treatment option, using either anterograde or retrograde approach. The objective of this study was to determine the post-operative facial nerve status and other complications following superficial parotidectomy by retrograde dissection for benign lesions of parotid gland. Material and Methods: This prospective clinical study included a total of 22 patients who had superficial Parotidectomy by retrograde technique involving marginal mandibular nerve dissection. These patients were studied post-operatively for facial nerve status, Frey's Syndrome, wound infection and salivary fistula. Results: Out of a total of 22 patients, 54.54% developed temporary facial palsy on ipsilateral angle of mouth and all of them recovered by the end of 3 months post-surgery. Two patients (9.09%) developed salivary gland fistula and both of them healed spontaneously within two weeks. Frey's Syndrome and wound infection were not seen in any of the patients included in the study. Histopathology of these lesions revealed pleomorphic adenoma (n=20) and Warthin's tumor (n=2), respectively. Conclusion: The use of marginal mandibular nerve as a landmark for retrograde dissection of facial nerve in superficial Parotidectomy is a reliable method to ensure lower percentage of facial nerve injury and associated complications.

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Section: Discussionmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

Superficial Parotidectomy by Retrograde approach through Marginal Mandibular Nerve Dissection

Hussain

Farid

Uddin

2019

JIMDC

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“…In a recent study it was reported that the incidence of temporary facial nerve injury after R.P was 13.6% and none were more than HB-2 (house brackman score). [7] Bhattacharya e tal had, [1] in his study in 2004, none of his patients injured (temporary or permanent) their facial nerve that underwent retrograde parotidectomy. Wang etal also reported no incidence of facial nerve paresis on his study of 383 patients.…”

Section: Discussionmentioning

confidence: 99%

“…[1,6] This technique also offers wide operative field visibility for both surgeons and the assistants thus resulting in less traction induced nerve injuries. [7] A wider operative field will help in easier dissection and better haemostasis. If the tumour is large or if the main trunk of the facial nerve is displaced by the tumour, it will be difficult to expose the main trunk and the retrograde technique may be useful.…”

Section: Discussionmentioning

confidence: 99%

Retrograde Facial Nerve Dissection Using Zygomatic Branch as Landmark in Parotid Gland Surgery for Pleomorphic Adenoma: A 4 Year Prospective Study of 40 Cases

Biswal¹,

Sebastian²

2018

AIMDR

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Background: The retrograde dissection for doing parotidectomy is technically easier and surgeon can limit the dissection to 1 or 2 branches of facial nerve if required and hence avoids injury to the trunk or other branches of facial nerve, aiming at removal of only the parotid parenchymal area that bears the tumour. Objectives: To compare our results with those of similar studies in the recent literature. To compare nerve recovery rates when zygomatic branch is used as landmark with that of other techniques from literature. Methods: In this study 40 patients with pleomorphic adenoma of parotid gland underwent superficial parotidectomy at V.S.S Medical College hospital Burla and S.C.B medical college Cuttack in a 4 year period between 2013 and 2016. All 40 patients underwent retrograde superficial parotidectomy. We compared our results with results of similar studies in the recent literature. Results: Although all 40 patients experienced paresis immediately after surgery, 25% patients completely recovered and 75% patients had facial nerve weakness at the end of first week. Among this 60% patients were having H.B-2 weakness, 7.5% had H.B-3 weakness, 5% had H.B-4 and 2.5% had H.B-5 weakness. Any injury equal to or more than H.B-3 was considered serious. 15% patients were having serious injury. None of the patients had H.B-6 (severe) facial nerve weakness. Conclusion: Transient nerve weakness after retrograde parotidectomy is common but recovery will be faster than that of ante grade technique and within 6 months to 1 year all patients should recover nerve function completely.

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“…This is defined as anterograde parotidectomy (AP) 2) . The alternative approach is retrograde parotidectomy (RP), wherein peripheral branches of the facial nerve are identified first and then dissected posteriorly to the main trunk 3) .…”

Section: Introductionmentioning

confidence: 99%

Indications for partial superficial parotidectomy for benign parotid gland tumors using the retrograde approach

Suzuki

Nakaegawa

Kobayashi

et al. 2020

FJMS

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A recent systematic review and metaanalysis suggest that retrograde parotidectomy is a safe procedure with no significant difference in facial nerve paralysis rates when compared to anterograde parotidectomy. The aim of the current study was to establish indications for partial superficial parotidectomy using the retrograde approach. To this end, the two surgical techniques were compared in terms of postoperative facial nerve paralysis, tumor size, location of the tumor, and surgical time. For tumor diameters of 30 mm or less, mean surgical time in the retrograde parotidectomy group was significantly shorter than in the anterograde parotidectomy group (p < 0.05). Our study indicates that retrograde parotidectomy may be more effective than anterograde parotidectomy for partial superficial parotidectomy for benign parotid tumors of 30 mm or less.

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Retrograde Parotidectomy and facial nerve outcomes: A case series of 44 patients

Cited by 16 publications

References 16 publications

Superficial Parotidectomy by Retrograde approach through Marginal Mandibular Nerve Dissection

Superficial Parotidectomy by Retrograde approach through Marginal Mandibular Nerve Dissection

Retrograde Facial Nerve Dissection Using Zygomatic Branch as Landmark in Parotid Gland Surgery for Pleomorphic Adenoma: A 4 Year Prospective Study of 40 Cases

Indications for partial superficial parotidectomy for benign parotid gland tumors using the retrograde approach

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