Investigation of arguments against properly indicated extracapsular dissection in the parotid gland

Mantsopoulos, Konstantinos; Scherl, Claudia; Iro, Heinrich

doi:10.1002/hed.24629

Cited by 34 publications

(25 citation statements)

References 24 publications

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“…According to the literature, pleomorphic adenomas (PAs) constitute about 36% to 70% of benign neoplasms, and more than 85% occur within the parotid gland (i.e., parotid PAs [PPAs]) 1–3 . Our data identified 33.5% to 36.4% of all benign salivary gland neoplasms as PPAs 4–6 …”

Section: Introductionmentioning

confidence: 66%

Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow‐up

et al. 2020

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Objectives/Hypothesis To assess long‐term results after the treatment of parotid pleomorphic adenomas (PPAs) using different surgical techniques and focusing on recurrence rates and the risk of adverse effects. Study Design Retrospective analysis. Methods Retrospective analysis of 182 patients treated exclusively for PPAs at a tertiary referral center between 2000 and 2004. Thorough follow‐up examinations over a mean period of 13 years were possible in 53.8% (n = 98/182). Tumors were categorized according to the European Salivary Gland Society (ESGS) system to improve the comparison of outcomes. After different surgical resection strategies, recurrence rates, postoperative facial nerve paresis (FNP), and incidence of Frey's syndrome were assessed. The follow‐up period included clinical examinations and imaging of every patient in the treating department. Results Of 182 patients, extracapsular dissection (ED) was performed in 29.7%, and other surgical modalities (OSMs), including facial nerve dissection, in 70.3%. After the long‐term follow‐up, 98% of all the patients (n = 96/98) were recurrence free. When recurrence rates were compared, no significant differences were noted (P < .331). ED resulted in significantly lower FNP rates compared to OSMs (P < .001). FNP rates significantly increased with size and location of the tumors according to ESGS categories (temporary and permanent FNP, P = .04). Surgical invasiveness corresponded to a significant increase in the incidence of Frey's syndrome (P < .001). Conclusions ED was associated with the lowest complication rates, but not with a higher risk of recurrence, when compared with OSM in the long‐term course. As ED can be performed in the majority of PPAs, it can be regarded as the treatment of choice whenever possible. Level of Evidence 4 Laryngoscope, 131:E445–E451, 2021

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Section: Introductionmentioning

confidence: 66%

Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow‐up

et al. 2020

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“…Another limitation lies in the fact that no sufficient data were available regarding the cosmetic result (scar formation) or postoperative pain. However, it seems that our department's philosophy allows adaptation of the skin incision and flap size to the size and location of the tumor, allowing for a significantly smaller incision in many cases managed by means of ECD . Concerning the incidence of salivary fistula, the reliability of our results is limited by the fact that more and more cases have been managed prophylactically using scopolamine for the prevention of this complication with outstanding results .…”

Section: Discussionmentioning

confidence: 97%

“…Surgical therapy for benign tumors of the parotid gland has been classified as follows: firstly, an ECD is defined as the removal of a tumor from the parotid gland with a cuff of healthy gland parenchyma where it is possible, without intending to pre‐identify the main trunk of the facial nerve or its branches . If it is intended to expose the facial nerve, the procedure is termed a partial superficial parotidectomy (PSP), since parts of the superficial lobe of the gland will remain in place.…”

Section: Methodsmentioning

confidence: 99%

“…This perception led him to advocate a more radical procedure in terms of obligate dissection of the main trunk and branches of the facial nerve in all cases . A change of philosophy at least led to superficial parotidectomy in all cases and was associated, by definition, with a higher risk of iatrogenic facial nerve palsy . Nevertheless, careful dissection of the facial nerve long remained the standard surgical method for treating benign lesions of the parotid gland, so that many working groups claimed that parotid surgery was the same as surgery of the facial nerve .…”

Section: Introductionmentioning

confidence: 99%

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Paradigm shift in surgery for benign parotid tumors: 19 years of experience with almost 3000 cases

2019

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Objectives The aim of this study was to explore the changes in philosophy in the surgical therapy of benign parotid tumors over a period of 19 years. Methods The records of all patients treated for benign parotid tumors between 2000 and 2018 were evaluated. Data were analyzed with respect to the number of procedures carried out per year of the study according to each of the different surgical modalities and the incidence of postoperative complications. Statistical analysis was performed using the x2 test. A P value of <.05 was considered statistically significant. Results A total of 2988 patients were included in this study. Our analysis showed that the increasing performance of extracapsular dissection was associated with a progressive reduction in the incidence of temporary facial nerve palsy and Frey's syndrome, while the rate of permanent facial nerve palsy remained consistently low. Conclusion One of the most controversial issues in head and neck surgery is which therapeutic approach is best in patients with benign parotid tumors. Our analysis demonstrated that a change of strategy towards reducing invasiveness was possible, with exceptional functional results. Avoidance of facial nerve dissection is feasible in more than two‐thirds of cases with benign tumors. Level of Evidence 4b Laryngoscope, 130: 1941–1946, 2020

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“…Interestingly, our analysis showed an excellent oncologic outcome, with no recurrences detected in our study sample. This result corresponds to the recurrence rates of 0–1.7% after submandibulectomy for submandibular pleomorphic adenomas as well as after less invasive surgical procedures for pleomorphic adenomas (extracapsular dissection) of the parotid gland . It seems that the macroscopic focal exposure of the capsule of the pleomorphic adenoma in the course of submandibulectomy, which in many cases is unavoidable, does not have a negative impact on the oncologic outcome of this surgical procedure.…”

Section: Discussionmentioning

confidence: 56%

Long‐term oncologic and functional outcome in pleomorphic adenomas of the submandibular gland

Mantsopoulos

Goncalves

Mantsopoulos

et al. 2017

Laryngoscope Investig Oto

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ObjectivesThe aim of the study was to evaluate the oncologic and functional long‐term outcome after surgical therapy of pleomorphic adenomas of the submandibular gland.MethodsThe medical charts of all patients treated for pleomorphic adenomas of the submandibular gland by means of submandibulectomy between 2000 and 2016 were studied retrospectively. Patients who had had revision after external primary surgery, as well as patients with insufficient data were excluded from our study sample.ResultsA total of 75 patients formed our study sample (28 men, 47 women, male:female ratio 0.59:1). Their mean age was 48 years (14–78 years). Mean follow‐up was 82 months (12–170 months). No recurrences of a pleomorphic adenoma could be detected in our study cases. Normal facial nerve function (House‐Brackmann grade I) in the direct postoperative phase was shown in 54/75 cases (72%). In the remaining 21/75 cases (28%), mild paresis of the marginal mandibular branch of the facial nerve (House‐Brackmann II) could be detected in the direct postoperative phase. All cases with facial palsy had recovered with normal facial nerve function (House‐Brackmann I) in 3–6 months.ConclusionOur study was able to show oncologic and consistently acceptable oncologic and functional outcomes after submandibulectomy for pleomorphic adenomas of the submandibular gland.Level of Evidence4.

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Investigation of arguments against properly indicated extracapsular dissection in the parotid gland

Cited by 34 publications

References 24 publications

Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow‐up

Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow‐up

Paradigm shift in surgery for benign parotid tumors: 19 years of experience with almost 3000 cases

Long‐term oncologic and functional outcome in pleomorphic adenomas of the submandibular gland

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