RESUMO
OBJECTIVE: The aim of the study was to trace the development of surgical therapy in a large cohort, examine its changes at one single institution that has been specializing in salivary gland pathologies over the last 22 years, and to determine the extent to which a possible shift in the surgical therapy of parotid benign tumors towards less radical methods was correlated with a change in the incidence of facial palsy and Frey's syndrome. STUDY DESIGN: Retrospective clinical study. METHODS: A retrospective evaluation of the records of all patients treated for benign parotid tumors at a tertiary referral center between 2000 and 2022 was carried out. Surgical methods were classified into four groups: extracapsular dissection, partial superficial parotidectomy, superficial parotidectomy and complete parotidectomy. RESULTS: A total of 4037 patients were included in the study. Our analysis demonstrated an increase in the total number of parotidectomies for benign lesions from 71 (2000) to 298 (2022), mostly due to the increase in extracapsular dissections (from 9 to 212). The increased performance of less radical surgery was associated with a significantly decreased incidence of perioperative complications. CONCLUSIONS: Our study showed that the increased performance of less radical surgery was associated with better functional outcomes over the years.
Assuntos
Dissecação , Paralisia Facial , Glândula Parótida , Neoplasias Parotídeas , Humanos , Estudos Retrospectivos , Neoplasias Parotídeas/cirurgia , Neoplasias Parotídeas/patologia , Masculino , Feminino , Pessoa de Meia-Idade , Glândula Parótida/cirurgia , Dissecação/métodos , Paralisia Facial/etiologia , Paralisia Facial/epidemiologia , Sudorese Gustativa/etiologia , Sudorese Gustativa/epidemiologia , Sudorese Gustativa/prevenção & controle , Adulto , Resultado do Tratamento , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Idoso , IncidênciaRESUMO
OBJECTIVE: The extent of surgery in benign superficial parotid tumors has no strong evidence-based consensus. Partial superficial parotidectomy (PSP) is a popular choice among surgeons. We retrospectively evaluated the hypothesis that it carries similar efficacy and greater safety than superficial parotidectomy (SP). PATIENTS AND METHODS: Between 2010 and 2016, 84 patients with benign superficial parotid tumors were enrolled in the study. Deep lobe and recurrent tumors were excluded. The patients were treated by SP; (40 patients) or PSP; (44 patients). The operative and postoperative morbidity, tumor recurrence, operative time, and length of hospitalization were analyzed. RESULTS: There was no significant difference regarding patients or tumors in baseline data. PSP showed significantly shorter operative time (P = .022), and hospital stay (P = .001), as well as significantly lower frequencies of postoperative transient facial nerve paralysis and Frey's syndrome, (P = .042 for each). Permanent facial dysfunction was nonsignificantly greater in SP. No tumor recurrence was detected in either group after a median follow-up of 7 years. CONCLUSIONS: PSP is a quicker and less extensive procedure. It was associated with a shorter hospital stay and fewer complications especially transient facial paralysis and Frey's syndrome with a recurrence rate comparable to that of SP.
Assuntos
Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Adulto , Idoso , Paralisia Facial/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Sudorese Gustativa/epidemiologiaRESUMO
Complications following parotid surgery with harmonic scalpel versus cold instruments were seldom discussed. The authors retrospectively analyzed the medical record of 94 patients who received parotid surgery at Tianjin National Clinical Research Center for Cancer between January 2012 and October 2015, and compared the complications in patients operated with either Harmonic FCS9 (HF) or traditional cold instruments (CI). The mean operative time was 65.1âminutes in HF group versus 88.9âminutes for CI group. Intraoperative blood loss was 35âmL in HF group versus 55âmL in CI group. The mean drainage time was 3.7 days in HF group compared with 4.9 days in CI group. The mean total drainage volume was 62âmL in HF group versus 89âmL in CI group. The occurrence of Frey syndrome showed no difference in these 2 groups. Thus, the use of the HF in the surgical treatment of parotid disease is safe and confers advantages over conventional methods of parotid dissection.
Assuntos
Dissecação/efeitos adversos , Dissecação/instrumentação , Doenças Parotídeas/cirurgia , Glândula Parótida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Perda Sanguínea Cirúrgica , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Instrumentos Cirúrgicos , Sudorese Gustativa/epidemiologiaRESUMO
PURPOSE: Comparison of Frey syndrome rates following superficial parotidectomy and partial superficial parotidectomy for pleomorphic adenoma. METHODS: Fifty patients diagnosed with pleomorphic adenoma and received surgical treatment at the Otolaryngology Department of Bagcilar Training and Research Hospital between January 2009 and October 2015 were reviewed retrospectively. The patients were specifically queried for Frey syndrome symptoms. The syndrome was investigated with Minor starch iodine test. The patients who underwent superficial parotidectomy were compared to those who underwent partial superficial parotidectomy in terms of Frey syndrome development and recurrence. RESULTS: In the partial superficial parotidectomy group, Frey syndrome symptoms were edema and increased sweating and burning sensation on the face in 7 patients (21.9%, Pâ=â0.735). In the superficial parotidectomy group, 5 patients exhibited edema (27.8%), 3 exhibited increased sweating (16.7%), and 5 exhibited burning sensation (27.8%). Minor test results were positive for 7 patients in the partial superficial parotidectomy group (21.8%) and 5 patients were positive (27.8%) in the superficial parotidectomy group. No recurrence was found in either group during the 5-year follow-up. No significant difference was found between 2 groups in terms of postoperative complications and recurrence. CONCLUSION: In terms of their effect on Frey syndrome development, there is no significant difference between partial superficial parotidectomy and superficial parotidectomy.
Assuntos
Adenoma Pleomorfo/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias , Sudorese Gustativa/epidemiologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Estudos Retrospectivos , Sudorese Gustativa/etiologia , Turquia/epidemiologiaRESUMO
BACKGROUND: Salivary gland tumors are an uncommon entity, comprising 3% to 6% of all head and neck tumors. Approximately 75% to 80% occur in the parotid gland, and 80% are benign. It is difficult to establish epidemiologic characteristics of parotid gland tumors due to their low incidence. We performed a retrospective study to analyze clinical diagnostic and therapeutic features of patients submitted to parotid gland surgery. METHODS: A retrospective study was performed, regarding all the patients (n = 96) submitted to surgery for treatment of parotid gland disease in the Department of Plastic and Reconstructive Surgery of Centro Hospitalar de S. João (Porto, Portugal) between 2002 and 2012. Medical records were analyzed and the following data were collected: patient age at diagnosis, sex, tumor location, symptom, tumor position, preoperative diagnosis techniques, type of operation performed, pathology, postoperative complications, adjuvant therapy (radiotherapy or chemotherapy), follow-up time, and tumor recurrence. SPSS was used for statistical analysis. RESULTS: Fifty-two percent of the patients were males and 48% females and mean age of 52.02. In 68.75% of the patients, superficial parotidectomy was performed. Benign pathology was found in 72% patients, and pleomorphic adenoma the most common tumor (39%). Facial paralysis (41.7%), Frey syndrome (9.4%), and great auricular nerve hyposthesia (10.4%) were major complications. Tumor recurrence was observed in 16 patients (16.7%), which forced 17 reoperations (17.7%). There were 5 deaths (5.2%). CONCLUSION: For most tumors, superficial parotidectomy is an effective treatment with acceptable morbidity. In patients of malignancy, treatment should be aggressive.
Assuntos
Neoplasias Parotídeas/epidemiologia , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Adenoma Pleomorfo/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante/estatística & dados numéricos , Doenças dos Nervos Cranianos/epidemiologia , Orelha/inervação , Paralisia Facial/epidemiologia , Feminino , Seguimentos , Humanos , Hipestesia/epidemiologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Glândula Parótida/cirurgia , Neoplasias Parotídeas/mortalidade , Neoplasias Parotídeas/cirurgia , Portugal/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Radioterapia Adjuvante/estatística & dados numéricos , Reoperação , Estudos Retrospectivos , Sudorese Gustativa/epidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: This study aims to investigate whether postoperative follow-up period, clinical signs or Minor test is effective to determine the incidence of Frey's syndrome following superficial parotidectomy. PATIENTS AND METHODS: Between January 2005 and December 2008, 30 patients, (16 males, 14 females; mean age 47.7±15.3 years, range 17 to 76 years) who underwent superficial parotidectomy in the Ear, Nose, Throat Clinic, were retrospectively analyzed. All patients were administered a questionnaire on clinical signs of Frey's syndrome and disease period, and Minor's test. RESULTS: The postoperative pathological examination showed pleomorphic adenoma, Whartin's tumor, basal cell adenoma and oncocytoma. The Minor's test result was positive in 50% of the patients. While 10% of the patients complained about excessive sweating requiring no treatment, none of them complained about the bad body odor. The disease was considered moderate based on the severity of the disease in all patients. CONCLUSION: The incidence of Frey's syndrome may vary according to the postoperative follow-up period and the diagnostic method applied, including assessment of clinical signs and Minor's test.
Assuntos
Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Sudorese Gustativa/diagnóstico , Sudorese Gustativa/epidemiologia , Adenolinfoma/patologia , Adenolinfoma/cirurgia , Adenoma/patologia , Adenoma/cirurgia , Adenoma Oxífilo/patologia , Adenoma Oxífilo/cirurgia , Adenoma Pleomorfo/patologia , Adenoma Pleomorfo/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/patologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Inquéritos e Questionários , Sudorese Gustativa/etiologia , Adulto JovemRESUMO
AIM: Parotid gland is the most common location for salivary gland tumors, more commonly pleomorphic adenoma and Warthin's tumor. Types of parotid surgery include superficial parotidectomy (SP), partial superficial parotidectomy (PSP), total conservative parotidectomy (TCP), enucleation (E), extracapsular dissection (ECD), and are related to different incidence of complications. The choice depends on tumors localization, dimension and histology. The aim was to compare complications rate such as facial and great auricular nerve impairment and Frey syndrome according to type of surgery performed. MATERIALS AND METHODS: We retrospectively review the management of 116 benign tumors of the parotid gland treated between January 2004 and January 2020 at our Department. RESULTS: Most frequent complication observed was a GAN deficiency (22.41%), permanent in 13% of cases. Post-operative facial nerve impairment was observed in 19 patients (persistent only in 1 case). Only Frey syndrome (4,31% of cases) seemed to be related to type of surgery (p<0.05) resulting more frequent in the group of patients that underwent "classical" parotidectomy, while facial nerve impairment, even if more frequent in this cases, did not statistically correlated with operative technique (p=0.054). CONCLUSIONS: Once experience is gained, in order to reduce post-operative morbidity extracapsular dissection is a reliable technique in the management of these neoplasms, even if attention has to be paid particularly in the removal of superficial masses "emerging" from the parenchyma. PSP is an alternative to SP, while CTP has to be reserved to selected cases ot tumors arising in the deep lobe. KEY WORDS: Benign tumor, Extracapsular dissection, Enucleation, Facial nerve Parotid gland, Parotidectomy, Superficial parotidectomy.
Assuntos
Neoplasias Parotídeas , Sudorese Gustativa , Humanos , Glândula Parótida/cirurgia , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Sudorese Gustativa/epidemiologia , Sudorese Gustativa/etiologia , Sudorese Gustativa/prevenção & controleRESUMO
Frey's syndrome was first described by Lucia Frey, a Polish neurologist in 1923. It is well accepted that it involves injury to the branches of the auriculotemporal nerve with subsequent aberrant regeneration. Due to this abnormal communication, the skin glands and vessels are always stimulated at the same time as eating and mastication, which results in symptoms such as flushing and sweating. The incidence of Frey's syndrome in the literature has been variously described from 6 to 96 per cent. We analyzed the chart of 18 patients who had parotidectomy from March 2002 to December 2009. All procedures were performed by a single surgeon at the same facility. A total of 16 superficial and three total parotidectomies were done; one patient had bilateral parotidectomy. Oxidized regenerated cellulose (Interceed) was used after 10 surgeries (study group) and no adjuvant was used after nine surgeries (control group). All of the surgeries were done using similar technique. All the patients were followed-up with for a period of about 6 months postoperatively. The absolute risk reduction associated with the placement of an Interceed was 11 per cent. The small number of cases (n = 19) and an empty cell limits statistical analysis (a Fisher's exact test revealed a P value of 0.44). Clearly the low number of procedures restricted the power to test these differences. The development of Frey's syndrome is a very disabling but under-reported complication. The placement of a temporary barrier like Interceed may help in the prevention of Frey's syndrome without increasing any complications.
Assuntos
Adenoma/cirurgia , Celulose Oxidada/uso terapêutico , Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Sudorese Gustativa/epidemiologia , Sudorese Gustativa/prevenção & controle , Adenoma/patologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/patologia , Estudos Retrospectivos , Sudorese Gustativa/diagnóstico , Resultado do TratamentoRESUMO
BACKGROUND: Frey's syndrome (FS) is defined as facial sweating due to gustatory stimuli following surgery or trauma of the parotid gland. Concomitant symptoms may occur in the area of the auriculotemporal nerve: swelling, facial flushing, and paresthesia. A misguided re-innervation of perspiratory glands by secretory parasympathetic fibres is likely responsible in the pathogenesis. The reported incidence in the literature varies considerably from 1.7% to 97.6%. The present study aims to clarify the incidence of FS. PATIENTS AND METHODS: A questionnaire was sent to 221 consecutive patients who underwent parotidectomy between 07/2005 and 07/2008. No selection for type of parotidectomy or histological result was made. Patients were invited to undergo a follow-up examination including Minor's iodine starch test. RESULTS: A total of 135 of 221 (61%) questionnaires were available for evaluation. In all, 82 patients took part in the follow-up, with a follow-up period of 2.8 years (15-51 months). According to the questionnaire, 54% of patients claimed to be free of symptoms. Sweating following gustatory stimuli was reported by 23% of patients. Of the 82 Minor's tests performed, 62.2% were positive. All patients with subjective presence of FS had a positive Minor's test. In 27%, Minor's test was positive although patients did not suffer from facial sweating subjectively ("subclinical FS"). In all, 39% had no subjective complaints and Minor's test was also negative. Cases with a positive Minor's test showed no statistically significant relation to the patients' age, gender or to the histological diagnosis or type of parotidectomy. CONCLUSION: The clinical incidence of FS in our study is 23%, although a positive Minor's iodine starch test was observed in 62% of cases. Therefore, it seems justifiable to differentiate between a symptomatic or clinical FS and a merely asymptomatic or subclinical FS. No correlation was observed between epidemiological factors and the occurrence of FS.
Assuntos
Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Glândula Parótida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Sudorese Gustativa/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Coleta de Dados , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVES: We aimed to compare the results of extracapsullary dissection (ED) with superficial parotidectomy (SP) in the surgical treatment of benign parotid tumors. PATIENTS AND METHODS: Forty-one patients who were diagnosed with pleomorphic adenoma of the parotid gland and underwent surgery between January 1992 and June 2000 were enrolled in this study. The patients were divided into two groups: the ED group (6 males, 15 females; mean age 47.2 years; range 32 to 57 years) and the SP group (7 males, 13 females; mean age 47.7 years; range 29 to 61 years). ED was performed on 21 patients and SP was performed on 20 patients. All patients were followed-up postoperatively and the mean follow-up time was 194 (range 117 to 264) months. RESULTS: Although no complications developed in the ED group patients during the follow-up period, there were several cases in the SP group: three cases of salivary fistula, one of Frey's syndrome, three case of temporary facial paresis and 13 of cosmetic deformity. The cosmetic deformities were as minimal depressions in the parotid region. There have been no recurrences in either group. There was a statistically significant difference between the two groups regarding cosmetic deformity (p=0.000 and X2=19.27). There was also a statistically significant difference between the two groups regarding general complications (p=0.001 and X2Y: 8.32). CONCLUSION: Extracapsullary dissection is a safe and reliable surgical procedure compared to superficial parotidectomy with a lower complication rate and a similiar recurrence rate.
Assuntos
Adenoma Pleomorfo/cirurgia , Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Adulto , Nervo Facial/cirurgia , Paralisia Facial/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fístula das Glândulas Salivares/epidemiologia , Sudorese Gustativa/epidemiologia , Resultado do TratamentoRESUMO
OBJECTIVES: To report the clinical outcomes of patients with chronic parotid sialadenitis treated with superficial parotidectomy, and to review the literature. METHODS: A retrospective case series was conducted of all patients undergoing parotidectomy for chronic parotid sialadenitis at our institution between 2009 and 2018. RESULTS: Eighteen superficial parotidectomies were performed, resulting in complete symptom resolution in 17 patients. There was only one recurrence, of a milder form of the disease, requiring no specific treatment. Eight temporary post-operative facial nerve palsies and one permanent palsy occurred. Further complications included post-operative wound haematoma, seroma, Frey's syndrome, neuropathic pain and wound infection. CONCLUSION: Superficial parotidectomy is sufficient to control patient symptoms, avoiding the increased morbidity associated with near-total parotidectomy. The literature does not point to a clear difference in either the incidence of recurrence or the risk of a facial nerve palsy between the two procedures. Furthermore, the symptoms attributed to recurrence are often not severe enough to warrant salvage near-total parotidectomy.
Assuntos
Doenças Parotídeas/patologia , Complicações Pós-Operatórias/epidemiologia , Sialadenite/diagnóstico , Sialadenite/cirurgia , Adulto , Idoso , Doenças do Nervo Facial/fisiopatologia , Paralisia Facial/epidemiologia , Feminino , Hematoma/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neuralgia/epidemiologia , Recidiva , Estudos Retrospectivos , Seroma/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Sudorese Gustativa/epidemiologia , Resultado do Tratamento , Ferimentos e Lesões/patologiaRESUMO
Surgical removal is the treatment of choice for many neoplasms of the parotid gland. This meta-analysis aimed to evaluate the differences between parotidectomy using a modified facelift incision (MFI) and parotidectomy using a modified Blair incision (MBI). A systematic search of the available literature in PubMed, Embase and the Cochrane Library was performed. Studies of adult patients who underwent open parotidectomy with presumed benign parotid neoplasms based on preoperative examinations were reviewed. The surgical outcomes of the MFI and MBI groups were collected. Intraoperative and postoperative parameters, including operative time, tumor size, cosmetic satisfaction, and incidences of facial palsy, Frey's syndrome and salivary complications, were compared. Dichotomous data and continuous data were analyzed by calculating the risk difference (RD) and the mean difference (MD) with the 95% confidence interval (CI), respectively. Seven studies were included in the final analysis. The pooled analysis demonstrated that the cosmetic satisfaction score was significantly higher in the MFI group (MD = 1.66; 95% CI 0.87-2.46). The operative duration in the MFI group was significantly longer than that in the MBI group (MD = 0.07; 95% CI 0.00-0.14). The MFI group exhibited a smaller tumor size (MD = - 2.27; 95% CI - 4.25 to - 0.30) and a lower incidence of Frey's syndrome (RD = - 0.18; 95% CI - 0.27 to - 0.10). The incidence of postoperative temporary facial palsy (RD = - 0.05; 95% CI - 0.12 to 0.03), permanent facial palsy (RD = - 0.01; 95% CI - 0.06 to 0.03) and salivary complications (RD = - 0.00; 95% CI - 0.05 to 0.05) was comparable between the two groups. Based on these results, MFI may be a feasible technique for improving the cosmetic results of patients who need parotidectomy when oncological safety can be ensured.
Assuntos
Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Ritidoplastia/métodos , Estética , Paralisia Facial/epidemiologia , Paralisia Facial/etiologia , Feminino , Humanos , Incidência , Masculino , Duração da Cirurgia , Glândula Parótida/patologia , Neoplasias Parotídeas/patologia , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos de Cirurgia Plástica/efeitos adversos , Ritidoplastia/efeitos adversos , Sudorese Gustativa/epidemiologia , Sudorese Gustativa/etiologiaRESUMO
OBJECTIVE/HYPOTHESIS: To define the best surgical technique able to reduce Frey syndrome (FS) incidence after parotidectomy. STUDY DESIGN: Systematic review and network meta-analysis. METHODS: An arm-based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were the incidence of subjective (clinical) and objective (positive starch-iodine test result) FS, respectively. RESULTS: A total of 3830 patients with a median age of 50.35 years (n = 2323; IQR 44.25-54.18) were included for six interventions [temporoparietal fascia (TPFF), free fat graft (FFG), acellular dermal matrix (ADM), sternocleidomastoid muscle (SCM) flap, and superficial musculoaponeurotic system (SMAS) flap]. If compared to no treatment, the greatest reduction of subjective (clinical) FS incidence was measured for the TPFF (OR: 0.07, CI: 0.004-0.57), the ADM (OR: 0.09, CI: 0.02-0.35), and the FFG (OR: 0.11, CI: 0.03-0.42) techniques. However, a significant difference was measured also for the SCM flap (OR: 0.38, CI: 0.18-0.73) and for the SMAS flap (OR: 0.42, CI: 0.19-0.97). All treatments showed a significant reduction of the objective FS incidence if compared to no treatment (FFG, OR: 0.06, CI: 0.002-0.62; TPFF, OR: 0.07, CI: 0.01-0.33; ADM, OR: 0.11, CI: 0.03-0.44; SMAS, OR: 0.36, CI: 0.17-0.71; SCM, OR: 0.40, CI: 0.19-0.74). CONCLUSIONS: TPFF, ADM, and FFG seem to be the best treatment strategies to prevent FS after parotidectomy. Further randomized controlled trials comparing these techniques should be conducted to define specific indications. Laryngoscope, 131:1761-1768, 2021.
Assuntos
Músculos do Pescoço/cirurgia , Glândula Parótida/cirurgia , Sistema Musculoaponeurótico Superficial/cirurgia , Retalhos Cirúrgicos/cirurgia , Sudorese Gustativa/etiologia , Sudorese Gustativa/prevenção & controle , Derme Acelular , Adulto , Teorema de Bayes , Fáscia/transplante , Humanos , Incidência , Pessoa de Meia-Idade , Músculos do Pescoço/transplante , Metanálise em Rede , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos de Cirurgia Plástica/métodos , Sistema Musculoaponeurótico Superficial/transplante , Retalhos Cirúrgicos/transplante , Sudorese Gustativa/epidemiologia , Sudorese Gustativa/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: In this prospective nonrandomized multicenter trial, we analyze the incidence of early and late complications after parotidectomy in correlation to the extent of dissection. METHODS: A total of 148 patients underwent a parotidectomy for a benign lesion in the superficial lobe. The number of intraoperatively dissected main facial nerve branches was photo-documented and defined the extent of tissue dissection. Early postoperative complications including sialocele were evaluated until 4 weeks after surgery. Late complications as facial nerve palsy, Frey's syndrome (FS) and the outcome of the scar and substance loss were furthermore assessed after 6 and 12 months. RESULTS: Early complications occurred in 22 patients (14%) and did not depend on the extent of facial nerve dissection (all P > .05). However, patients with higher number of intraoperatively dissected facial nerve branches showed significantly higher palsy scores on the first postoperative day (P = .026). FS occurred with incidence of 69% and correlated significantly to the extent of dissection (P = .003). Appearance of the scar and substance loss improved significantly during the follow-up (P < .001 and P < ,005, respectively) without significant correlation to the extent of dissection (P > .05 for both variables after 12 months). CONCLUSIONS: Less extensive tissue dissection resulted in better postoperative facial nerve function on the first postoperative day and in lower incidence of FS after 12 months. However, incidence of early complications did not depend on the extent of surgery. The study was registered in the German Clinical Trials Register prior to conducting the research. DRKS-ID: DRKS00008967, URL:http://apps.who.int/trialsearch/.
Assuntos
Dissecação/efeitos adversos , Nervo Facial/cirurgia , Paralisia Facial/epidemiologia , Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Sudorese Gustativa/epidemiologia , Adulto , Idoso , Estudos de Coortes , Dissecação/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/patologia , Satisfação do Paciente , Fatores de TempoRESUMO
OBJECTIVE/HYPOTHESIS: Elevation of the superficial musculoaponeurotic system (SMAS) with or without fat graft interposition during superficial parotidectomy prevents a concave facial deformity and Frey's syndrome. STUDY DESIGN: Retrospective, case-control study. METHODS: Charts for 248 patients who underwent superficial parotidectomy were reviewed for pathologic, radiographic, clinical, and operative data. Sixteen patients who underwent SMAS elevation and 34 patients who underwent SMAS elevation with fat graft interposition were included in two study groups. Nonreconstructed controls were randomly selected from a pool of patients who had unilateral, superficial parotidectomy and were matched based on pathologic specimen volume. Patients were surveyed for their postoperative symptoms. RESULTS: Patients undergoing SMAS elevation alone (n = 16) compared with controls (n = 19) had greater facial symmetry (12% vs. 32%, P = .147) and a lower incidence of symptomatic Frey's syndrome (6.3% vs. 18.6%, P = .382). Patients undergoing SMAS elevation and fat graft interposition (n = 34) compared with controls (n = 38) had less facial asymmetry (9% vs. 39%, P = .002) and a lower incidence of symptomatic Frey's syndrome (6% vs. 28%, P = .04). Complications among the study and control groups were comparable. CONCLUSIONS: Simultaneous reconstruction of a superficial parotidectomy defect using SMAS elevation with or without fat grafting may improve postoperative facial symmetry and decrease the incidence of symptomatic Frey's syndrome without increasing complications.
Assuntos
Gordura Abdominal/transplante , Músculo Esquelético/cirurgia , Neoplasias Parotídeas/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Tela Subcutânea/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Estética , Assimetria Facial/epidemiologia , Nervo Facial/patologia , Nervo Facial/cirurgia , Fáscia/patologia , Fasciotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Invasividade Neoplásica , Neoplasias Parotídeas/patologia , Satisfação do Paciente , Período Pós-Operatório , Estudos Retrospectivos , Tela Subcutânea/patologia , Inquéritos e Questionários , Sudorese Gustativa/epidemiologiaRESUMO
OBJECTIVE: To present the results of patients who underwent superficial or total parotidectomy because of parotid gland tumors in our tertiary care clinic. METHODS: The data of 362 patients who underwent parotid surgery from January 2008 to November 2015 were collected and analyzed in demographic, histopathological features, and complications. RESULTS: Three hundred sixty-nine cases (performed in 359 patients) were analyzed and we assessed complications of parotid surgery such as transient or permanent facial paralysis and Frey's syndrome. Pleomorphic adenomas and Warthin's tumors consisted 74% of all parotid gland tumors. These tumors were generally located in the superficial lobe and tail of the parotid gland (81%). Also, tumor size in the positive surgical margin group was larger than in the negative surgical margin group (p=0.012). CONCLUSIONS: Most of parotid gland tumors are benign. However, the frequency of malignancy increases in deep lobe of parotid gland. High grade malignant tumors have more tendency to have positive surgical margin during surgery, and facial paresis preoperatively.
Assuntos
Adenolinfoma/patologia , Adenoma Pleomorfo/patologia , Carcinoma de Células Acinares/patologia , Carcinoma Mucoepidermoide/patologia , Carcinoma de Células Escamosas/secundário , Neoplasias Parotídeas/patologia , Adenolinfoma/epidemiologia , Adenolinfoma/cirurgia , Adenoma Pleomorfo/epidemiologia , Adenoma Pleomorfo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Acinares/epidemiologia , Carcinoma Mucoepidermoide/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Criança , Pré-Escolar , Paralisia Facial/epidemiologia , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos , Glândula Parótida/cirurgia , Neoplasias Parotídeas/epidemiologia , Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Sudorese Gustativa/epidemiologia , Carga Tumoral , Adulto JovemRESUMO
OBJECTIVE: To review a single surgeon's experience with parotidectomy with an emphasis on examining the appropriate use of partial superficial parotidectomy and the differences in early outcomes observed with the various types and extent of parotidectomy used. STUDY DESIGN AND SETTING: A series of 237 patients who underwent parotidectomy over a 10-year period was reviewed. RESULTS: Postoperative complications included facial nerve weakness (18%), sialocele (6.3%), wound infection (3.8%), hematoma (3.8%), and symptomatic Frey's syndrome (1.7%). More extensive surgical procedures, including complete superficial or total parotidectomy, were associated with a 2.7 times greater incidence of immediate postoperative facial nerve weakness compared with partial superficial parotidectomy. CONCLUSION: Partial superficial parotidectomy is associated with a decreased incidence of transient postoperative facial nerve weakness compared with more extensive procedures such as complete superficial or total parotidectomy. Intraoperative frozen section was an accurate means of selecting patients for the partial superficial parotidectomy procedure. SIGNIFICANCE: Partial superficial parotidectomy is an effective method for treating benign tumors confined to the superficial lobe.
Assuntos
Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Biópsia por Agulha Fina , Eletromiografia , Paralisia Facial/epidemiologia , Paralisia Facial/etiologia , Paralisia Facial/fisiopatologia , Feminino , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Segunda Neoplasia Primária/epidemiologia , Neoplasias Parotídeas/epidemiologia , Neoplasias Parotídeas/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/secundário , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Sudorese Gustativa/epidemiologia , Sudorese Gustativa/etiologiaRESUMO
CONCLUSIONS: Advanced age, long operation time and large specimen volume were significant risk factors for transient facial palsy after conservative parotidectomy. Revision operation was the only risk factor for development of a permanent palsy. Risk factors for Frey's syndrome were not found. The incidence of Frey's syndrome was not altered by the use of a sternocleidomastoid muscle flap or other implantation material. OBJECTIVES: The results of studies identifying risk factors for facial palsy and Frey's syndrome after parotidectomy are contradictory. This study attempted to identify these risk factors by performing a retrospective review of a large series of patients. PATIENTS AND METHODS: A total of 610 standardized conservative parotidectomies for benign diseases performed between 1989 and 2004 were studied retrospectively. The risk factors for facial palsy and Frey's syndrome were determined by univariate and if possible by multivariate analysis of variables related to patient demographics and operation characteristics. RESULTS: The rates of transient facial palsies, permanent facial palsies and Frey's syndrome were 18%, 4%, and 4%, respectively. Significant univariate and multivariate risk factors for development of a transient facial palsy were age>70 years, operation time>260 min, and a specimen volume>70 cm3. The only significant risk factor for the development of a permanent palsy was prior surgery. A significant risk factor for the development of Frey's syndrome could not be estimated.
Assuntos
Paralisia Facial/etiologia , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Sudorese Gustativa/etiologia , Adenolinfoma/cirurgia , Adenoma Pleomorfo/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Paralisia Facial/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Parotidite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Sudorese Gustativa/epidemiologia , Resultado do TratamentoRESUMO
INTRODUCTION: Frey syndrome is a sequela observed after parotidectomy and the reported incidence varies enormously in the literature. Diagnosis is evaluated by presence of the classic triad of gustatory sweating, heating and flushing while feeding and documented by Minor starch-iodine test. AIM: To evaluate the incidence of this syndrome in patients submitted to partial parotidectomy at Centro Otorrinolaringológico de Limeira, from 1994 to 2004, including presence of signs and symptoms and the surgical technique. MATERIAL AND METHOD: Fourteen patients undergoing partial parotidectomy with sternocleidomastoid muscle flap answered a questionnaire and were classified as positive or negative by Minor starch-iodine test in a clinical retrospective study. RESULTS: 21% of the patients presented symptoms and positive iodine test. CONCLUSION: Only the patients presenting clinical symptoms had a positive test and the adopted surgical technique was efficient due to low incidence of the syndrome.
Assuntos
Glândula Parótida/cirurgia , Complicações Pós-Operatórias/etiologia , Sudorese Gustativa/etiologia , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Prevalência , Estudos Retrospectivos , Retalhos Cirúrgicos , Inquéritos e Questionários , Sudorese Gustativa/diagnóstico , Sudorese Gustativa/epidemiologiaRESUMO
OBJECTIVE: Extracapsular dissection (ECD) has become an accepted, less invasive alternative for the removal of select benign parotid lesions that may reduce complications. Minimal margin extracapsular dissection (MECD) with dissection on or closer to the tumor capsule may be a reasonable alternative to ECD. The objective of this study is to review the complications and safety of the MECD technique at a single institution. SUBJECTS AND METHODS: Medical records for patients who underwent MECD for suspected benign parotid lesions were reviewed. Outcome measurements included intraoperative findings, complications, and recurrences. RESULTS: Forty patients underwent a MECD for suspected benign parotid lesions. The average tumor size was 2.2 cm. Frozen section revealed low-intermediate grade mucoepidermoid carcinoma in 2 (5%) cases, requiring completion of a superficial parotidectomy at the same setting. There was 1 case of temporary facial nerve weakness and no cases of Frey syndrome. No tumor recurrences were observed within the follow-up period (average 3.5 years.) CONCLUSION: In the hands of an experienced surgeon, MECD may be a viable alternative to formal superficial parotidectomy. This study reports low rates of nerve weakness and Frey syndrome. Long-term follow-up is necessary to determine the ultimate risk of recurrence.