The Extended Indication of Parotidectomy Using the Modified Facelift Incision in Benign Lesions: Retrospective Analysis of a Single Institution

Abstract

The modified facelift incision is feasible for most benign parotid lesions regardless of tumor location, even for anterior or superior tumors. Using the modified facelift incision may be extended with a surgeon's accumulated experience, but for a large deep-lobe tumor, the modified Blair incision is still considered useful.

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.…”

“…Most extirpative surgeons still opt for traditional approaches such as the Blair incision, which are effective from an oncologic standpoint, but not ideal from an aesthetic point of view. In searching for a more aesthetically pleasing scar after parotidectomy, surgeons have tried various approaches (Terris et al, 1994;Lee et al, 2011). One of them is the modified facelift incision, which has gained increasing popularity for its cosmetic benefits; however, several authors (Upile et al, 2010) advise that this approach may not be suitable for all parotid tumors, especially those located in the periphery of the parotid gland or in cases of deep lobe tumors where wide access is required to avoid tumor rupture.…”

“…The most accepted theory about the pathophysiology of Frey's syndrome describes an aberrant regrowth of the parasympathetic nerve fibers that originally innervated the parotid gland. After a neural injury occurs during the parotidectomy, the regenerating fibers cause the innervation of interrupted sympathetic fibers of the sweat glands and the subcutaneous blood vessels in the facial skin, instead of connecting the secretomotor cells of the parotid acini (Lee et al, 2011). In order to prevent Frey's syndrome, several techniques have been described to create mechanical barriers against aberrant nerve ingrowth.…”

“…The combination of a facelift incision and an SMAS flap prevents a conspicuous hollow at the angle of the mandible, and reduces Frey's syndrome frequency (Lee et al, 2011). The overall incidence of Frey's syndrome following parotidectomy depends on the thoroughness of the evaluation and the time elapsed since the surgery.…”

Salivary gland pathology in the paediatric population: implications for management and presentation of a rare case

“…The size and location of the mass must be taken into account to ensure adequate access, in order to achieve complete excision. 7,8 In children, the recurrence rate for pleomorphic adenoma is 20 per cent, compared with 1 to 9 per cent in adults. 4 This means that the planning and execution of surgery need to be done by an experienced surgeon who operates on similar cases on a regular basis.…”