minimize the morbidity of parotidectomy.
Explore This IssueSeptember 2012
Study design: Literature review with meta-analysis.
Setting: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston; Department of Otorhinolaryngology, University of Erlanger-Nürnberg, Bavaria, Germany.
Synopsis: Nine studies, with 1,882 patients from five countries, were evaluated. The decision to use ECD varied among studies, but the tumors were generally superficial, clinically benign tumors of the parotid gland.
Several limited the tumor size to 2.5 cm, while others used a cutoff of 4 cm. The recurrence rates for ECD and SP were 1.5 percent and 2.4 percent, respectively. Rates of transient facial nerve paresis for ECD and SP were 8 percent and 20.4 percent, respectively. There was no difference in the rate of permanent facial nerve paralysis.
Symptomatic Frey’s syndrome was reported by 4.5 percent of ECD patients, compared with 26.1 percent of SP patients. However, the studies provided insufficient detail to determine the timing of the Frey’s syndrome evaluation, which may be relevant, because symptomatic Frey’s syndrome in the immediate post-operative period may lessen over time.
The authors noted that most of the studies did not use pre-operative imaging of fine needle aspiration cytology (FNAC). They recommended the use of FNAC and appropriate imaging in the evaluation of tumors being considered for ECD.
Bottom line: There was no difference in the rate of tumor recurrence or permanent facial paralysis between SP and ECD, while ECD appeared to have a decreased incidence of transient facial nerve palsy and Frey’s syndrome.
Reference: Albergotti WG, Nguyen SA, Zenk J, Gillespie MB. Extracapsular dissection for benign parotid tumors: a meta-analysis. Laryngoscope. 2012;122(9):1954-1960.
—Reviewed by Sue Pondrom