Is extracapsular dissection a better option for benign parotid tumors?
Background: While a superficial or total parotidectomy is considered the gold standard surgical intervention for benign parotid tumors, the surgery risks intraoperative damage to the facial nerve. In fact, the rate of temporary paresis of the facial nerve is 15 to 25 percent after superficial parotidectomy and 20 to 50 percent after total parotidectomy, with a 5 to 10 percent rate of permanent facial paresis. Extracapsular dissection without exposure of the facial nerve’s main trunk has recently been favored as an alternative. Data on the incidence of facial nerve lesions and other acute postoperative complications, however, is lacking.
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March 2010Study Design: Retrospective analysis between 2000 and 2008 of 934 patients operated on for a newly diagnosed benign tumor of the parotid gland. Of these, 377 (40 percent) underwent extracapsular dissection. The authors provided a classification of techniques based on the extent of dissection of the facial nerve, with extracapsular dissection being the cases in which the tumor was removed without exposure of the main trunk of the facial nerve. The function of the facial nerve was assessed pre- and post-surgery using the House-Brackmann grading system.
Setting: University of Erlangen-Nuremberg, Germany
Synopsis: Of the 377 patients in the study who had extracapsular dissection, 18 (4.8 percent) developed a fluid accumulation in the form of a seroma, 13 (3.5 percent) a hematoma in the area of the wound, eight (2.1 percent) a salivary fistula, four (1 percent) lasting disturbances of sensation, and three (0.8 percent) secondary bleeding from the area of operation. The most commonly reported unwanted effect was hypoesthesia of the cheek or earlobe, reported in 38 (10.1 percent) patients. Normal facial nerve function was seen in 346 (91.8 percent) patients postoperatively. However, 31 patients (8.2 percent) showed facial nerve weakness immediately after the operation; of these, 23 patients had complete resolution in 14 days to three months. While some point to a higher recurrence rate with extracapsular dissection and partial parotidectomy, the authors said a clear distinction should be made between the modern technique of extracapsular dissection and the historical technique of enucleation and its recurrence rates.
Bottom Line: Extracapsular dissection, which has a lower risk of postoperative complications, is a viable surgical alternative to superficial or total parotidectomy.
Citation: Klintworth N, Zenk J, Koch M, et al. Postoperative complications after extracapsular dissection of benign parotid lesions with particular reference to facial nerve function. Laryngoscope. 2010;120(3):485-491.