Ultrasound can help to indirectly predict contact of parotid tumors to the facial nerve, correct intraglandular localization, and appropriate surgical technique

Psychogios, Georgios; Rueger, Holger; Jering, Monika; Tsoures, E; Künzel, Julian; Zenk, Johannes

doi:10.1002/hed.25811

Cited by 19 publications

(16 citation statements)

References 30 publications

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“…Fine‐ or core‐needle biopsies are not performed in our department in these distinct situations. Furthermore, US was helpful in most cases in classifying tumor ESGS categories 25,36 and in estimating the surgical extent preoperatively 37 . Despite thorough preoperative planning, the final decision as to which surgical modality should be chosen is made during the operation, and therefore requires an experienced surgeon familiar with the different techniques.…”

Section: Discussionmentioning

confidence: 99%

Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow‐up

et al. 2020

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Objectives/Hypothesis To assess long‐term results after the treatment of parotid pleomorphic adenomas (PPAs) using different surgical techniques and focusing on recurrence rates and the risk of adverse effects. Study Design Retrospective analysis. Methods Retrospective analysis of 182 patients treated exclusively for PPAs at a tertiary referral center between 2000 and 2004. Thorough follow‐up examinations over a mean period of 13 years were possible in 53.8% (n = 98/182). Tumors were categorized according to the European Salivary Gland Society (ESGS) system to improve the comparison of outcomes. After different surgical resection strategies, recurrence rates, postoperative facial nerve paresis (FNP), and incidence of Frey's syndrome were assessed. The follow‐up period included clinical examinations and imaging of every patient in the treating department. Results Of 182 patients, extracapsular dissection (ED) was performed in 29.7%, and other surgical modalities (OSMs), including facial nerve dissection, in 70.3%. After the long‐term follow‐up, 98% of all the patients (n = 96/98) were recurrence free. When recurrence rates were compared, no significant differences were noted (P < .331). ED resulted in significantly lower FNP rates compared to OSMs (P < .001). FNP rates significantly increased with size and location of the tumors according to ESGS categories (temporary and permanent FNP, P = .04). Surgical invasiveness corresponded to a significant increase in the incidence of Frey's syndrome (P < .001). Conclusions ED was associated with the lowest complication rates, but not with a higher risk of recurrence, when compared with OSM in the long‐term course. As ED can be performed in the majority of PPAs, it can be regarded as the treatment of choice whenever possible. Level of Evidence 4 Laryngoscope, 131:E445–E451, 2021

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Section: Discussionmentioning

confidence: 99%

Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow‐up

et al. 2020

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“…(Anatomical) Criteria that influence decision making in benign parotid surgery are tumor size, tumor location (in caudal or cranial part of the parotid gland), mobility of the tumor, distance from the surface of the parotid gland, proximity to the retromandibular vein (RMV), the FN and the Stensen's duct (ESGS level V). Especially the proximity of the tumor to the RMV can be detected with ultrasound or MRI and has been proven to be a great indicator of proximity to the FN [62,63]. Therefore, it is very important for the surgeon to thoroughly examine the available imaging of the patient and choose the proper surgical procedure before entering the operating theatre [64].…”

Section: Indications For Different Surgical Techniques In Benign Paro...mentioning

confidence: 99%

Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors

Psychogios

Bohr

Constantinidis

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Surgical treatment of benign parotid tumors has developed in the direction of less invasive procedures in recent years and has raised great debate about the best surgical approach. Aim of this article is to analyse anatomical and other factors that are important in selection of the appropriate surgical technique in treatment of benign parotid tumors. Furthermore, to discuss the risk of complications and recurrent disease according to selected operation. Finally, to define patient selection criteria to facilitate decision making in parotid surgery and become a guide for younger surgeons. Methods Literature review and authors' personal opinions based on their surgical experience. Results All possible surgical techniques for benign parotid surgery with advantages and disadvantages are being described. An algorithm with anatomical and other criteria influencing decision making in benign parotid surgery is presented. Conclusion Surgeons nowadays have many options to choose from for benign parotid surgery. ECD is one of the many surgical techniques available in parotid surgery and can achieve excellent results with proper training and if used for proper indications. PSP is mainly indicated in large tumors of the caudal part of the PG (ESGS level II). SP represents a universal solution in parotid surgery and should be the first technique young surgeons learn. TP has only few but important indications in benign parotid surgery. Surgeons need to carefully consider the patient and his/her preoperative imaging as well as her or his own special expertise to select the most appropriate surgical technique.

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“…Die Ultraschalluntersuchung kann durch die Lagebeziehung des Tumors zu anderen sichtbaren anatomischen Landmarken einen Hinweis darauf geben, ob der Tumor wahrscheinlich Kontakt zum Nerv hat oder nicht [ 4 ]. Mit hochauflösendem Ultraschall ist der N. facialis prinzipiell darstellbar, verlangt aber bislang eine hohe Expertise und ist für die klinische Routine noch nicht geeignet [ 5 ].…”

Section: Präoperative Beurteilung Der Funktion Des N Facialisunclassified

Preservation, reconstruction, and rehabilitation of the facial nerve

Thielker

Kouka

Guntinas‐Lichius

2022

HNO

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Der Umgang mit dem N. facialis ist bei der Operation eines Parotiskarzinoms wichtig für die Langzeitlebensqualität des Patienten. In etwa 2 Drittel der Fälle ist der N. facialis nicht vom Tumor befallen. In diesen Fällen sind neben vollständiger Tumorentfernung die Identifizierung und der Erhalt des Nervs für eine erfolgreiche Operation wesentlich. Ist der Nerv vom Tumor infiltriert, muss der betroffene Teil des Nervs im Rahmen einer radikalen Parotidektomie reseziert werden. Die primäre Nervenrekonstruktion, sofern möglich, führt zu den besten funktionellen und kosmetischen Langzeitergebnissen. Das individuell optimale Therapiekonzept basiert zum einen auf der klinischen Prüfung der Gesichtsbeweglichkeit, zum anderen auf der präoperativen Bildgebung, um die Lagebeziehung zwischen Tumor und Nerv zu verstehen, und schließlich auf einer elektrophysiologischen Untersuchung zur Funktion des Nervs. Intraoperativ hilft ein standardisiertes Vorgehen, um den Nerv zu identifizieren und zu erhalten. Wenn eine radikale Parotidektomie indiziert ist, kann bereits die präoperative Diagnostik helfen, neben der einzeitigen Rekonstruktion auch die adjuvante postoperative Therapie zu planen. Das Ziel der Rehabilitation ist die Wiederherstellung von Tonus, Symmetrie und Bewegung des gelähmten Gesichts. Die Wiederherstellung des Augenschlusses hat hohe Priorität. Bei der chirurgischen Therapie von Gesichtslähmungen gab es in den letzten Jahren viele Verbesserungen. Die vorliegende Arbeit gibt einen Überblick über die jüngsten Fortschritte in der Diagnostik, den Operationstechniken und weiteren Möglichkeiten zur Protektion des gesunden N. facialis. Anderseits wird die Rehabilitation des tumorinfiltrierten N. facialis im Kontext der Behandlung von Speicheldrüsenmalignomen beschrieben.

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Ultrasound can help to indirectly predict contact of parotid tumors to the facial nerve, correct intraglandular localization, and appropriate surgical technique

Cited by 19 publications

References 30 publications

Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow‐up

Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow‐up

Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors

Preservation, reconstruction, and rehabilitation of the facial nerve

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