Fabio Nicoli1,2,3, Christopher D'Ambrosia1,4, Davide Lazzeri2,3, Georgios Orfaniotis1, Pedro Ciudad1, Michele Maruccia1, Li Tzong Shiun1,5, Bulent Sacak1,6, Shih-Heng Chen5, Hung-Chi Chen1. 1. Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan. 2. Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Rome, Italy. 3. Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy. 4. Columbia University School of Medicine, New York, USA. 5. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. 6. Department of Plastic and Reconstructive Surgery, Marmara University School of Medicine, Istanbul, Turkey.
Abstract
BACKGROUND: Parotidectomy has well-documented post-operative complications. Dissection of the facial nerve branches can be challenging even under loupe magnification, and partial, or complete injury of the nerve branches can occur during surgery. To reduce this risk and the associated complications, we propose a number of microsurgical best practices, which can be performed during parotidectomy. METHODS: A retrospective survey was conducted on 109 patients (45 males and 64 females, average age 46.2 years, range of 6 to 74 years) who underwent parotidectomy in two different institutions. RESULTS: Our data showed no permanent injury to the facial nerve, and 17% of neuroapraxia that had resolved with time. Post-operative complications have occurred in 33 cases (30% rate). In the superficial parotidectomy cohort (78 patients), the number of complications was 17 (21%). In the total parotidectomy cohort (31 patients), the number of complications was 16 (51%). CONCLUSIONS: Based on our results, we believe that the use of microsurgical techniques during parotidectomy may represent a useful tool in improving accuracy and minimising local tissue trauma that can affect nerve recovery. This is particularly true in situations such as tumor recurrence, tissue fibrosis or in case of sizeable tumors around the facial nerve branches. We believe that the decreased risk of facial nerve post-operative symptoms outweigh the disadvantage of increased operative time of this procedure.
BACKGROUND: Parotidectomy has well-documented post-operative complications. Dissection of the facial nerve branches can be challenging even under loupe magnification, and partial, or complete injury of the nerve branches can occur during surgery. To reduce this risk and the associated complications, we propose a number of microsurgical best practices, which can be performed during parotidectomy. METHODS: A retrospective survey was conducted on 109 patients (45 males and 64 females, average age 46.2 years, range of 6 to 74 years) who underwent parotidectomy in two different institutions. RESULTS: Our data showed no permanent injury to the facial nerve, and 17% of neuroapraxia that had resolved with time. Post-operative complications have occurred in 33 cases (30% rate). In the superficial parotidectomy cohort (78 patients), the number of complications was 17 (21%). In the total parotidectomy cohort (31 patients), the number of complications was 16 (51%). CONCLUSIONS: Based on our results, we believe that the use of microsurgical techniques during parotidectomy may represent a useful tool in improving accuracy and minimising local tissue trauma that can affect nerve recovery. This is particularly true in situations such as tumor recurrence, tissue fibrosis or in case of sizeable tumors around the facial nerve branches. We believe that the decreased risk of facial nerve post-operative symptoms outweigh the disadvantage of increased operative time of this procedure.
Authors: S A Reza Nouraei; Yasmin Ismail; Mark S Ferguson; Neil R McLean; Richard H Milner; Peter J Thomson; Andrew R Welch Journal: ANZ J Surg Date: 2008-03 Impact factor: 1.872