Facelift Approach in Benign Parotid Surgery, Frey Syndrome, and Total Superficial Parotidectomy

2011 ◽  
Vol 69 (10) ◽  
pp. 2486-2487 ◽  
Author(s):  
Athanassios Kyrgidis ◽  
Stefanos Triaridis
Keyword(s):  
Superficial Parotidectomy ◽  
Parotid Surgery

Parotidectomy. Preserving the posterior branch of the great auricular nerve

1997 ◽  
Vol 111 (6) ◽  
pp. 556-559 ◽  
Author(s):  
N. R. Christensen ◽  
S. D. Jacobsen
Keyword(s):  
Superficial Parotidectomy ◽  
Posterior Branch ◽  
Great Auricular Nerve ◽  
Number Of Patients ◽  
Parotid Surgery

AbstractThe great auricular nerve is often sacrificed in superficial parotidectomy, even though its posterior branch often can be preserved. By cautious dissection of the great auricular nerve it is possible to preserve the posterior branch in 70.5 per cent of the operations.Ninety-five patients who had undergone superficial parotidectomy were included. A significantly higher number of patients had subjective sequelae if the posterior branch of the nerve had been cut, compared to the patients with a preserved nerve. A significantly higher rate of sensory morbidity was found if the nerve had been cut. In patients with a preserved posterior branch of the great auricular nerve there was no increase in other potential sequelae after parotidectomy.Therefore, this additional dissection should be considered, where appropriate, in routine parotid surgery.

scholarly journals Factors associated with facial nerve palsy in patients undergoing superficial parotidectomy for pleiomorphic adenoma: our experience of eight and half years

2019 ◽  
Vol 6 (1) ◽  
pp. 60
Author(s):  
Dheer S. Kalwaniya ◽  
Goutam Kothathi Chowdegowda ◽  
Monish Raj ◽  
Jaspreet S. Bajwa ◽  
Satya V. Arya ◽  
...  
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Pleomorphic Adenoma ◽  
Surgical Approaches ◽  
Depth Of Invasion ◽  
Tumor Depth ◽  
Facial Paresis ◽  
Superficial Parotidectomy ◽  
Parotid Surgery ◽  
Nerve Paresis

<p class="abstract"><strong>Background:</strong> The pleomorphic adenoma comprises 45-60% of all salivary gland tumors most often in parotid gland up to 80%. The association between the facial nerve and the gland is responsible for most of the technical difficulties and complications of the surgical approaches.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective observational study performed in a unit of General Surgery, Safdarjung Hospital, New Delhi from May 2011 to October 2019 of all patients who underwent superficial parotidectomy for pleomorphic adenoma of parotid gland. The data was tabulated and results made using SPSS 21.0 system.  </p><p class="abstract"><strong>Results:</strong> Male:female ratios are 29:33. Average age was 47.1 years (31-61). Average duration of disease was 2.2 years (0.3-5). 4 were operated for recurrence. Facial paresis occurred in 7 out of 62 patients (11.3%), 4 females and 3 males. 11 patients have tumor greater than 4 cm, out of these 11 patients 2 patients had pre-op facial paresis. Out of 51 patients (size &lt;4 cm), 2 suffered facial paresis and out of 11 patients (size &gt;4 cm), 5 suffered same. Out of 59 patients with depth of tumor &lt;2 cm, 4 patients had post-op facial paresis. All the three patients having tumor depth &gt;2 cm suffered post op facial paresis. Patients with pre-op facial nerve paresis had mean duration of tumor 3.35 year (±0.92) while with post-op facial nerve paresis had mean duration of tumor 2.99 year (±1.35).</p><p class="abstract"><strong>Conclusions:</strong> Meticulous separation of facial nerve from parotid tissue is key to preservation of the facial nerve. But factors like size of tumor, depth of invasion, previous surgery do affect the outcome in parotid surgery.</p>

scholarly journals A case series of superficial parotidectomy under local anesthesia

2015 ◽  
Vol 1 (1) ◽  
pp. 27 ◽  
Author(s):  
I. D. Singh ◽  
J. R. Galagali ◽  
Maj Abhipsa Hota
Keyword(s):  
Facial Nerve ◽  
Local Anesthesia ◽  
Case Series ◽  
Low Grade ◽  
Superficial Parotidectomy ◽  
Therapeutic Choice ◽  
Parotid Surgery ◽  
The Face ◽  
Anesthesia Technique ◽  
Special Circumstances

<p class="abstract"><span lang="EN-US">Superficial parotidectomy is the biopsy procedure of choice for all parotid neoplasm’s as well as therapeutic choice for small low-grade malignancies. The key to successful parotid surgery is identification of the facial nerve. It is usually done under general anesthesia (GA).The main focus in this procedure is to remove entire superficial parotid gland along with a disease and at the same time preventing any iatrogenic injury to facial nerve and its peripheral branches which supplies over the face. We present three cases of superficial parotidectomies done under local anesthesia technique. The objectives of these reports are to discuss the clinical presentation, diagnosis and management of these growths surgically under local as an alternative method or when it is desired under some special circumstances and the merits. This technique may avoid the use of facial nerve monitor.</span></p>

scholarly journals POSTERIOR AURICULAR NERVE – A NOVEL LANDMARK FOR IDENTIFICATION OF THE FACIAL NERVE IN SUPERFICIAL PAROTIDECTOMY

2021 ◽  
Vol Volume 9 (upjohns/volume9/Issue2) ◽  
pp. 10-14
Author(s):  
Arulalan Mathialagan
Keyword(s):  
Facial Nerve ◽  
Pleomorphic Adenoma ◽  
Nerve Trunk ◽  
Target Area ◽  
Superficial Parotidectomy ◽  
Tertiary Referral Center ◽  
Individual Variations ◽  
Parotid Surgery ◽  
Auricular Branch ◽  
Nerve Identification

ABSTRACT Background-Facial nerve identification and preservation is the most critical step in parotid surgery. Though there are described landmarks to locate the facial nerve trunk, they have individual variations. The posterior auricular nerve (PAN) is a branch of the facial nerve and is always present, it can be followed to reach the facial nerve trunk. MATERIALS AND METHODS A retrospective cohort study in which analysis of parotidectomy performed from January 2017 to November 2018 at our tertiary referral center was done. RESULTS A total of 23 parotidectomies were performed, of which 18 cases were pleomorphic adenoma. In four cases of pleomorphic adenoma we could clearly identify and preserve the PAN. Using PAN as the landmark the facial nerve trunk was located, all its peripheral branches were dissected and preserved. PAN identification narrows down the target area of dissection to identify the facial nerve trunk. CONCLUSION The posterior auricular branch of the facial nerve can be used as a standard landmark in parotid surgeries, that almost always leads to the facial nerve trunk. CLINICAL SIGNIFICANCE Though identification of PAN may be difficult in all cases, effort must be made to identify it under magnification. If done meticulously PAN can be an ideal landmark to identify facial nerve in parotid surgery. KEYWORDS Parotid surgery, Superficial Parotidectomy, Posterior auricular nerve, Facial nerve.

IDENTIFICATION OF THE FACIAL NERVE TRUNK DURING SUPERFICIAL PAROTIDECTOMY BY TRIDENT LANDMARK

2019 ◽  
Vol 2 (1) ◽  
pp. 17-26
Author(s):  
Yasser Hatata ◽  
Mohamed Ibrahim ◽  
Reda Fawzy ◽  
Hazem Elgohary
Keyword(s):  
Facial Nerve ◽  
Nerve Trunk ◽  
Superficial Parotidectomy

scholarly journals Augmented Reality with HoloLens® in Parotid Tumor Surgery: A Prospective Feasibility Study

ORL ◽  
2021 ◽  
pp. 1-10
Author(s):  
Claudia Scherl ◽  
Johanna Stratemeier ◽  
Nicole Rotter ◽  
Jürgen Hesser ◽  
Stefan O. Schönberg ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Tumor Surgery ◽  
Parotid Tumor ◽  
Hand Gestures ◽  
Surgical Performance ◽  
3D Images ◽  
Additional Information ◽  
Parotid Surgery ◽  
Surgical Field ◽  
Improve Planning

<b><i>Introduction:</i></b> Augmented reality can improve planning and execution of surgical procedures. Head-mounted devices such as the HoloLens® (Microsoft, Redmond, WA, USA) are particularly suitable to achieve these aims because they are controlled by hand gestures and enable contactless handling in a sterile environment. <b><i>Objectives:</i></b> So far, these systems have not yet found their way into the operating room for surgery of the parotid gland. This study explored the feasibility and accuracy of augmented reality-assisted parotid surgery. <b><i>Methods:</i></b> 2D MRI holographic images were created, and 3D holograms were reconstructed from MRI DICOM files and made visible via the HoloLens. 2D MRI slices were scrolled through, 3D images were rotated, and 3D structures were shown and hidden only using hand gestures. The 3D model and the patient were aligned manually. <b><i>Results:</i></b> The use of augmented reality with the HoloLens in parotic surgery was feasible. Gestures were recognized correctly. Mean accuracy of superimposition of the holographic model and patient’s anatomy was 1.3 cm. Highly significant differences were seen in position error of registration between central and peripheral structures (<i>p</i> = 0.0059), with a least deviation of 10.9 mm (centrally) and highest deviation for the peripheral parts (19.6-mm deviation). <b><i>Conclusion:</i></b> This pilot study offers a first proof of concept of the clinical feasibility of the HoloLens for parotid tumor surgery. Workflow is not affected, but additional information is provided. The surgical performance could become safer through the navigation-like application of reality-fused 3D holograms, and it improves ergonomics without compromising sterility. Superimposition of the 3D holograms with the surgical field was possible, but further invention is necessary to improve the accuracy.

Prevention of Frey’s Syndrome with the Use of Porcine Dermal Collagen Graft: Retrospective Analysis of 76 “Formal” Parotidectomies for Benign Pathologies

2021 ◽  
pp. 000348942199018
Author(s):  
Kostas Vahtsevanos ◽  
Angelos Chatziavramidis ◽  
Ioannis (Yiannis) Papadiochos ◽  
Georgios Koloutsos ◽  
Anastasios Stefanidis ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Frey’S Syndrome ◽  
Randomized Controlled Studies ◽  
Parotid Surgery ◽  
Porcine Dermal Collagen ◽  
Frey's Syndrome ◽  
Dermal Collagen ◽  
Group A ◽  
Group B ◽  
Collagen Graft

Background: Frey’s syndrome is a well-known complication of parotid surgery; its prevention may be achieved by the use of an interpositional barrier between the overlying flaps and the exposed parenchymal bed of parotid gland. The aim of this study was to retrospectively evaluate clinical outcomes with and without the interpositional placement of a porcine dermal collagen graft (PDCG) for prevention of syndrome occurrence. Methods: We conducted a 20-year retrospective study including the patients who had undergone “formal” (superficial, total, or subtotal) parotidectomies for benign pathologies. The inclusion criteria also involved patients that were (i) regularly monitored about clinical symptoms related to syndrome, and (ii) examined with Minor starch-iodine test. The severity of the diagnosed syndrome was retrospectively evaluated according to the grading score system of Luna-Ortiz. To assess group differences in terms of the extent of dissection in operating sites, we estimated the tumor and histological specimen volumes using the available dimensions. Results: We included 73 patients who had undergone 76 formal parotid surgeries. The surgical sites were divided into 2 groups: (1) Group A consisted of 44 sites that were reconstructed with a SMAS flap, and (2) Group B, comprised 32 sites where a PDCG was additionally applied as an artificial preventive barrier. At a mean follow-up of 26.3 months, a significantly lower incidence of clinically diagnosed Frey’s syndrome was found after the use of dermal collagen interpositional barrier ( P = .031). Specifically, subjective symptoms were reported at an incidence of 31.8% in Group A and 6.7% in Group B. Minor’s test was positive at an incidence of 59.09% in Group A and 21.87% in Group B ( P = .004, 95% CI). Severe Frey’s syndrome was observed in 31.82% of the patients of Group A and in 3.12% of the patients of Group B ( P = .002, 95% CI). Since there were no statistical significant differences between the volumes of the removed tumors and the excised histological specimens, the extent of dissection was not proved to influence the occurrence of Frey’s syndrome in the compared groups, Conclusion: Porcine dermal collagen is a safe, practical, and useful means for parotid reconstruction, since it seems to contribute in prevention of Frey’s syndrome when increased amount of glandular tissue has to be removed. Additional randomized controlled studies with bigger samples are required to better assess the PDCG use in parotid surgery.

Innovative Technique to Reduce Incidence of Frey's Syndrome after Parotid Surgery

2011 ◽  
Vol 77 (3) ◽  
pp. 351-354 ◽  
Author(s):  
Neeraj Singh ◽  
Monica Kohli ◽  
Harjeet Kohli
Keyword(s):  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Control Group ◽  
Regenerated Cellulose ◽  
P Value ◽  
Frey’S Syndrome ◽  
Exact Test ◽  
Parotid Surgery ◽  
Frey's Syndrome ◽  
Aberrant Regeneration

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.

scholarly journals Superficial Parotidectomy: Impact of Postoperative Drainage

2020 ◽  
pp. 014556132094238 ◽  
Author(s):  
Charlotte Fog Nielsen ◽  
Charlotte Bjerg Sand Riis ◽  
Anne Louise Bach Christensen ◽  
Frank Mirz ◽  
Kasper Basse Reinholdt ◽  
...  
Keyword(s):  
Tumor Size ◽  
Best Practice ◽  
Facial Nerve Palsy ◽  
Regional Hospital ◽  
Male Gender ◽  
Risk Of Infection ◽  
Superficial Parotidectomy ◽  
Suction Drain ◽  
Postoperative Drainage ◽  
Nose And Throat

Background: Use of suction drain after superficial parotidectomy (SP) is based on national consensus considered best practice, but there is no evidence on the effect of the treatment. The aim of the present study is to evaluate the effectiveness of drainage after SP by evaluating the rate of complications after SP in relation to the (ie, duration) of drainage and tumor size. Methods: Retrospective analysis was performed involving data from all consecutive patients undergoing SP at the Ear, Nose, and Throat department, Regional Hospital West Jutland, Denmark, between January 1, 2011, and December 31, 2017. Demographics including comorbidity, medication, tumor size, postoperative secretion through the drainage, as well as complications (hematoma, seroma, infection, fistulas, Frey syndrome, facial nerve palsy) were registered. Patients with secretion below 25 mL were compared to patients with secretion above 25 mL, that is, drainage less than 24 hours versus longer than 24 hours. Results: Two hundred five consecutive patients undergoing SP were enrolled. The overall risk of postoperative infection was 16.2%. Ten of 33 patients with infection were also diagnosed with an hematoma or seroma. The risk of infection increased with secretion above 25 mL (27.2%) compared to patients with less than 25 mL (13.1%; P = .0318). The same accounts for the risk of seromas/hematomas ( P = .0055). We found no evidence that demographics or comorbidity correlated to the secretion in the drainage, but there is a tendency toward male gender having a higher risk off secretion above 25 mL (odds ratio 1.39). Conclusion: Overall, the risk of complications after SP increased with secretion beyond 25 mL (ie, drainage for more than 24 hours). This applied in particular to infections and seromas/hematomas demanding treatment. The use of routine drainage after SP is questionable, and a randomized trial is warranted to unravel the necessity of postoperative drainage.

Sign in / Sign up

Export Citation Format

Share Document