Extracapsular dissection versus partial superficial parotidectomy for the treatment of benign parotid tumours

The purpose of this study was to compare the complications of patients treated for a benign parotid tumour (BPT) by extracapsular dissection (ECD) vs. partial superficial parotidectomy (PSP). A comprehensive literature investigation was conducted by searching electronic databases. A systematic review and meta-analysis of comparative studies were performed to assess ECD and PSP for the treatment of BPTs with fixed-effects models. The outcomes analysed were transient or permanent facial nerve injury, Frey syndrome, recurrence rate, infection, and salivary fistula/sialocele. A total of 1641 patients from seven studies (1120 ECD-treated and 521 PSP-treated patients) were included in this meta-analysis. Transient facial nerve injury (odds ratio (OR) = 0.28, 95% confidence interval (CI): 0.11–0.71; p = 0.008) and Frey syndrome (OR = 0.12, 95% CI: 0.03–0.48; p = 0.003) were less prevalent in the ECD group. The rates of permanent facial nerve injury (OR = 0.77, 95% CI: 0.35–1.70; p = 0.520), recurrence rate (OR = 0.17, 95% CI: 0.02–1.75; p = 0.14), infection (OR = 0.70, 95% CI: 0.07–6.67; p = 0.76), and salivary fistula/sialocele (OR = 0.40, 95% CI: 0.06–2.66; p = 0.350) were similar in both groups. Although there was a trend that ECD showed a reduced risk for complications, the present results are not sufficient to conclude that ECD is more beneficial than PSP.     

腮腺浅叶良性肿瘤区域性和浅叶切除临床研究

目的    观察腮腺浅叶良性肿瘤区域性切除术和浅叶切除术的疗效及并发症发生率,为合理选择术式提供依据。 方法    回顾性分析2001年1月至2008年12月焦作市第二人民医院口腔科收治的68例腮腺浅叶良性肿瘤患者病历资料,其中腮腺区域性切除术38例,腮腺浅叶切除术30例。随访2 ~ 5年,记录肿瘤复发、面瘫、Frey综合征和涎瘘的发生例数。对所得数据进行分析。结果    随访2~5年,所有患者均未复发。腮腺区域性切除术后并发症发生率13.15%,传统腮腺浅叶切除术为66.67%。结论    腮腺区域性切除术可作为体积较小的腮腺浅叶良性肿瘤治疗的首选术式,具有手术创伤小、并发症少及肿瘤复发率低等优点。     

腮腺浅叶多形性腺瘤区域性切除的临床疗效分析

目的探讨腮腺浅叶多形性腺瘤区域性切除的临床效果。方法56例腮腺浅叶多形性腺瘤患者纳入试验组,行肿瘤及瘤体周围腺体区域性切除术。另选56例行肿瘤及腮腺浅叶切除术的腮腺浅叶多形性腺瘤患者纳入对照组。对病历资料进行回顾性研究。比较2组临床疗效及术后涎瘘、面瘫及味觉性出汗综合征发生率。结果随访3个月～5年,试验组均无肿瘤复发,腮腺术区凹陷畸形不明显,腮腺分泌功能均基本正常;对照组亦无肿瘤复发,但均有不同程度的腮腺区凹陷畸形,腮腺均无分泌功能。试验组术后发生涎瘘例数明显少于对照组（χ2=5.23,P〈0.05）,发生面瘫例数明显少于对照组（χ2=16.10,P〈0.05）,发生味觉性出汗综合征例数明显少于对照组（χ2=18.60,P〈0.05）。结论治疗腮腺浅叶多形性腺瘤,肿瘤及瘤体周围腺体区域性切除术优于肿瘤及腮腺浅叶切除术。     

腮腺多形性腺瘤81例回顾性分析

目的:比较腮腺多形性腺瘤区域性切除术与浅叶切除术两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供参考依据。方法:总结2002-01—2008-06期间收治的腮腺多形性腺瘤81例,其中54例行腮腺区域性切除术,27例行腮腺浅叶切除术,随访3～9年。回顾性分析腮腺多形性腺瘤区域性切除术与浅叶切除术两种术式的术后复发率及并发症发生情况。结果:采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而肿瘤的复发率无明显差异。结论:区域性切除术手术创伤小,并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式。     

改良腮腺部分切除术在老年腮腺下极良性肿瘤中的临床应用

目的:探讨改良腮腺部分切除术在老年腮腺良性肿瘤手术中的临床应用价值。方法:回顾性地研究2005年8月-2010年10月我院治疗的老年腮腺下极良性肿瘤患者86例,其中,采用改良腮腺部分切除术患者37例,采用传统的腮腺浅叶切除术患者49例;所有患者随访1-5年,对比其并发症的发生率及肿瘤复发情况。结果:采用腮腺浅叶切除术组面部畸形明显,暂时性面瘫发生率为20.4%(10/49),味觉出汗综合征发生率为40.8%(20/49),涎瘘发生率4.1%(2/49);采用改良腮腺部分切除术组患者术区面部畸形较轻,暂时性面瘫发生率为5.4%(2/37),味觉出汗综合征发生率为8.1%(3/37),P<0.05,本组无涎瘘发生;2组患者随访期间均无肿瘤复发。结论:腮腺部分切除术具有手术创伤小,并发症少,术后面部畸形小等优点,是老年腮腺下极良性肿瘤治疗的理想术式。     

腮腺功能性切除与浅叶切除术式的比较研究

目的：比较经典腮腺浅叶切除术式与功能性腺体切除术式的并发症情况,为临床选择术式提供依据。方法：随访2000～2008年间,选择经典腮腺浅叶切除术式病例120例,功能性腺体切除术式病例80例,对术后效果及并发症进行对比研究。结果：功能性腺体切除术,术后暂时性面瘫发生率,积液、涎漏发生率,面部瘢痕及凹陷畸形程度等均较经典腮腺浅叶切除术者轻,发生率亦低。结论：对于较小的腮腺浅叶良性肿瘤,应首选功能性腺体及肿瘤切除术术式。     

腮腺多形性腺瘤区域性切除术与浅叶切除术的比较研究

目的 比较腮腺多形性腺瘤区域性切除术与浅叶切除术两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供依据.方法 总结1998年1月～2004年6月间收治的腮腺多形性腺瘤61例,其中24例采用腮腺区域性切除术,37例行腮腺浅叶切除术,随访时间3～9年.结果 采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而肿瘤的复发率无明显差异.结论 区域性切除术手术创伤小,并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式.     

腮腺区域性切除术在治疗腮腺浅叶多形性腺瘤中的体会

目的探讨腮腺多形性腺瘤两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供依据。方法总结1999年1月至2007年1月间汕头市第二人民医院收治的腮腺多形性腺瘤90例,其中44例采用腮腺区域性切除术,46例行腮腺浅叶切除术,随访时间2～9年。结果采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而采用两种术式肿瘤的复发率差异无统计学意义。结论区域性切除术手术创伤小．并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式。     

内镜辅助下腮腺切除术14例报道

目的：探讨内镜辅助下进行腮腺手术切除的临床效果。方法：对2004年10月-2006年9月就诊的15例腮腺肿物住院患者采用无注气内镜辅助下腮腺切除手术。通过耳垂后下方皮纹小切口，在颈深筋膜浅层，采用高频超声刀切割分离，远端借助监视器锐性分离，暴露腮腺浅叶。内镜下解剖面神经主干及分支，超声刀切除腮腺，伤口负压引流。结果：耳垂后下方切口长4．0—5．4cm，平均4．8cm。手术麻醉时间平均115min。腮腺浅叶切除3例，部分腮腺浅叶切除11例。术后病理诊断为多形性腺瘤8例，Warthin瘤4例，淋巴上皮病1例，淋巴结反应性增生1例。随诊6～31个月，平均14个月。面神经轻度麻痹5例，均在6个月内恢复正常。结论：内镜辅助下腮腺切除手术适用于腮腺浅叶良性肿瘤的切除，切口小且隐蔽，手术创伤小，有利于患者的恢复。     

A meta-analysis of the pros and cons of partial superficial parotidectomy versus superficial parotidectomy for the treatment of benign parotid neoplasms

ObjectivesSalivary gland tumors are predominantly benign and frequently localized in the parotid gland (P). The treatment consists primarily of surgical removal; however, the appropriate extent remains a subject of debate. In suitable tumors, superficial parotidectomy (SP) may be substituted for less invasive partial superficial parotidectomy (PSP) (I C). This systematic review analyzed the available literature, comparing PSP and SP with regards to several postoperative outcome parameters (O).Materials and methodsEstablished medical databanks were screened for articles evaluating outcomes of PSP compared with SP, published between 1955 and 2019. These data were assessed by pooled risk and odds ratios via meta-analysis.Results11 studies with 1272 patients were included. There was no significant difference in tumor recurrence between PSP and SP (primary outcome). Furthermore, no differences in the occurrence of permanent facial nerve paralysis (FNP), salivary fistula, great auricular nerve analgesia, or hematoma were observed between the groups. However, PSP displayed significantly reduced rates of transient FNP, Frey's syndrome, scar deformity, and xerostomia, as well as shorter surgical time, compared with SP (secondary outcomes).ConclusionBased on these data, PSP can be recommended as a surgical technique for the treatment of superficially located, small, benign parotid tumors.     

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目的探讨腮腺多形性腺瘤的治疗方法。方法通过对1992—2009年江苏省徐州市第六人民医院口腔科收治的148例腮腺多形性腺瘤患者的临床资料进行总结,比较分析腮腺浅叶切除术(88例患者)与腮腺区域性切除术(60例患者)两种术式治疗腮腺多形性腺瘤的效果。结果采用腮腺区域性切除术治疗的病例,术后瘢痕、局部凹陷畸形、暂时性面瘫、涎瘘、Frey综合征及腮腺功能等方面明显优于采用腮腺浅叶切除术的病例。两种术式的术后复发率差异无统计学意义。结论应根据肿瘤的部位及大小选择不同的术式,对界限清楚、体积较小的腮腺浅叶多形性腺瘤应尽量采用腮腺区域性切除术,预防面部凹陷畸形,减少并发症;对过大或边界不清的肿瘤仍宜采用传统腮腺浅叶切除术,以减少复发。     

腮腺良性肿瘤两种切除术式的疗效比较

目的 :探讨改良腮腺部分切除术在腮腺良性肿瘤治疗中的临床应用价值。方法 :回顾性分析漯河市中心医院收治的62例腮腺良性肿瘤病例,按照手术切除方法的不同分为改良组和传统组,传统组采用传统腮腺浅叶切除术治疗,另一组采用保留腮腺咬肌筋膜的"肿瘤+腮腺部分切除术"治疗(研究组),比较两组患者的疗效、并发症发生率及复发率。结果:术后随访6~48个月,两组患者的复发率无显著性差异(P>0.05)。研究组术后并发症发生率显著低于传统组(P<0.05)。结论:改良腮腺部分切除术手术创伤小,术后并发症少,在直径<4 cm的腮腺浅叶良性肿瘤手术中,具有很高的临床应用价值。     

A modified centripetal approach to parotidectomy

A modified centripetal approach to parotidectomy is reported. A total of 422 benign parotid tumors, 383 of which were primary and 39 of which were recurrent, were treated by this technique. The pleomorphic adenoma was the most common type (94.79%) in the series. Superficial parotidectomy was done in 178 cases, and total parotidectomy, in 244 cases. No permanent facial paralysis occurred after parotidectomy in the primary tumor group. Seven recurrences were observed after surgery in the recurrent tumor group.     

微创技术在腮腺良性肿瘤区域性切除术中的应用

目的:探讨内镜及低温等离子射频消融在腮腺良性肿瘤切除术中应用的临床价值及相关技术。方法:收集临床病例38例,随机分为A、B 2组,A组应用改良耳屏切口作为入路,借助内镜在腮腺咬肌筋膜下分离建腔,并解剖面神经相关分支,采用低温等离子射频消融将肿瘤及部分腺体切除。B组采用传统术式。通过比较2组的手术时间、术后引流量,术后3个月的问卷调查,面神经功能评价内镜及射频消融在腮腺浅叶良性肿瘤手术中的应用价值。采用SPSS13.0软件包对数据进行统计学分析。结果:手术时间、术区疼痛程度、面神经功能在2组间无显著差异(P>0.05);而术后引流量、术区麻木程度、面部美观满意度在2组间有显著差异(P<0.05)。结论:应用内镜辅助下低温等离子射频消融实施改良耳屏切口的腮腺良性肿瘤区域性切除安全可行,并发症低于传统术式,瘢痕隐蔽,达到了微创治疗的效果。     

Soft Tissue Changes in Patients With Dentoalveolar Protrusion Treated With Maximum Anchorage: A Systematic Review and Meta-analysis

ObjectiveThis meta-analysis aimed at comparing the angular and linear changes of soft tissue profile using conventional anchorage techniques and mini-implant (MI)-based space closure in patients with dentoalveolar protrusion.Materials and MethodsElectronic databases, viz. PubMed, Embase, and Cochrane Central Register of Controlled Trials, were searched for relevant literature from their inception to December 2017 according to the specific inclusion and exclusion criteria. The following Medical Subject Heading terms were used for searching: “skeletal anchorage”, “temporary anchorage devices”, “miniscrew implant”, “mini-implant”, “micro-implant”. Selected randomized control trials (RCTs) were assessed for their quality using Cochrane's Risk of Bias Tool, whereas the Newcastle-Ottawa scale was used for non-RCTs. Standardized mean difference (SMD) and 95% confidence interval (CI) were obtained with either fixed- or random-effects models based on the heterogeneity of the included studies.ResultsA total of 5 articles (2 RCTs with moderate risk of bias and 3 high-quality non-RCT studies) were included in the final analysis. The nasolabial angle had significantly greater changes in the MI group than in the conventional anchorage group (SMD = 0.68, 95% CI = 0.39 to 0.97, P < .0001). Significantly higher retraction of the upper lip was seen in the MI group than in the conventional group (SMD = ?0.51, 95% CI = ?0.84 to ?0.18; P = .002). No significant difference was seen in the facial convexity (SMD = ?0.34, 95% CI = ?0.76 to 0.07, P = .106) and lower lip retraction (SMD = 0.28, 95% CI = ?1.72 to 2.28, P = .784) between the groups.ConclusionIt was seen that MIs facilitated favorable soft tissue profile than the conventional anchorage devices. However, more high-quality studies are warranted to confirm the clinical effectiveness of MIs.     

腮腺区良性肿瘤术后并发症发生的相关因素分析

目的： 探讨腮腺良性肿瘤术后各类并发症发生的相关因素。方法：搜集并整理我院2010—2015年手术治疗的215例腮腺良性肿瘤患者的病例资料,回顾分析一般资料、手术治疗中不同因素及术后并发症的发生情况。采用SPSS17.0软件包对资料进行χ2检验。结果：术后积涎或涎瘘、面神经功能障碍及Frey综合征的发生与手术治疗中不同因素（手术切口、术中是否缝扎腺体残端、面神经解剖方式、手术切除范围及是否行胸锁乳突肌瓣转移修复等）之间具有显著相关性（P＜0.05）。结论：“N”形切口在解剖形态上不利于术后常规引流渗出液,需配合负压引流管,以减少术后积涎的发生。缝扎腺体残端能有效避免术后积涎及涎瘘的发生。顺行法解剖面神经及腮腺肿瘤区域性切除能加快手术速度,减少面神经的解剖量及暴露时间,从而减轻术后面神经功能障碍的发生。胸锁乳突肌瓣的转移修复能很好避免术后Frey综合征的发生。     

腮腺混合瘤术后并发症的临床分析

目的：探讨腮腺混合瘤术后并发症发生原因及防治措施。方法：对118例腮腺混合瘤的治疗和预后进行回顾性分析。结果：面神经麻痹、涎瘘、Frey＇s综合征、复发为其常见并发症,其中术后面神经麻痹45例（38.1%）,涎瘘21例（17.8%）,Frey＇s综合征5例（4.2%）,复发3例（2.5%）。结论：明确解剖层次,轻柔细心操作,术后处置及时妥善可有效减少和防止术后并发症。     

小儿腮腺血管瘤的手术治疗

目的 探讨小儿腮腺血管瘤的手术治疗要点和手术治疗效果。方法 收集1996～2000年收治的小儿腮腺血管瘤20例，年龄2个月～3岁，均施行保留面神经的腮腺及血管瘤切除术。面神经剥离采用主干到分支的顺行法。随访1～3年。结果 创口全部I期愈合，无感染、无涎瘘、无永久性面瘫等并发症。面部外形无明显凹陷畸形。结论 本病早期手术治疗可获得满意治疗效果。小儿面神经分支类型与成人无明显差异，保护面神经及控制出血是手术成功的关键。     

ACCURACY OF CLINICAL AND RADIOGRAPHIC MEASUREMENTS OF PERIODONTAL INFRABONY DEFECTS OF DIAGNOSTIC TEST ACCURACY (DTA) STUDIES: A SYSTEMATIC REVIEW AND META-ANALYSIS

BackgroundThe aim of this study was to determine the accuracy of clinical and radiographic measurements of infrabony periodontal defects.MethodsThe MEDLINE-Pubmed and Cochrane-CENTRAL electronic databases were searched from initiation to May 2020. The inclusion criteria were clinical trials, human subjects with at least one infrabony defect, measurements of clinical attachment level (CAL), radiographic bone level (rBL), and intraoperative bone level (iBL) used as the reference standard.ResultsIn total, 11 studies including 17 comparisons were included in this meta-analysis. All 17 comparisons showed that the values of the CAL and rBL measurements underestimated the iBL values. For CAL, the analysis showed a significant difference of means of -1.22 (P < .00001; 95%CI: [-1.49; -0.95]) and for rBL -1.10 (P < .00001; 95%CI: [-1.34; -0.85]). No significant DiffM were observed between the CAL and rBL measurements (DiffM -0.05; P = .76; 95%CI: [-0.39; 0.28]).ConclusionThe results of this systematic review and meta-analysis show that both clinical and radiographic measurements substantially underestimate the bone level when compared to intraoperative level measurements. However, there was no significant difference in the results between the clinical attachment level measurements and the radiographic observation.     

腮腺手术中顺行法与逆行法解剖对面神经功能影响的比较研究

目的:比较腮腺手术中顺行法与逆行法解剖对面神经功能影响的差异。方法:腮腺浅叶良性肿瘤临床病例107例,随机采用顺行法(48例)与逆行法(59例)解剖面神经,统计手术时间、观察患者术后面瘫情况及统计神经功能恢复时间。结果:所有病例术后均无出现永久性面瘫,采用顺行法与逆行法解剖面神经完成手术所需的手术时间、术后暂时性面瘫的发生率及神经功能恢复所需的时间分别是:(46.33±4.85) min,14.58%,(2.04±0.95)个月;(42.51±4.23) min,33.90%,(2.47±0.97)个月。两种术式的手术时间差异无显著性;两种术式术后暂时性面瘫发生率及恢复时间(P<0.05)差异均存在显著性。结论:腮腺手术中熟练操作顺行法解剖面神经可有效减少面瘫的发生。