Systematic review and meta-analysis of modified facelift incision versus modified Blair incision in parotidectomy

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.

Modified facelift incision and superficial musculoaponeurotic system flap in parotid malignancy: a retrospective study and review of the literature

Background Data reporting the use of modified facelift incision (MFI) approach with or without superficial musculoaponeurotic system (SMAS) reconstruction in parotid malignancy are limited. To enhance the limited knowledge in this subject, the authors of the current study report quality data of MFI in patients with parotid malignancy with or without SMAS reconstruction. Methods We performed a retrospective review of parotid malignancy patients treated with the MFI over a 5-year period (2015–2019) in the 1st ENT University Department, University of Athens, Greece. Results We identified five patients with parotid malignancy. We performed MFI parotidectomy in 5/5 patients and SMAS reconstruction in 2/5 patients. All tumors were classified as T1N0M0. After a mean follow-up of 43.6 months (minimum, 36; maximum, 55), we noted no recurrence. The patients reported no Frey’s syndrome. Conclusions The authors of the current study suggest consideration of the MFI approach in parotid malignancy. A MFI approach should at least favor small parotid tumors without neck metastatic disease (T1cN0). Surgeons could also address larger tumors with a MFI approach. Surgeons should reconstruct the parotid lodge with a SMAS advancement flap in tumors not in proximity with the SMAS.

Cervicomastoidfacial versus modified facelift incision for parotid surgery: a patient feedback comparison

INTRODUCTION Traditionally, the cervicomastoidfacial (CMF) incision is used to excise benign tumours of the parotid gland. The rhytidectomy or modified facelift (MF) incision allows an alternative approach which leaves no visible neck scar. The objective of this study was to establish the frequency of each surgical approach used and identify any difference in complication and patient satisfaction between the two incisions for benign conditions of the parotid gland. PATIENTS AND METHODS A retrospective analysis of 101 case notes for patients who underwent parotidectomy by both ENT and maxillofacial departments between January 2006 and February 2008 was undertaken. All histologically confirmed cases of malignancy were excluded. For each incision, immediate postoperative complications were obtained from the notes. A postal patient outcome evaluation questionnaire sought information regarding persistent and late complications as well as a visual analogue scar satisfaction score for both incisions. RESULTS Overall, 79 parotidectomies were included (59 CMF incisions, 20 MF incisions). Of CMF incisions, 34% suffered facial weakness immediately postoperatively versus 20% of MF incisions. Of CMF incisions, 4% suffered postoperative haematomas versus none following MF incisions. In the study cohort, 47 (60%) responded to the postal feedback questionnaire (33 CMF versus 14 MF respondents). Information regarding immediate and late postoperative ipsilateral facial paraesthe-sia and gustatory sweating was obtained. Mean visual analogue scar satisfaction scores were 9.4 for CMF incisions and 8.9 for MF incisions. CONCLUSIONS Immediate and late complications for CMF and MF approaches for benign disease parotidectomy were comparable, but scar satisfaction following MF incision was not greater than CMF incisions.