OBJECTIVE: Reconstruction of soft tissue defects after total parotidectomy requires a feasible and effective pedicled flap with sufficient volume. In this study, we introduce a modified submandibular gland flap (SMGF) for functional reconstruction of soft tissue defects resulting from total parotidectomy.
METHODS: This study included 12 patients diagnosed with parotid gland carcinoma undergoing total parotidectomy and ipsilateral selective neck dissection. The modified SMGF was harvested and transferred to the parotid bed. This procedure was coupled with anastomosis between the parotid gland duct and Wharton\'s duct. The feasibility of the surgery, postoperative complications, facial profile restoration, and salivary secretion were assessed.
RESULTS: All SMGFs pedicled only over the proximal facial artery survived without major complications. Facial profiles were well-restored, and salivary secretion was partially reserved. During the postoperative follow-up, no tumor recurrence was observed in any of the cases, and the volume of the SMGFs did not show obvious atrophy.
CONCLUSIONS: The modified SMGF is a viable solution for volume restoration and functional reconstruction after total parotidectomy.
CONCLUSIONS: This modified technique is simple and feasible for the functional reconstruction of soft tissue defects after total parotidectomy compared to other flaps and is worthy of clinical promotion.

UNASSIGNED: Incision scars and postoperative cosmesis are critical in the management of benign parotid tumors. Traditional incisions have a typical visible scar in the retromandibular area or require wide skin flaps.
UNASSIGNED: In this study, we introduced a new surgical approach called the tri-split flap approach and evaluated its technical feasibility and surgical outcomes.
UNASSIGNED: Eleven patients with clinically benign parotid gland tumors underwent the tri-split flap approach and were followed for six to ten months postoperatively. Facial weakness, salivary fistula formation, first bite syndrome, earlobe numbness, and the subjective cosmetic results were evaluated.
UNASSIGNED: All tumors were completely excised, and the patients were highly satisfied with the esthetic outcome of the surgery. No patients developed wound dehiscence, facial nerve injury, or first bite syndrome during the follow-up period. One patient developed a minor salivary fistula that resolved after three weeks.
UNASSIGNED: The tri-split flap approach not only provides adequate exposure of the surgical site to achieve complete resection of benign parotid gland neoplasms but also results in a very short and highly concealed post-operative scar. This technique is a potential surgical approach in parotidectomy.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s12663-021-01605-1.

Endoscopic parotidectomy has the potential to become a reliable procedure for benign and low-grade malignant parotid gland tumors. Based on the previous literature review and our own clinical experience, we introduced in detail the surgical procedure of single incision-plus approach for gasless endoscopic parotidectomy. This method contributes a logical approach to achieving endoscopic resection of parotid gland tumor and preservation of facial nerve, which can be summarized into the following seven-step method: preoperative preparation; design of retroauricular-hairline incision and plus-incision; surgical cavities creation and coalescence; separation of surgical boundaries; separation and protection of the facial nerve trunk; processing of the branches of facial nerve; en bloc resection of the superficial parotid gland and tumor. Endoscopic parotidectomy is a more difficult procedure than conventional parotid surgery, requiring more precision as well as more experience and equipment. The learning curve of time and frequency is influenced by many factors, like anatomy, instruments, procedures and patience. We contribute our clinical exploration of anatomical precautions, feasible instruments, and surgical procedures and summarize precautions under single incision-plus in gasless endoscopic parotidectomy. Given the growing interest in the aesthetic process of the parotid region, the seven-step method may have the potential to be a method for teaching gasless endoscopic parotidectomy.

UNASSIGNED: This network meta-analysis aimed to comprehensively compare the operative and postoperative outcomes of different parotidectomy incisions.
UNASSIGNED: Embase, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials were searched up to April 2022. A complete Bayesian network meta-analysis was performed using the Markov Monte Carlo method in OpenBUGS.
UNASSIGNED: Seventeen studies with 1609 patients were included. Thirteen were retrospective cohort studies, three were prospective cohort studies, and one was a randomized controlled study. The quality of evidence was rated as very low in most comparisons. The incision satisfaction score of the modified facelift incision (MFI), retroauricular hairline incision (RAHI), V-shaped incision (VI) were higher than that of the modified Blair incision (MBI) (MBI vs. MFI: mean difference [MD] -1.39; 95% credible interval [CrI] -2.23, -0.57) (MBI vs. RAHI: MD -2.25; 95% CrI -3.40, -1.12) (MBI vs. VI: MD -2.58; 95% CrI -3.71, -1.46); the tumor size treated by VI was smaller than that by MBI (MD 5.15; 95% CrI 0.76, 9.38) and MFI (MD 5.16; 95% CrI 0.34, 9.86); and the risk of transient facial palsy in the MFI was lower than that in the MBI (OR 2.13; 95% CrI 1.28, 3.64). There were no differences in operation time, drainage volume, wound infection, hematoma, salivary complications, Frey syndrome, or permanent facial palsy between incision types.
UNASSIGNED: The traditional MBI is frequently used for large tumor volumes, but the incision satisfaction score is low and postoperative complication control is poor. However, emerging incisions performed well in terms of incision satisfaction scores and control of complications. More randomized controlled trials are needed to compare the different parotidectomy incisions. Patients should be fully informed about the characteristics of each incision to make the most informed decision, along with the physician\'s advice.
UNASSIGNED: PROSPERO, identifier CRD42022331756.

The aim of this study was to compare modified partial superficial parotidectomy (MPSP) with conventional partial superficial parotidectomy (CPSP) in a retrograde approach, and to determine whether MPSP can reduce the risk of injury to the MMB of the facial nerve and the rate of postoperative facial palsy. Patients with benign parotid gland tumors of the superficial lobe were included retrospectively in two groups: one group was treated with CPSP; the other group was treated with MPSP, in which the MMB was dissected in an anterograde direction or not dissected. The patients\' sex and age, location of tumor, size of tumor (maximum tumor diameter), histopathological distribution, operative time, and incidence of postoperative facial nerve weakness were compared. There was no significant difference in operative time between the two groups (p = 0.913). There was a significant difference (p = 0.008) in postoperative facial nerve weakness, with temporary facial nerve weakness observed in 19 and five patients in the CPSP and MPSP groups, respectively. Furthermore, there was a significant difference (p = 0.009) in MMB weakness, with temporary MMB weakness observed in 15 and three patients in the CPSP and MPSP groups, respectively. There was no significant difference (p = 0.564) in the weakness of other branches between the two groups. All cases of paresis scored ≤3 on the House-Brackmann scale, and all cases of temporary facial nerve weakness resolved within 6 months of surgery. No patient developed permanent paralysis. Within the limitations of the study, it seems that modified partial superficial parotidectomy (MPSP) should be preferred over conventional partial superficial parotidectomy (CPSP) whenever appropriate.

BACKGROUND: Postoperative sialoceles and fistulas are frequent surgical complications of parotid tumor resection. Extracapsular dissection by the sternocleidomastoid muscle-parotid space approach (ECD-SMPSA) is a minimally invasive technique. To our knowledge, the characteristics of sialoceles and fistulas secondary to ECD-SMPSA have not been reported.
METHODS: This prospective study enrolled 52 patients who underwent ECD-SMPSA without sialocele/fistula prevention measures. Postoperative sialoceles and fistulas were evaluated during 2 months of follow-up.
RESULTS: Among the 52 patients, only one male patient developed a mild sialocele. No salivary fistulas occurred. The overall rate of sialocele/fistula formation was 1.92%.
CONCLUSIONS: When treating clinically benign tumors that involve the sternocleidomastoid muscle-parotid space, ECD-SMPSA may prevent postoperative formation of sialoceles and salivary fistulas.

The clinical implications of great auricular nerve (GAN) preservation or sacrifice during parotid surgery have long been a topic of controversy. This study aimed to compare sensory recovery rates and quality of life (QoL) in patients who had undergone superficial parotidectomy and had their GAN preserved or sacrificed. Fifty patients were prospectively analysed, 28 with the GAN preserved, and 22 with it sacrificed. The primary outcomes were tactile sensitivity and QoL. The secondary outcomes were operating times and other complications. There was a gradual improvement in tactile sensitivity in both groups, which showed a statistically significant difference favouring the preserved group at 1, 3, 6, and 9 months postoperatively (p<0.05). There was no statistically significant difference in tactile sensation for both groups at 12 months postoperatively. The overall sensory recovery rates in the GAN preserved and sacrificed groups after 1, 3 ,6, 9 and 12 months were 42.8%, 42.8%, 57.1%, 57.1%, and 78.5%, and 0%, 0%, 13.6%, 27.3%, and 59.1%, respectively. According to the QoL assessment, there was a significant difference in mean (SD) loss of sensation scores (sacrificed group 0.86 (0.94) and preserved group 0.39 (0.62), p= 0.039). However, there were no statistical differences between the groups regarding other categories of the questionnaire. No significant difference was seen between groups regarding operating time and other complications. This study concluded that when evaluated objectively, sensory impairment ultimately lessened in severity in the second half of the first postoperative year. GAN preservation minimised sensation disturbance in long-term results, but overall QoL seemed to be unaffected following GAN preservation or sacrifice.

OBJECTIVE: The present study was designed to investigate whether acellular dermal matrix (ADM) grafts could prevent Frey\'s syndrome (FS) and improve esthetic scores following parotidectomy.
METHODS: From January 2015 to December 2019, 175 patients underwent parotidectomy. We divided the patients into two groups: the ADM group and the control group. We included in each group 30 patients according to a propensity score matched analysis.
RESULTS: FS was subjective in 1 patient (3%) from the ADM group and 9 patients (30%) from the control group (P=0.015). Patients in the ADM group had a subjective esthetic score of 6.1 + 1.7 compared with 5.2 + 1.7 in the control group. The subjective esthetic score for patients in the ADM group was higher than that for patients in the control group (P =0.040).
CONCLUSIONS: The present clinical study suggests that ADM grafts are effective in preventing FS and improving esthetic scores after parotidectomy.

Salivary fistula is a relatively common complication in patients who have undergone a parotidectomy. The purpose of this study was to investigate the effects of bipolar coagulation forceps use on salivary fistulas.
From March 2015 to June 2020, 177 patients who underwent a parotidectomy in the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital of Central South University were recruited. The patients were divided into an experimental group and a control group based on whether bipolar coagulation forceps or sutures were used, respectively.
The drainage output of the experimental group was significantly lower than that of the control group (p = 0.04). The duration of dressing pressure applied in the experimental group was significantly shorter than that in the control group (p = 0.0003). Moreover, the incidence of salivary fistula in the experimental group (9.8%, 8/82) was notably lower than that in the control group (34.7%, 33/95) (p < 0.0001). In the logistic regression model for salivary fistula development, both the use of bipolar coagulation forceps (p = 0.0021) and drainage output (p = 0.0237) were associated with the presence of salivary fistulas.
Our findings indicate that the use of bipolar coagulation forceps decreases the incidence of salivary fistula in patients who have undergone a parotidectomy. The use of bipolar coagulation forceps is a safe, effective, and convenient method to prevent salivary fistulas in patients who undergo a parotidectomy.
Current Controlled Trials ChiCTR2100044722, Date: 26/03/2021, Retrospectively registered.

The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis (NMA) is to answer the following questions: (1) Does the extent of surgical resection of benign parotid tumors increase the risk of postoperative complications? (2) What is the best surgical intervention for treatment of benign parotid tumors that can provide an acceptable balance between tumor recurrence rate and other postoperative complications? A comprehensive search on PubMed, Embase, Scopus, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of tumor recurrence, facial nerve weakness (temporary [TFW] or permanent [PFP]), Frey\'s syndrome (FS), sialocele, and salivary fistula. The Bayesian network meta-analysis (NMA) accompanied by a random effect model and 95% credible intervals (CrI) were calculated using the GeMTC R package. Forty-four studies with a total of 7841 participants were included in the current NMA comparing five surgical interventions, namely enucleation, extracapsular dissection (ECD), partial superficial parotidectomy (PSP), superficial parotidectomy (SP), and total parotidectomy (TP). Enucleation showed the highest recurrence rate compared to ECD, SPS, SP, and TP. No statistical differences were observed concerning the recurrence rate when ECD, PSP, SP, and TP were compared together. There was an increased incidence of TFW and FS with the increase in the extent of parotid resection, while no significant difference was found when comparing enucleation with ECD and PSP. SP showed the highest incidence of PFP, and salivary fistula compared to ECD, PSP, and TP. The tumor recurrence rates in enucleation, ECD, PSP, SP, and TP were 14.3%, 3.6%, 3.7%, 2.8%, and 1.4%, respectively. The current NMA demonstrated that the risk of TFW and FS increases with the increase in the extent of parotid resection and that ECD and PSP can be considered the treatment of choice for benign parotid tumors, as both provide an acceptable balance between the incidence of tumor recurrence and facial nerve dysfunction.