Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction
Abstract Background Patients undergoing superficial parotidectomy for benign parotid lesions are at risk of postoperative complications, most notably cosmetic complications such as facial paralysis and contour defects, and functional complications including Frey’s syndrome. Traditionally, surgical d...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40463-020-00472-z |
| _version_ | 1797972865856831488 |
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| author | Jonathan C. Melong Matthew H. Rigby Martin Corsten Jonathan R. B. Trites Angela Bulter S. Mark Taylor |
| author_facet | Jonathan C. Melong Matthew H. Rigby Martin Corsten Jonathan R. B. Trites Angela Bulter S. Mark Taylor |
| author_sort | Jonathan C. Melong |
| collection | DOAJ |
| description | Abstract Background Patients undergoing superficial parotidectomy for benign parotid lesions are at risk of postoperative complications, most notably cosmetic complications such as facial paralysis and contour defects, and functional complications including Frey’s syndrome. Traditionally, surgical drains have been placed at the end of surgery to prevent hematoma and sialocele formation. However, this can increase the risk of postoperative complications and contribute to a prolonged course in hospital. To try and prevent these risks and complications, we introduced a novel technique of a drainless parotidectomy by reconstructing the resulting parotid bed defect with a superiorly based sternocleidomastoid (SCM) rotational flap and by placement of gelfoam into the wound bed and a facelift dressing postoperatively to provide additional hemostasis and avoid drain placement. Methods All patients with benign parotid disease undergoing a drainless superficial parotidectomy and reconstruction with a superiorly based SCM rotational flap at our center were identified within a prospective cohort database between July 2010–2018. Primary outcomes included postoperative cosmetic and functional outcomes, complications and length of hospital stay. A secondary cost analysis was done to compare this novel technique to traditional superficial parotidectomy with surgical drain placement. Results Fifty patients were identified within the database and were included in the final analysis. The average length of hospital stay was 1.02 days. All patients were satisfied with their aesthetic outcome at 1 year. During long term follow-up, 63% of patients reported normal appearance of the operated side. Seven patient’s (14%) developed temporary facial paresis following surgery. All patients had resultant normal facial function at follow-up in 1 year. No patients developed subjective Frey’s Syndrome. Two patients (4%) developed a postoperative sialocele requiring drainage and one patient (2%) developed a hematoma on extubation requiring evacuation and drain placement. Cost analysis demonstrated a cost savings of approximately $975 per person following surgery. Conclusion In the current study, we introduced a novel approach of a drainless superficial parotidectomy using a superiorly based SCM flap, gelfoam and placement of a post-operative facelift dressing. This drainless approach was associated with good long-term cosmetic and functional outcomes with few postoperative complications. This new technique may also offer the potential for long-term savings to the health care system. |
| first_indexed | 2024-04-11T03:55:03Z |
| format | Article |
| id | doaj.art-48b3a62b3b3e4c16896a1fb88448de85 |
| institution | Directory Open Access Journal |
| issn | 1916-0216 |
| language | English |
| last_indexed | 2024-04-11T03:55:03Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj.art-48b3a62b3b3e4c16896a1fb88448de852023-01-02T00:50:36ZengBMCJournal of Otolaryngology - Head and Neck Surgery1916-02162020-10-014911710.1186/s40463-020-00472-zProspective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstructionJonathan C. Melong0Matthew H. Rigby1Martin Corsten2Jonathan R. B. Trites3Angela Bulter4S. Mark Taylor5Department of Otolaryngology Head & Neck Surgery, Dalhousie UniversityDepartment of Otolaryngology Head & Neck Surgery, Dalhousie UniversityDepartment of Otolaryngology Head & Neck Surgery, Dalhousie UniversityDepartment of Otolaryngology Head & Neck Surgery, Dalhousie UniversityDepartment of Otolaryngology Head & Neck Surgery, Dalhousie UniversityDepartment of Otolaryngology Head & Neck Surgery, Dalhousie UniversityAbstract Background Patients undergoing superficial parotidectomy for benign parotid lesions are at risk of postoperative complications, most notably cosmetic complications such as facial paralysis and contour defects, and functional complications including Frey’s syndrome. Traditionally, surgical drains have been placed at the end of surgery to prevent hematoma and sialocele formation. However, this can increase the risk of postoperative complications and contribute to a prolonged course in hospital. To try and prevent these risks and complications, we introduced a novel technique of a drainless parotidectomy by reconstructing the resulting parotid bed defect with a superiorly based sternocleidomastoid (SCM) rotational flap and by placement of gelfoam into the wound bed and a facelift dressing postoperatively to provide additional hemostasis and avoid drain placement. Methods All patients with benign parotid disease undergoing a drainless superficial parotidectomy and reconstruction with a superiorly based SCM rotational flap at our center were identified within a prospective cohort database between July 2010–2018. Primary outcomes included postoperative cosmetic and functional outcomes, complications and length of hospital stay. A secondary cost analysis was done to compare this novel technique to traditional superficial parotidectomy with surgical drain placement. Results Fifty patients were identified within the database and were included in the final analysis. The average length of hospital stay was 1.02 days. All patients were satisfied with their aesthetic outcome at 1 year. During long term follow-up, 63% of patients reported normal appearance of the operated side. Seven patient’s (14%) developed temporary facial paresis following surgery. All patients had resultant normal facial function at follow-up in 1 year. No patients developed subjective Frey’s Syndrome. Two patients (4%) developed a postoperative sialocele requiring drainage and one patient (2%) developed a hematoma on extubation requiring evacuation and drain placement. Cost analysis demonstrated a cost savings of approximately $975 per person following surgery. Conclusion In the current study, we introduced a novel approach of a drainless superficial parotidectomy using a superiorly based SCM flap, gelfoam and placement of a post-operative facelift dressing. This drainless approach was associated with good long-term cosmetic and functional outcomes with few postoperative complications. This new technique may also offer the potential for long-term savings to the health care system.http://link.springer.com/article/10.1186/s40463-020-00472-zSuperficial parotidectomyDrainless parotidectomySternocleidomastoid flapFrey’s syndromeContour defectFacial paralysis |
| spellingShingle | Jonathan C. Melong Matthew H. Rigby Martin Corsten Jonathan R. B. Trites Angela Bulter S. Mark Taylor Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction Journal of Otolaryngology - Head and Neck Surgery Superficial parotidectomy Drainless parotidectomy Sternocleidomastoid flap Frey’s syndrome Contour defect Facial paralysis |
| title | Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction |
| title_full | Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction |
| title_fullStr | Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction |
| title_full_unstemmed | Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction |
| title_short | Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction |
| title_sort | prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction |
| topic | Superficial parotidectomy Drainless parotidectomy Sternocleidomastoid flap Frey’s syndrome Contour defect Facial paralysis |
| url | http://link.springer.com/article/10.1186/s40463-020-00472-z |
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