Incidence of postoperative facial weakness in parotid tumor surgery: a tumor subsite analysis of 794 parotidectomies

Jin, Hokyung; Kim, Bo Young; Kim, Heejung; Lee, Eun-Kyu; Park, Woori; Choi, Sung Yong; Chung, Man Ki; Son, Young‐Ik; Baek, Chung‐Hwan; Jeong, Han‐Sin

doi:10.1186/s12893-019-0666-6

Cited by 57 publications

(76 citation statements)

References 44 publications

(74 reference statements)

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“…Complications were compared among all patients when stratified by parotidectomy approach ( complications. 15,16 The current study reviews the largest published single surgeon As noted, 924 cases reviewed were managed in an established and consistent manner for the time period studied, with commensurate close follow-up. This represents the largest single surgeon series and compares favorably in size to single institutional series over a similar time period reported in the literature.…”

Section: Management Approachmentioning

confidence: 99%

“…The literature is marked by smaller single institution series limited in number and scope, as well as larger database series lacking in specific detail. 8,[14][15][16][17][18][19] Other recent series from single institutions are larger in their scope and consistency, but they do possess the critical limiting variable of combined experiences of multiple surgeons participating over many years. 16,[20][21][22] Large single surgeon experiences utilizing a distinct and consistent approach to the management of parotid masses over a multi-year period in an academic setting are lacking.…”

mentioning

confidence: 99%

“…8,[14][15][16][17][18][19] Other recent series from single institutions are larger in their scope and consistency, but they do possess the critical limiting variable of combined experiences of multiple surgeons participating over many years. 16,[20][21][22] Large single surgeon experiences utilizing a distinct and consistent approach to the management of parotid masses over a multi-year period in an academic setting are lacking. 23 To address these limitations and to provide insight into the specific issues surrounding parotidectomy surgery, we reviewed the large single surgeon experience of the primary author (D. G. D.) utilizing a consistent operative approach to parotid salivary gland mass management applied in an academic institution with trainee involvement.…”

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confidence: 99%

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Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

Deschler

Kozin

Kanumuri

et al. 2020

Laryngoscope Investig Oto

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Objective: As large single-surgeon series in the literature are lacking, we sought to review a single-surgeon's experience with parotidectomy in an academic center, with a focused analysis of pathology, technique, and facial nerve (FN) weakness. Benchmark values for complications and operative times with routine trainee involvement and without continuous FN monitoring are offered. Materials and Methods: All patients who underwent parotidectomy, performed by D. G. D., for benign and malignant disease between January 2004 and December 2018 at an academic center were reviewed. Results: A total of 924 parotidectomies, with adequate evaluatable data were identified. The majority of patients had benign tumors (70.9%). Partial/superficial parotidectomy was the most common approach (65.7%). Selective FN branch sacrifice was rare (12.3%), but significantly more common among patients with malignant pathology (33.8% vs 3.5% for benign, P < .0001). Among patients with intact FN, post-operative short-and long-term FN weaknesses were rare (6.5% and 1.7%, respectively). These rates were lower among patients with benign tumors (5.4% and 1.3%). Partial/superficial parotidectomy for benign tumors was associated with a low rate of short-and long-term FN weaknesses (2.7% and 0.9%). Mean OR time was 185 minutes. Conclusion: This is the largest single-surgeon series on parotidectomy, spanning 15 years. We demonstrate excellent long-and short-term FN paresis rates with acceptable operative times without regular use of continuous FN monitoring and with routine trainee involvement. These findings may provide valuable insight into parotid tumor pathology, FN outcomes, and feasibility and expectations of performing parotidectomy in an academic setting.

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Section: Management Approachmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

Deschler

Kozin

Kanumuri

et al. 2020

Laryngoscope Investig Oto

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“…They considered facial contour restoration and color match of the skin paddle when present. The observers reviewed the photographs and scored the results on a 5-point Likert's scale that ranged from "poor result" (1) to "excellent result" (5). A mean score greater than 3 was considered as a satisfactory result.…”

Section: Methodsmentioning

confidence: 99%

“…This accounts for approximately 302.47 new cases per year in the United States. 4,5 The histologic subtypes most frequently responsible for oncologic facial palsy (FP) are salivary gland cancers, FN schwannomas, and squamous cell carcinomas. 6,7 Their extension often goes beyond the parotid compartment and requires extensive local resection leading to complex multitissue type defects.…”

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confidence: 99%

Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap

Mangialardi

Honart

Qassemyar³

et al. 2020

J Reconstr Microsurg

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Background Cancer involving the parotid gland region may originates from parotid parenchyma itself or from locoregional organs and in rare cases, the facial nerve (FN) has to be sacrificed during tumor resection. In these cases, cancer extension often goes beyond the parotid compartment and requires extensive local resection responsible for complex multitissular defects. The goals of reconstruction may be summarized in the following two components: (1) restoration of the volumetric tissue defect and (2) FN reconstruction. The aim of this study is to describe our surgical technique and our cosmetic results using the chimeric scapulodorsal vascularized nerve (SDVN) flap to reconstruct extensive maxillofacial defects associated with FN sacrifice. Methods All patients undergone an extensive maxillofacial resection with FN sacrifice and primarily reconstructed with a SDVN flap were included. We classified the maxillofacial defects into six groups based on the type of resection. Intraoperative data including flap composition, topography of FN injury, length of nerve gap, and number of nervous anastomosis were recorded. Results Twenty-nine patients were included. Mean follow-up was 38.7 months. The harvested flaps included the SDVN combined with different components according to the defect group. A satisfactory volumetric restoration was obtained in 93% of cases. The mean number of distal nervous anastomosis was 4.5. The length of the vascularized grafted nerve ranged from 7 to 10 cm. Conclusion This is largest series presented in literature on primary FN reconstruction utilizing a vascularized nerve graft. We believe that the chimeric SDVN flap should be highly considered for these cases due to its versatility. The surgeon is able to use single donor site available soft and hard tissues components along with a vascular motor nerve graft, which offers a great length and number of distal branches, and easily matches with the extracranial FN trunk and its peripheral ramifications.

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Comparison of Parotidectomy With Observation for Treatment of Pleomorphic Adenoma in Adults

Kligerman

Jin

Ayoub

et al. 2020

JAMA Otolaryngol Head Neck Surg

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leomorphic adenoma, a slow-growing, benign salivary gland tumor with incidence rates between 2.4 and 4.9 per 100 000 persons per year, is the most common salivary gland tumor. 1,2 The current mainstay of treatment for pleomorphic adenoma is surgical excision. 1 However, parotidectomy is associated with significant risk of complications. The rate of permanent facial nerve injury after parotidectomy, for instance, is up to 26% according to a meta-analysis. 3 Other less serious but still common adverse effects of parotidectomy include risks of Frey syndrome, first bite syndrome, and skin hypo-anesthesia. 4 It is also important to consider the perioperative risk of general anesthesia. Consequently, the risk of complications should be considered when recommending surgery. Some of the reasons for recommending parotidectomy include correction of cosmetic deformity caused by a tumor, diagnosis and treatment of potential missed malignant neoplasms, and prevention of malignant transformation.Pleomorphic adenoma is associated with an estimated 1.5% risk of malignant transformation to carcinoma ex pleomorphic adenoma within the first 5 years of diagnosis if left untreated. 5 This risk may increase to 10% if left untreated for more than 15 years. 5 Although the risk of malignant transformation is low, it is substantial for younger patients owing to their longer life expectancy and justifies surgery. However, many patients who receive a diagnosis of pleomorphic adenoma late in life may never develop malignant transformation, and surgery may be associated with unnecessary risk.To our knowledge, there is no consensus regarding optimal management of pleomorphic adenoma in adults. Furthermore, it is unclear at what age parotidectomy ceases to be beneficial for elderly patients with pleomorphic adenoma. This decision analytical model compared parotidectomy with observation for the management of pleomorphic adenoma in adults 50 years or older. The study was intended to support IMPORTANCE There is no consensus regarding optimal management of pleomorphic adenoma in adults.OBJECTIVES To compare parotidectomy with observation for the management of pleomorphic adenoma in patients 50 years or older by age.DESIGN AND SETTING This decision analytical model was performed from November 21, 2019, to June 15, 2020, using a Markov model. Model variables and ranges were selected based on a literature review. A 1-way sensitivity analysis was performed to evaluate the age threshold at which each algorithm, either upfront elective parotidectomy or observation, would be favored. A Monte Carlo probabilistic sensitivity analysis using variable ranges was then performed 5 times with patients in the model assigned a starting age of 50, 60, 70, 80, and 90 years to assess how age at diagnosis would be associated with the model results.MAIN OUTCOMES AND MEASURES Model outcomes were measured with quality-adjusted life-years (QALYs). RESULTSIn the study models, the age thresholds at which observation became more beneficial than parotidectomy were 88.5 years f...

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Incidence of postoperative facial weakness in parotid tumor surgery: a tumor subsite analysis of 794 parotidectomies

Cited by 57 publications

References 44 publications

Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap

Comparison of Parotidectomy With Observation for Treatment of Pleomorphic Adenoma in Adults

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