Case Series-An Overview of Extracapsular Dissection of Parotid Tumours

Extra Capsular Dissection (ECD) differs markedly from classic surgical approaches to the parotid neoplasm because facial nerve dissection is not performed. Factors noted to favor this approach include mobility of the tumor within the gland, a thin covering of capsule and glandular tissue, and a tumor large enough to allow digital manipulation during dissection. Imaging, fine needle aspiration cytology, and neuron-monitoring play a heightened role in ECD [1]. The AIM of this article is to report case series on surgical management of few types of parotid tumors by extra capsular dissection and to assess longterm results after the treatment of Parotid tumors using surgical technique ECD. This case series includes five different parotid tumors such as Warthin’s tumor, Pleomorphic adenoma, Sialadenoma papilliferum of parotid, chronic sialoadenitis, Parotid cystadenoma, out of 30 cases operated in our hospital. All the patients in this study received appropriate surgical treatment (ECD) and done a follow up evaluation every month. Extra capsular dissection is a safe, reliable and recommended technique to manage the small benign superficial parotid tumors if the case is selected properly.

1153 “To FNA Or to Not FNA, That Is the Question.” A 5-Year Retrospective Epidemiological Study Of 238 Surgical Parotid Cases Treated at An East Yorkshire OMFS Unit

Introduction Fine needle aspiration (FNA) is a surgical procedure used to aid with diagnosis and subsequent treatment planning. This study compares FNA histology with final histology (gold standard) for diagnostic accuracy in parotid surgery patients. Method A retrospective investigation of patient records from January 2014-January 2019 was performed to find eligible patients that underwent parotid surgery. Histology reports of the ultrasound (US) FNA and final parotid sample were compared for diagnostic accuracy and ability to differentiate between malignant & benign tumours. Results 240 parotid surgeries on 238 patients were undertaken between 2014-2019 under OMFS and ENT specialities. 137 US FNA’s were performed, of these, there was an 85% diagnostic rate. Of the diagnostic FNA’s 79% reach gold standard, with the histology matching that of the final histology. Of the 24 without diagnostic accuracy, 2/3 were still able to differentiate between malignant and benign lesions. Overall, the US FNA’s were able to differentiate malignant and benign parotid lesions in 93% of cases. Conclusions The audit has proven US FNA to be an accurate diagnostic test, it gives extra data to aid in the decision making and planning for parotid surgeries. Although US FNA has shown to be more accurate in diagnosing benign parotid tumours; it is useful in detecting cellular change which could be indicative of malignancy.

Case series-an overview of extracapsular dissection of parotid tumours

<p>Extra capsular dissection (ECD) differs markedly from classic surgical approaches to the parotid neoplasm because facial nerve dissection is not performed. Factors noted to favor this approach include mobility of the tumor within the gland, a thin covering of capsule and glandular tissue, and a tumor large enough to allow digital manipulation during dissection. Imaging, fine needle aspiration cytology, and neuron-monitoring play a heightened role in ECD. The aim of this article is to report case series on surgical management of few types of parotid tumors by extra capsular dissection and to assess long-term results after the treatment of parotid tumors using surgical technique ECD.This case series includes five different parotid tumors such as Warthin’s tumor, Pleomorphic adenoma, Sialadenoma papilliferum of parotid, chronic sialoadenitis, parotid cystadenoma, out of 30 cases operated in our hospital. All the patients in this study received appropriate surgical treatment (ECD)<strong> </strong>and done a follow up evaluation every month.</p>

Parotid tumours

Salivary gland tumours are uncommon and account for just 6% of all head and neck neoplasms. Worldwide incidence varies, from 0.4 to 13.5 cases per 100 000 population. The parotid gland is by far the most commonly affected site, accounting for 80% of cases. The vast majority of these tumours are benign; only approximately 20–25% being malignant. This article considers the relevant clinical anatomy of the parotid gland, key aspects of assessment with history and examination, and when to refer to secondary care for further investigation. It will touch on the common benign and malignant parotid neoplasms and give an overview of secondary care management.

Prospective Study on Effectiveness of Facial Nerve Monitoring in Improving the Surgical Outcomes for Parotidectomy of Benign Parotid Tumours in a Tertiary Hospital in South India

BACKGROUND Salivary gland diseases are rare but an important group of disorders. Following surgeries involving the parotid gland, facial nerve paresis is a common postoperative complication. The reported worldwide incidence of facial nerve paresis following parotidectomy is approximately 20 - 60 %. We need to determine the incidence of facial nerve paresis in the post-operative period following superficial, adequate, or extra-capsular parotidectomy of benign parotid tumours with the use of intraoperative facial nerve monitoring. METHODS A non-randomised interventional trial was initiated once cleared by the institutional review board. With the calculated sample size of 44, the patients underwent nervemonitoring for the identification of the branches of the facial nerve. Clinical grading of the nerve function was done using the House-Brackmann score on the postoperative days 2, 7, and 60. The findings were compared with the historical controls (HC) of 53 patients who underwent similar procedures but with no intraoperative facial nerve monitoring. All patients were recruited in continuity for over two years. RESULTS The incidence of facial nerve paresis was 30 - 40 % and 10 - 20 % in the historical control and nerve monitoring group, respectively (P = 0.07). The duration of surgery in the nerve monitoring group was 83 ± 30 minutes and 95 ± 15 minutes in the HC group. The incidence of nerve paresis was similar among the trainees and consultants suggestive of adequate training. CONCLUSIONS Intraoperative facial nerve monitoring is a useful adjunct to reduce the incidence of early postoperative facial nerve paresis. The technique would not prolong the duration of the procedure. The technique may be utilized safely on a routine basis even during surgical training. KEYWORDS Facial Nerve Monitoring, Parotidectomy, Benign Parotid Tumour, HouseBrackmann Score