Superficial Parotidectomy by Retrograde approach through Marginal Mandibular Nerve Dissection

Background: Parotid gland is most commonly involved in tumors, comprising about 80% of the salivary gland neoplasms. Majority of parotid tumors are benign in nature, the most common being pleomorphic adenoma. Superficial Parotidectomy is the preferred treatment option, using either anterograde or retrograde approach. The objective of this study was to determine the post-operative facial nerve status and other complications following superficial Parotidectomy by retrograde dissection for benign lesions of parotid gland.Material and Methods: This prospective clinical study included a total of 22 patients who had superficial Parotidectomy by retrograde technique involving marginal mandibular nerve dissection. These patients were studied post-operatively for facial nerve status, Frey’s Syndrome, wound infection and salivary fistula.Results: Out of a total of 22 patients, 54.54% developed temporary facial palsy on ipsilateral angle of mouth and all of them recovered by the end of 3 months post-surgery. Two patients (9.09%) developed salivary gland fistula and both of them healed spontaneously within two weeks. Frey’s Syndrome and wound infection were not seen in any of the patients included in the study. Histopathology of these lesions revealed pleomorphic adenoma (n=20) and Warthin’s tumor (n=2), respectively.Conclusion: The use of marginal mandibular nerve as a landmark for retrograde dissection of facial nerve in superficial Parotidectomy is a reliable method to ensure lower percentage of facial nerve injury and associated complications.

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Minimally Invasive Surgery for Parotid Pleomorphic Adenoma

Ear Nose & Throat Journal ◽

10.1177/014556130508400517 ◽

2005 ◽

Vol 84 (5) ◽

pp. 308-311 ◽

Cited By ~ 33

Author(s):

Robert L. Witt

Keyword(s):

Facial Nerve ◽

Pleomorphic Adenoma ◽

Operating Time ◽

Frey’S Syndrome ◽

Superficial Parotidectomy ◽

Facial Contour ◽

Great Auricular Nerve ◽

Objective Reduction ◽

Frey's Syndrome ◽

Nerve Dysfunction

Compared with total parotidectomy and complete superficial parotidectomy for the removal of a parotid pleomorphic adenoma, partial superficial parotidectomy with dissection and preservation of the facial nerve—defined as the excision of a tumor with a 2-cm margin of normal parotid parenchyma except at the point where the tumor abuts the facial nerve—is associated with a lower incidence of transient facial nerve dysfunction, facial contour disfigurement, and subsequent Frey's syndrome. The partial procedure is not associated with any increase in recurrence, and it requires less operating time. The author hypothesized that the use of this procedure to remove a benign pleomorphic adenoma might result in even less morbidity (transient or permanent facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and hypoesthesia) without increasing the risk of recurrence if only a 1-cm margin of normal parotid parenchyma was removed and if the posterior branches of the great auricular nerve were preserved. To test this hypothesis, the author conducted a retrospective study of 30 patients—15 who had undergone the standard partial procedure (2-cm margin with great auricular nerve sacrifice) and 15 who had undergone the modified version (1-cm margin with great auricular nerve preservation). After a mean follow-up of 10 years, there were no significant differences between the two groups in terms of facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and recurrence. Moreover, preservation of the posterior branches of the great auricular nerve did not prevent alterations in sensitivity (i.e., hypoesthesia) in 7 of the 15 patients (46.7%). Although a 1-cm area of normal parotid parenchyma around a benign pleomorphic adenoma was a safe margin, it was no better than a 2-cm margin in terms of morbidity and recurrence. Preservation of the posterior branches of the great auricular nerve will result in an objective reduction in hypoesthesia in approximately half of patients, but because it does not ensure freedom from sensitivity alterations in all cases, patients should be advised of the risk of postoperative numbness in the earlobe and the infraauricular area.

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Partial superficial parotidectomy for pleomorphic adenoma of the parotid gland

BMJ Case Reports ◽

10.1136/bcr-2020-238759 ◽

2021 ◽

Vol 14 (6) ◽

pp. e238759

Author(s):

Auric Bhattacharya ◽

Madhumati Singh ◽

Anjan Shah ◽

Lynn Lilly Varghese

Keyword(s):

Salivary Gland ◽

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Needle Aspiration ◽

Superficial Parotidectomy ◽

Salivary Gland Tumours ◽

Patient Reported ◽

The Face ◽

Needle Aspiration Cytology

Pleomorphic adenoma, otherwise called as benign mixed tumour, is the most common salivary gland tumour which accounts for 60% of all benign salivary gland tumours. The clinical, radiological and histopathological presentations are varied. The tumour occurs in diverse anatomical sites and can consist of epithelial and mesenchymal components. In this case report, the patient reported with an asymptomatic swelling on the face. CT scan with contrast was advised. The clinical, roentgenographic findings and Fine Needle Aspiration Cytology were indicative of pleomorphic adenoma of the parotid gland. Treatment included partial superficial parotidectomy under general anaesthesia using the modified Blair’s incision. The facial nerve was not involved. Part of the gland along with the tumour was resected completely superficial to the facial nerve with a margin of normal tissue all around. Histopathologic examination of tissue specimen confirmed the lesion as pleomorphic adenoma. The patient was asymptomatic at 6-month follow-up.

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Superficial Parotidectomy by Retrograde Facial Nerve Dissection

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v10i1.17909 ◽

2017 ◽

Vol 10 (1) ◽

pp. 25-27

Author(s):

Narendra Vikram Gurung ◽

D Shrestha ◽

A Acharya ◽

A Gurung ◽

S Shrestha ◽

...

Keyword(s):

Salivary Gland ◽

Parotid Gland ◽

Facial Nerve ◽

Head And Neck Neoplasms ◽

Complication Rate ◽

Gland Tumor ◽

Superficial Parotidectomy ◽

Salivary Fistula ◽

Parotid Tumors ◽

Parotid Gland Tumor

Introduction: Tumors of the salivary gland are relatively uncommon and represent less than two percentage of all head and neck neoplasms. Parotid gland tumor comprises 85% of the salivary gland tumors of which 80% are being benign. Superficial parotidectomy is the commonest procedure done for parotid tumors which can be performed by either anteretrograde or retrograde facial nerve dissection technique.Methods: Outcome of 60 patients after superficial parotidectomy with retrograde facial nerve dissection has been studied.Results: Total of 60 patients had been studied. Complications like facial nerve weakness, Freys syndrome, salivary fistula, and wound infection were taken into account. Among them, 13.33% patients developed temporary facial nerve weakness, followed by temporary salivary fistula, 1.6%. None of the patients developed any severe complication.Conclusion: Superficial parotidectomy by retrograde facial nerve dissection is an easy technique to carry out with low complication rate and without compromising surgical outcome.Journal of Gandaki Medical CollegeVol. 10, No. 1, 2017, page: 25-27

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Cross-sectional study on the occurrence of Frey's syndrome following superficial parotidectomy or extracapsular dissection

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2020.01.003 ◽

2020 ◽

Vol 48 (3) ◽

pp. 199-202 ◽

Cited By ~ 1

Author(s):

Lorenz Kadletz ◽

Klaus Taucher ◽

Stefan Janik ◽

Stefan Grasl ◽

Matthäus C. Grasl ◽

...

Keyword(s):

Cross Sectional Study ◽

Sectional Study ◽

Frey’S Syndrome ◽

Superficial Parotidectomy ◽

Cross Sectional ◽

Extracapsular Dissection ◽

Frey's Syndrome

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215113003514 ◽

2014 ◽

Vol 128 (1) ◽

pp. 104-106 ◽

Cited By ~ 1

Author(s):

L Jablenska ◽

A Trinidade ◽

V Meranagri ◽

P Kothari

Keyword(s):

Salivary Gland ◽

Pleomorphic Adenoma ◽

Rare Case ◽

Paediatric Population ◽

Review Of The Literature ◽

Resonance Imaging ◽

Superficial Parotidectomy ◽

History Of ◽

Painless Mass ◽

Salivary Gland Pathology

AbstractIntroduction:Salivary gland pathology in the paediatric population is rare and can present management challenges regarding both investigation and treatment.Method:Case report and review of available literature.Results:A seven-year-old, fit, well girl presented with a two-month history of a painless mass over the left parotid area. Ultrasonography confirmed the presence of a well-defined, 1.5 × 2 cm, predominantly solid lesion with minor internal cystic spaces arising from the superficial part of the gland. Magnetic resonance imaging showed no invasion of the deep lobe or skeletal erosion. Superficial parotidectomy was performed via a facelift incision. Histopathology confirmed a diagnosis of pleomorphic adenoma. Review of the literature emphasised important differences in managing this pathology in the paediatric population when compared with adults.Conclusion:We present the youngest reported case of a pleomorphic adenoma of the parotid gland, detail its management, and discuss the general approach to parotid pathology management in the paediatric population.

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195591 ◽

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

Background: 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.Methods: 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. Results: 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 <4 cm), 2 suffered facial paresis and out of 11 patients (size >4 cm), 5 suffered same. Out of 59 patients with depth of tumor <2 cm, 4 patients had post-op facial paresis. All the three patients having tumor depth >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).Conclusions: 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.

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Pediatric Pleomorphic Adenoma of the Parotid: Case Report, Review of Literature and Novel Therapeutic Targets

Children ◽

10.3390/children5090127 ◽

2018 ◽

Vol 5 (9) ◽

pp. 127 ◽

Cited By ~ 1

Author(s):

Girish Gulab Meshram ◽

Neeraj Kaur ◽

Kanwaljeet Singh Hura

Keyword(s):

Salivary Gland ◽

Case Report ◽

Pleomorphic Adenoma ◽

Personalized Therapy ◽

Salivary Gland Tumors ◽

Diverse Group ◽

Review Of Literature ◽

Superficial Parotidectomy ◽

Novel Therapeutic

Salivary gland tumors are extremely rare and encompass a diverse group of histologies. Less than 5% of the affected population is pediatric. We present a case of 6-year-old child with pleomorphic adenoma of the parotid. The patient underwent a superficial parotidectomy. Recurrence was not observed in the six months of follow-up. Surgery is the mainstay of the management of benign salivary gland tumors. Although novel molecular agents are being explored, personalized therapy would be a challenge due to the rarity and vast genetic/histologic variations of salivary gland tumors.

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