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

Abstract

ObjectiveThe primary aim of this meta-analysis was to test the null hypothesis of no difference in facial nerve dysfunction in studies that compared classical antegrade facial nerve dissection (AFND) versus retrograde facial nerve dissection (RFND) during benign parotid surgery.MethodsA comprehensive search of PubMed, the Cochrane Central Register of Controlled Trials, Scopus, Google Scholar, Science Direct and relevant journals was undertaken up to June 27, 2018. Randomized controlled clinical trials (RCTs), controlled clinical trials (CCTs), and retrospective studies aimed at comparing the effect of AFND vs. RFND during parotidectomy were included. The outcome measures included facial nerve dysfunction, Frey’s syndrome, recurrence, silaocele, salivary fistula, operating time length of hospital stay, and estimated blood loss. Pooled risk ratio (RR) and weighted mean differences (MD) with 95% confidence intervals were calculated using either a fixed-effects or random-effects model.ResultsTen studies; four RCTs and five retrospective studies were included. There were 570 patients (319 in RFND group and 251 in AFND group). 481 patients in 9 studies reported the incidence rate of facial nerve dysfunction. No statistical significant difference was observed between both groups concerning the occurrence of transient or permanent facial nerve paralysis (p = 0.44 and 0.11 respectively). One out 10 studies reported the incidence rate of sialocele, however no statistical difference was observed between the two techniques. There was reduction in the operative time (19.30 min), amount of blood loss (25.08 ml) and amount of healthy salivary tissues removed (12.20 mm) in RFND compared with AFND.ConclusionsAccording to the results of the current review there is no evidence demonstrating a significant advantage of one approach over another, therefore, well-designed standardized RCTs are required.

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

“…Main advantages of the method are the standardized identification of the FN which makes its protection independent of tumor size and location and correct function of the neuromonitoring, and thus being very well teachable in a standardized way to junior surgeons [59]. In a minority of patients, where the tumor has a substantial volume around the stylomastoid foramen, especially anterior and inferior, a retrograde preparation of the FN is necessary in order not to injure the tumor capsule [60,61].…”

Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature

“… 39 For facial nerve dissection during benign parotid surgery, the occurrence of facial nerve paralysis was not seen to differentiate in accordance with which dissection technique was used, be it classical antegrade, or retrograde facial nerve dissection. 40 …”

Partial Superficial Parotidectomy Versus Extracapsular Anatomical Dissection for the Treatment of Benign Parotid Tumors

“…Another limitation of this retrospective study is considered to be the lack of data regarding retrograde facial nerve dissection. According to the current literature, antegrade and retrograde facial nerve dissection did not demonstrate any significant advantage regarding surgical outcomes (19). Therefore, there is still insufficient evidence regarding which dissection approach produces the best results in the treatment of parotid tumors (19).…”