An objective assessment of proximal and distal facial nerve exploration during superficial parotidectomy

Abstract

Aim:This study was undertaken to compare the proximal and distal facial nerve exploration approach during superficial parotidectomy.Materials and Methods:A retrospective analysis of patients who underwent superficial parotidectomy at our center was conducted. Cases were divided into those who underwent superficial parotidectomy using distal facial nerve exploration and those who underwent standard proximal facial nerve exploration. Statistical comparisons of intraoperative blood loss and margin status (negative, focally, positive) were conducted between these two approaches.Results:A total of 39 patients underwent superficial parotidectomy at our center between 2008 and 2010. The technique used in most of the cases was conventional proximal nerve exploration technique (29 cases). Distal exploration of the buccal branch was undertaken only in 10 cases, on account of difficulty in locating the main trunk intraoperatively due to the presence of postinflammatory fibrosis. The average patient age was 48 years with a female preponderance (67%). Both the techniques consumed almost same average operative time (2.4 hours) and average intraoperative blood loss (68.0 cc vs 25.4 cc) was more in the cases where proximal nerve exploration was resorted (S.E (d) = 0.89). No significant difference in surgical margin status was noticed between the two techniques (P > 0.05).Conclusion:Both the techniques are efficient without compromising the surgical margins, but the average intraoperative blood loss is less in distal facial nerve exploration technique.

Antegrade versus retrograde facial nerve dissection in benign parotid surgery: Is there a difference in postoperative outcomes? A meta-analysis

“…Assessment of other variables such as Frey’s syndrome[ 46 , 47 ] salivary fistula,[ 44 ] [ 47 ] sialocele [ 53 ], recurrence rate[ 46 ][ 47 ] and amount of healthy salivary gland removed, [ 46 ] operative time,[ 45 – 47 , 52 ] blood loss[ 45 , 47 , 51 ] and length of postoperative stay in the hospital[ 39 ] was summarized in the Table 4 and Data underlying the meta-analysis ( S1 Data ).…”

“…Concerning quality assessment of included studies, four studies were considered as having low risk of bias[ 44 , 45 , 49 , 52 ], and six studies were scored as moderate risk of bias[ 46 – 48 , 50 , 51 , 53 ]. ( Table 2 ).…”

“…The pooled overall effect was (Random; MD, 19.30 min; 95% CI, -2.79–41.39, P = 0.09). The volume of blood loss during surgery was reported in three studies[ 45 , 47 , 51 ]. Two studies[ 45 ][ 51 ] reported significant reduction in volume of blood loss in RFND versus AFND whereas one study[ 47 ] reported non-significant difference in volume of blood loss between both groups ( Table 4 ).…”

“…The volume of blood loss during surgery was reported in three studies[ 45 , 47 , 51 ]. Two studies[ 45 ][ 51 ] reported significant reduction in volume of blood loss in RFND versus AFND whereas one study[ 47 ] reported non-significant difference in volume of blood loss between both groups ( Table 4 ). Sialocele [ 53 ] and the length of postoperative hospital stay[ 47 ] were evaluated only in two separate studies.…”

“…This finding was in line with our finding, however, the authors included three studies which were excluded from our systemic review and meta-analysis due to inclusion of malignant tumors [ 12 , 34 , 36 ]( Table 3 ). Additionally, they did not include four more studies with benign tumors in their meta-analysis[ 44 , 45 , 47 , 51 ]. Moreover, the current systemic review and meta-analysis also reported the outcomes of AFND versus RFND in regard to Frey’s syndrome, recurrence rate, sialocele, salivary fistula and blood loss which were not reported in the Stankovic et al’s study[ 54 ] ( Table 3 ) and ( S1 Data ).…”