Surgical Treatment of Chronic Parotitis

Abstract

Introduction chronic parotitis (CP) is a hindering, recurring inflammatory ailment that eventually leads to the destruction of the parotid gland. When conservative measures and sialendoscopy fail, parotidectomy can be indicated. Objective to evaluate the efficacy and safety of parotidectomy as a treatment for CP unresponsive to conservative therapy, and to compare superficial and near-total parotidectomy (SP and NTP). Methods retrospective consecutive case series of patients who underwent parotidectomy for CP between January 1999 and May 2012. The primary outcome variables were recurrence, patient contentment, transient and permanent facial nerve palsy and Frey syndrome. The categorical variables were analyzed using the two-sided Fisher exact test. Alongside, an elaborate review of the current literature was conducted. Results a total of 46 parotidectomies were performed on 37 patients with CP. Near-total parotidectomy was performed in 41 and SP in 5 cases. Eighty-four percent of patients was available for the telephone questionnaire (31 patients, 40 parotidectomies) with a mean follow-up period of 6,2 years. Treatment was successful in 40/46 parotidectomies (87%) and 95% of the patients were content with the result. The incidence of permanent and transient facial nerve palsy was 0 (0%) and 12 (26.1%), respectively. Frey syndrome manifested in 20 (43.5%) patients. Neither this study nor careful review of the current literature resulted in evident difference between SP and NTP regarding the primary outcome variables. Conclusion parotidectomy is a safe and effective treatment for CP in case conservative therapy fails. There is no evidence of a distinct difference between SP and NTP regarding efficiency, facial nerve palsy or Frey syndrome.

Superficial parotidectomy for chronic parotid sialadenitis: a case series and review of the literature

“…Van der Lans et al . 12 performed 5 superficial and 41 near-total parotidectomies, and found no significant association between the extent of the parenchymal resection and the incidence of temporary facial nerve palsy. Similar conclusions were drawn by Patel et al .…”

“…Van der Lans et al . 12 reported recurrence in six patients (13 per cent), three undergoing superficial parotidectomy and three near-total. Four of these patients were managed conservatively, one opted for salvage near-total parotidectomy and one declined any further treatment.…”

“…Therefore, it appears the incidence of a permanent facial nerve palsy following parotidectomy performed for chronic parotid sialadenitis is low, and comparable with parotidectomy carried out for other benign parotid disease. 10–12…”

“…This result is corroborated by four other studies in the literature detailing enough information to allow statistical analyses ( p > 0.1–0.3). 9,12,14,15

Surgical management of chronic parotid sialadenitis should be considered only when conservative therapy has failed Studies have shown good results with parotidectomy, widely considered the choice treatment for medically refractory chronic parotid sialadenitis Risk of permanent facial nerve palsy with superficial parotidectomy is low and comparable with parotidectomy for other benign parotid disease This study demonstrates that superficial parotidectomy is safe and effective for medically refractory chronic parotid sialadenitis Superficial parotidectomy obviates the need for a more extensive parenchymal resection associated with increased morbidity

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Superficial Parotidectomy for Juvenile Recurrent Parotitis

“…Specimens were reviewed for key features including periductal inflammation/fibrosis and infiltration of inflammatory cells, variable dilation of intraglandular ducts, and acinar atrophy with profound fibrosis and/or deposition of fatty tissue. 11 A diagnosis of lymphoma was excluded where appropriate. For two patients, tissue slides could not be obtained and were excluded from this portion of the analysis.…”