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Benign tumours affecting the deep lobe of the parotid gland: how to select the optimal surgical approach.

Casani AP, Cerchiai N, Dallan I, Seccia V, Sellari Franceschini S - Acta Otorhinolaryngol Ital (2015)

Bottom Line: Some additional procedures were easily performed in order to improve aesthetical results (rotational flap of sternocleidomastoid muscle, free abdominal fat transfer); these had the same results as selective deep parotidectomy.TCA (or TPTCA) ensures the best control of the facial nerve, providing good exposure and good functional and aesthetical results (without sparing the superficial parenchyma if additional techniques are performed with the aim of reducing skin depression in the treated area).Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical and Surgical Pathology, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy.

ABSTRACT
Many types of approaches allow extra-capsular dissection in the deep parotid parenchyma in the treatment of benign tumours. A transcervical approach (TCA), transparotid approach (TPA) and a combined transcervical-transparotid approach (TPTCA) are the three main procedures performed to expose the deep parenchyma. We conducted a retrospective chart review enrolling 24 consecutive patients treated for benign tumours affecting the deep lobe of the parotid. Review of the surgical data was accompanied by careful follow-up to establish surgical morbidity, functional (Frey's Syndrome and first-bite syndrome) and aesthetical outcomes. A TPA was performed in the majority of cases; in 26% superficial parotidectomy was not required (selective deep parotidectomy). Minor's test showed a low rate of Frey's syndrome (3 cases of 23, 13%). No long-lasting first-bite syndrome was reported. Some additional procedures were easily performed in order to improve aesthetical results (rotational flap of sternocleidomastoid muscle, free abdominal fat transfer); these had the same results as selective deep parotidectomy. TCA (or TPTCA) ensures the best control of the facial nerve, providing good exposure and good functional and aesthetical results (without sparing the superficial parenchyma if additional techniques are performed with the aim of reducing skin depression in the treated area). The choice of the approach should have only the aim of safe resection and should not be influenced by aesthetical outcome; the craniocaudal level of the tumour seems to be the best indicator of the feasibility of the procedure also considering the branches of the facial nerve. In our experience, mandibulotomy can always be avoided.

No MeSH data available.


Related in: MedlinePlus

Four consecutive coronal preoperative MRI scans in a TCA; the images show the presence of healthy salivary tissue (black asterisk) between the tumour (white arrow) and the LPM (white asterisk).
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Figure 3: Four consecutive coronal preoperative MRI scans in a TCA; the images show the presence of healthy salivary tissue (black asterisk) between the tumour (white arrow) and the LPM (white asterisk).

Mentions: TCA was performed in 1 patient (4.2%) a; the tumour was 1.5 cm in diameter and completely extra-glandular, located in the prestyloid compartment of the PPS, with a clear manifestation of healthy salivary tissue between the tumour and the LPM on MRI (Fig. 3).


Benign tumours affecting the deep lobe of the parotid gland: how to select the optimal surgical approach.

Casani AP, Cerchiai N, Dallan I, Seccia V, Sellari Franceschini S - Acta Otorhinolaryngol Ital (2015)

Four consecutive coronal preoperative MRI scans in a TCA; the images show the presence of healthy salivary tissue (black asterisk) between the tumour (white arrow) and the LPM (white asterisk).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4443562&req=5

Figure 3: Four consecutive coronal preoperative MRI scans in a TCA; the images show the presence of healthy salivary tissue (black asterisk) between the tumour (white arrow) and the LPM (white asterisk).
Mentions: TCA was performed in 1 patient (4.2%) a; the tumour was 1.5 cm in diameter and completely extra-glandular, located in the prestyloid compartment of the PPS, with a clear manifestation of healthy salivary tissue between the tumour and the LPM on MRI (Fig. 3).

Bottom Line: Some additional procedures were easily performed in order to improve aesthetical results (rotational flap of sternocleidomastoid muscle, free abdominal fat transfer); these had the same results as selective deep parotidectomy.TCA (or TPTCA) ensures the best control of the facial nerve, providing good exposure and good functional and aesthetical results (without sparing the superficial parenchyma if additional techniques are performed with the aim of reducing skin depression in the treated area).Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical and Surgical Pathology, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy.

ABSTRACT
Many types of approaches allow extra-capsular dissection in the deep parotid parenchyma in the treatment of benign tumours. A transcervical approach (TCA), transparotid approach (TPA) and a combined transcervical-transparotid approach (TPTCA) are the three main procedures performed to expose the deep parenchyma. We conducted a retrospective chart review enrolling 24 consecutive patients treated for benign tumours affecting the deep lobe of the parotid. Review of the surgical data was accompanied by careful follow-up to establish surgical morbidity, functional (Frey's Syndrome and first-bite syndrome) and aesthetical outcomes. A TPA was performed in the majority of cases; in 26% superficial parotidectomy was not required (selective deep parotidectomy). Minor's test showed a low rate of Frey's syndrome (3 cases of 23, 13%). No long-lasting first-bite syndrome was reported. Some additional procedures were easily performed in order to improve aesthetical results (rotational flap of sternocleidomastoid muscle, free abdominal fat transfer); these had the same results as selective deep parotidectomy. TCA (or TPTCA) ensures the best control of the facial nerve, providing good exposure and good functional and aesthetical results (without sparing the superficial parenchyma if additional techniques are performed with the aim of reducing skin depression in the treated area). The choice of the approach should have only the aim of safe resection and should not be influenced by aesthetical outcome; the craniocaudal level of the tumour seems to be the best indicator of the feasibility of the procedure also considering the branches of the facial nerve. In our experience, mandibulotomy can always be avoided.

No MeSH data available.


Related in: MedlinePlus