Cervicomastoidfacial versus modified facelift incision for parotid surgery: a patient feedback comparison

Abstract

Ann R Coll Surg Engl 2010; 92: 40-43 40Indications for parotidectomy include benign and malignant tumours as well as inflammatory conditions of the parotid gland.1 Traditionally, the cervicomastoidfacial incision (alternatively known as the modified Blair incision) is used for surgery of the parotid gland which offers excellent surgical access to the parotid gland, but leaves a visible scar in the neck. Alternatively, for suspected benign tumours, a more cosmetic modified facelift (rhytidectomy) incision can be considered which leaves no visible neck scar.2 At the Luton & Dunstable Hospital, parotidectomy is performed by ear nose and throat (ENT) and maxillofacial surgeons. We retrospectively analysed parotidectomies performed by both departments over a 2-year period. The aim of this study was to establish the frequency of each surgical approach used and to identify any difference in complication and patient satisfaction of the operative scar between the two incisions. Patients and MethodsA retrospective analysis of case notes for patients who underwent parotidectomy by both ENT and maxillofacial departments between January 2006 and February 2008 was undertaken. All operations were either performed or supervised by a consultant. Only benign indications for parotidectomy were considered for this study; thus, histologically confirmed cases of malignancy were excluded. The numbers of patients who underwent parotidectomy via a cervicomastoidfacial and modified facelift incision were counted. For each incision, details regarding immediate postoperative facial nerve weakness and wound haematoma were obtained from the notes. A patient-outcome evaluation questionnaire was posted to all included patients at least 6 months following their parotid surgery. Information regarding facial paraesthesia and gustatory sweating was sought, The rhytidectomy or modified facelift (MF) incision allows an alternative approach which leaves no visible neck scar. The objective of this study was to establish the frequency of each surgical approach used and identify any difference in complication and patient satisfaction between the two incisions for benign conditions of the parotid gland. PATIENTS AND METHODS A retrospective analysis of 101 case notes for patients who underwent parotidectomy by both ENT and maxillofacial departments between January 2006 and February 2008 was undertaken. All histologically confirmed cases of malignancy were excluded. For each incision, immediate postoperative complications were obtained from the notes. A postal patient outcome evaluation questionnaire sought information regarding persistent and late complications as well as a visual analogue scar satisfaction score for both incisions. RESULTS Overall, 79 parotidectomies were included (59 CMF incisions, 20 MF incisions). Of CMF incisions, 34% suffered facial weakness immediately postoperatively versus 20% of MF incisions. Of CMF incisions, 4% suffered postoperative haematomas versus none following MF incisions. In the study cohort, 47 (60%) responded to the ...

Modified facelift approach combined with a superficial musculoaponeurotic system flap in the treatment of benign parotid tumors

“…Temporary changes to facial movements may happen in between 10% and 70% of cases (Hegazy et al, 2011), andLee et al, (2011) did not observe differences between the incidence of facial paralysis in patients undergoing parotidectomy by the modified facelift incision or the classic Blair approach. Contrary to this, Wasson et al (2010) found a 34% of facial nerve dysfunction in patients operated via the Blair incision, compared to 20% in the cases approached through a modified facelift. In our study, we found a transient facial nerve dysfunction in 15 patients (24%), but in all cases the recovery was spontaneous and complete, irrespectively of the surgical approach.…”

Intra-auricular modification of facelift incision with sternocleidomastoid flap - a cosmetic approach for parotidectomy: how we do it

“…The modified facelift incision is performed to avoid a neck scar and therefore improve cosmetic outcome, but no study has yet measured or compared patient satisfaction of the surgical scar for each approach. Contrary to that published by others in the literatures, intra‐auricular modification of facelift incision group scored better about the postoperative scar compared with the cervicomastoidfacial incision in the follow‐up questionnaire from phone call 7 . Even though we did not experience many cases, our results were encouraging.…”

“…Contrary to that published by others in the literatures, intra-auricular modification of facelift incision group scored better about the postoperative scar compared with the cervicomastoidfacial incision in the follow-up questionnaire from phone call. 7 Even though we did not experience many cases, our results were encouraging. While using intra-auricular modification of facelift incision, the neck and pre-auricular scar which the patients most concerned about could be minimised owing to the following factors: post-auricular hairline incision, retrotragal incision and the abbreviation of extension incision above the tragus.…”

Parotidectomy via Individualized Mini-Blair Incision

“…In pursuit of an alternative cervical incision, Appiani and Delfino [12] described the modified facelift incision (MFI) using a retroauricular incision and positioning the cervical cut posteriorly near the hair line, thus avoiding the most visible part of the scar. It has been argued that the MFI has better cosmetic results than the MBI [13,14]. However, there is still concern that this incision limits surgical exposure.…”