Gland-preserving robotic surgery for benign submandibular gland tumours: a comparison between robotic and open techniques

Benign tumours of the submandibular gland are usually treated surgically. Gland-preserving techniques, which can be used to completely remove the tumour, preserve the function of the gland and reduce complications, but conventional open operations result in obvious scars on the neck. We aimed to investigate the feasibility and efficacy of gland-preserving robotic surgery using a hairline approach. We compared robotic with open techniques for gland-preserving operations to remove benign tumours of the submandibular gland. Patients were matched for age and sex (4 in each group). All patients in the robotic surgery group had their tumours removed successfully through hairline approaches. No patient had operative complications or postoperative functional nerve deficit, and an aesthetically pleasing outcome was achieved by concealing the scars within the hairline. Robotic operations took longer than open operations. No recurrence was noted during follow-up. Gland-preserving robotic surgery is a feasible alternative to conventional techniques and has potential advantages for safety and aesthetic outcome.     

Functional outcomes after submandibular gland-sparing neck dissection in patients with oral squamous cell carcinoma

The feasibility of submandibular gland (SMG) preservation during neck dissection has been described. The aim of this study was to analyse the functional outcomes in patients undergoing SMG preservation during neck dissection for cT1–2N0 oral squamous cell carcinoma. Consecutive patients were divided into two groups based on the management of the SMG, and underwent a saliva flow test before surgery, 7 days after surgery, and at 3, 6, 9, and 12 months after surgery. All enrolled patients completed the fourth version of the University of Washington Quality of Life (UWQOL) questionnaire at 12 months after surgery. In patients who underwent SMG preservation during neck dissection, the flow rate at 7 days after surgery was significantly lower than that preoperative; however, it gradually returned to baseline at 9 months after surgery. The saliva flow rate at 9 months after surgery was similar to that at 12 months after surgery. Further, patients with SMG preservation had higher scores for the activity, swallowing, chewing, and saliva domains than patients without SMG preservation. The results of the study suggest that saliva secretion ability can be preserved following SMG-sparing neck dissection, and that SMG preservation improves postoperative quality of life.     

Gland-preserving surgery can effectively preserve gland function without increased recurrence in treatment of benign submandibular gland tumour

The most widely accepted treatment for neoplasms of the submandibular gland usually involves excision of the entire gland. Our aim was to establish a gland-preserving operation for benign tumours of the submandibular gland and evaluate its efficacy. We treated 40 patients from January 2007 to December 2008 with benign submandibular gland tumours who were listed to have an operation that either preserved the gland or sacrificed it. Duration of operation, extent of injury to the nerve, postoperative function of the gland, aesthetic appearance, and recurrence were assessed. We found no significant difference in baseline characteristics among the 20 patients in each group (19 men; 21 women, mean (SD) age of 34 (33.8 ± 5.72) years. The extent of injury to the lingual nerve and submandibular branch, together with deformities of the facial contour, were significantly less in the group in which the gland was preserved. Postoperative salivary production and overall patients’ satisfaction were also better in that group. There was no recurrence in either group during the follow up period of 38 months–5 years. The gland-preserving procedure has advantages over the typical approach in which the gland is sacrificed. There is less risk of injury to the nerve, less deformity of the facial contour, better preservation of function, and patients are more satisfied. The gland-preserving technique should therefore be the first choice for management of benign submandibular tumours.     

Feasibility and advantages of endoscope-assisted parotidectomy: a systematic review and meta-analysis

The object of this paper was to explore the feasibility and advantages of endoscope-assisted parotid tumour resection. Three databases (PubMed, Web of Science, and Cochrane) were used to search for all related randomised controlled trials or controlled trials (up to November 2019). The key parameters for assessment included ‘Endoscope’, ‘Endoscopes’, ‘Cancer of Parotid’, and ‘Parotid Cancer’. To evaluate the feasibility and advantages of endoscope-assisted resection of parotid tumours, the data for each parameter were pooled, based on patients who received endoscope-assisted surgery and those who received conventional surgery. This meta-analysis included seven studies, involving 170 patients in the endoscopy group and 270 patients in the control group. The analysis using the pooled data showed that there were no significant differences in the operating times between the two groups; however, the endoscopy group had significantly shorter incisions and less intraoperative bleeding. In addition, the patients who received endoscope-assisted surgery had lower incidences of temporary facial paralysis and Frey’s syndrome after surgery. Patients in the endoscopy group had greater postoperative satisfaction. Endoscope-assisted parotid tumour resection results in only a small, concealed incision wound and fewer postoperative complications. Therefore, it is promising for the surgical treatment of parotid tumours.     

Endoscope-assisted hairline approach for resecting maxillofacial masses

The endoscope-assisted hairline approach is becoming a preferred technique in several surgical disciplines because of its advantage of good cosmetic outcomes. However, such operations are not yet standard for benign lesions in the maxillofacial area due to the anatomical complexity of this region. This study describes an endoscope-assisted technique for resecting benign lesions in the maxillofacial area via a hairline approach. The clinical outcomes with this approach were compared to those obtained with the conventional transcutaneous approach. Benign maxillofacial lesions were excised via endoscope-assisted hairline approach in 27 patients and via transcutaneous approach in 28 patients. Clinical outcomes and complications related to the procedures were evaluated; the primary outcome was the efficacy of the procedure and the secondary outcome was cosmetic satisfaction. There were no significant differences with respect to overall demographic characteristics between the groups, although the operation time was longer for the hairline approach (P = 0.001). Cosmetic satisfaction showed much better results for the hairline approach (P = 0.001). Endoscope-assisted excision of benign maxillofacial lesions via the hairline approach is a feasible method with excellent cosmetic results.     

耳后发际联合耳屏缘切口在腮腺上极良性肿瘤切除术的应用

目的 探讨耳后发际联合耳屏缘切口在腮腺上极良性肿瘤切除术的临床效果.方法 采用耳后发际联合耳屏缘切口对20例腮腺上极良性肿瘤行手术治疗并分析其疗效与美容效果.结果 20例患者腮腺上极良性肿瘤均被顺利完整切除,术中冰冻及术后常规病理报告均为良性.术后2例出现暂时性耳垂麻木,1例出现暂时性面神经颧支麻痹,1例发生术后涎瘘;所有病例无味觉出汗综合征、无术后出血、无皮瓣坏死等并发症,随访24~48月,未见复发,手术切口疤痕不明显,美容效果满意.结论 腮腺上极良性肿物切除术应用耳后发际联合耳屏缘切口术式安全、可行,切口隐蔽.     

Comparison of endoscope-assisted versus conventional resection of parotid tumors

Endoscopically-assisted partial parotidectomy for benign tumours has been reported, but we have evaluated its feasibility through different concealed incisions compared with conventional parotidectomy. A total of 124 patients with parotid tumours were enrolled in this retrospective study: an endoscopically-assisted group (n = 37) compared with a group operated on conventionally (n = 87). The incision for endoscopically-assisted partial, total parotidectomy and selective neck dissection was based on location and pathological characters of the parotid tumour. The sex and age of the patients, diameter of the tumour, and histopathological features were comparable between the two groups. The mean length of the incision in the endoscopic group was significantly shorter than that in the conventional group. However, intraoperative blood loss, operating time, and duration of hospital stay were significantly reduced, and postoperative secretion of saliva was significantly improved in the endoscopic group, among whom there were no recurrences of tumour. More importantly, all patients who had endoscopically-assisted operations were satisfied with the cosmetic result. Endoscopically-assisted parotidectomy is superior to conventional resection as judged by postoperative cosmetic and functional outcomes. It is noteworthy that the site of incision depends mainly on location, and on the suspected low grade of malignancy of the parotid tumour seen on preoperative computed tomography and magnetic resonance images.     

腮腺浅叶不同区域良性肿瘤功能性切除术的探讨

目的:探讨腮腺浅叶不同区域功能性切除术在腮腺浅叶良性肿瘤治疗中的临床应用。方法:112例腮腺浅叶肿瘤患者术前临床检查配合B超或MRI检查倾向于良性肿瘤,其中72例根据不同区域采用功能性切除术,40例采用传统腮腺浅叶切除术,术后随访1周～5年,观察两组术后并发症及肿瘤复发情况。结果:112例良性肿瘤患者术后肿瘤均无复发,两组在Frey综合征、耳垂区麻木发生率方面差异明显,有统计学意义(P<0.01),两组在面神经功能损伤、涎漏和面部畸形的发生率方面亦有差异,有统计学意义(P<0.05)。结论:腮腺浅叶不同区域功能性切除术疗效优于腮腺浅叶切除术。     

腮腺良性肿瘤功能性外科治疗的临床分析

目的:比较不同手术方式治疗腮腺良性肿瘤的疗效,临床参数和术后并发症。方法:88例腮腺良性肿瘤患者被随机分为2组,传统术式组47例,即保留面神经,肿瘤及腮腺切除术;功能性外科治疗术式组41例,即美容除皱切口、胸锁乳突肌肌瓣、植入脱细胞真皮基质和保留面神经及耳大神经的肿瘤及腮腺部分切除术。通过3～30个月的随访,观察术后肿瘤复发、面瘫、涎瘘、Frey综合征、耳廓区麻木感、面部外形、口干、手术时间、出血量及术后住院时间情况。结果:2组相比,面瘫、肿瘤复发、口干和涎瘘发生率以及手术时间、出血量、术后住院时间差异均无显著性。传统的术式组耳廓区麻木感、Frey综合征和面部外形明显不对称的发生率分别为65.96%、31.91%和42.55%;功能性腮腺切除术组的发生率分别为36.59%7、.32%和9.76%(P<0.05)。结论:与传统腮腺术式相比,功能性腮腺切除术不增加手术时间和出血量,术后并发症较少。     

Wide excision of accessory parotid gland with anterior approach

Accessory parotid gland tissue has been described as salivary tissue adjacent to the Stensen duct that is distinctly separate from the main body of the parotid gland. Of all parotid gland tumors, 1% to 8% arise from the accessory parotid gland. Little is known about the accessory parotid gland, and it is seldom mentioned in the literature. Between 1999 and 2010, we have treated and followed 8 patients with tumors of the accessory parotid gland. There were 5 males and 3 females with a mean age of 35 years. They all presented with an asymptomatic cheek mass, and 4 of them underwent fine-needle aspiration. Ultrasound or computed tomographic scan was used in all patients. All the patients underwent surgical intervention with standard parotidectomy incision and anterior extension. The mean follow-up time was 44 months (range, 6-120 months). Seven patients had benign disease. Four cases were pleomorphic adenoma, and the remaining 3 benign cases were parotid cyst, basal cell adenoma, and hemangioma. Only 1 patient had a malignant tumor that was a lymphoepithelioma-like carcinoma. In 7 cases, wide excision (excision of mass and accessory lobe of the parotid gland) was done because of the intra-accessory parotid gland lesion. One patient had concomitant superficial parotidectomy because the tumor was located very close to and has involved the parotid gland proper. There was no serious postoperative complication and recurrence. Prudent preoperative diagnostic evaluation and meticulous surgical approach are the keys to successful management of midcheek lesions. A wide excision of the accessory lobe of the parotid gland can be a definitive surgery in case of solitary tumor with an intact parotid fascia, and wide excision with anterior approach through a standard parotidectomy incision is preferred to a direct incision over the mass.     

Functional outcomes and patient satisfaction after vascularized osteocutaneous scapula flap reconstruction of the mandible in patients with benign or cancerous tumours

Pre- and postoperative longitudinal assessment of oral functions including masticatory force, masticatory ability with solids, speech intelligibility, and subjective satisfaction was conducted for patients who underwent vascularized osteocutaneous scapula flap reconstruction after mandibulectomy. Postoperative changes in oral function and patient satisfaction were examined in relation to tumour type (i.e., cancerous vs. benign). A change in masticatory force was associated with a reduction in the number of occlusal support zones after surgery and clearly differed by tumour type. Despite all patients showing reduced masticatory force postoperatively, all were satisfied with the improvements in eating and chewing, which were greater in patients with benign tumours than in those with cancerous tumours. Although both groups of patients expressed satisfaction with the aesthetic appearance after surgery, patients with cancerous tumours were more satisfied. However, both groups showed decreased speech intelligibility scores and lower satisfaction with speech after surgery. Preoperative support in the form of reassurance and helping to alleviate anxiety about postoperative appearance would be beneficial for all patients, with additional support provided based on the specific tumour type.     

改良耳周切口在腮腺良性肿瘤切除术中的应用

目的 评价改良耳周切口在腮腺良性肿瘤切除术中应用的临床效果.方法 32例腮腺良性肿瘤患者,应用改良耳周切口行区域性腺体切除术、保留面神经和耳大神经的腮腺良性肿瘤切除术.术后随访,观察改良耳周切口的美观度及临床疗效.结果 所有患者均临床Ⅰ期愈合,无涎瘘发生.随访3 ～ 36个月,患者术后切口隐蔽,瘢痕小,腮腺区凹陷畸形不明显;无1例复发;有1例患者出现Frey's综合征;5例患者术后出现耳垂麻木,术后3 ～10个月内逐渐得到恢复.对32例患者行面神经功能评价:3例患者House-Brackmann分级为Ⅱ级,其余均为Ⅰ级.患者对切口的美观度比较满意.结论 改良耳周切口隐蔽,瘢痕小,并发症低于传统术式,术后美容效果理想.     

Omega incision face-lift approach and SMAS rotation advancement flap in parotidectomy for prevention of contour deficiency and conspicuous scars affecting the neck

To overcome the disadvantages after the surgical removal of tumours of the parotid gland, especially the depressed facial deformity and conspicuous cervical scar formation subsequent to parotid surgery, we have concentrated on omega face-lift incision in combination with an SMAS rotation advancement flap for the last several years using a lazy omega incision. Nine patients (3 male and 6 female) ranging in age from 43 to 68 years (mean age: 56.3 years) fulfilled the selection criterion of having a clinically benign discrete parotid lump with a benign preoperative fine needle cytology result. Parotidectomy was performed using the modified omega face-lift incision in conjunction with the rotation advancement SMAS flap. All patients underwent follow-up every 3 months in the first year. During the follow-up, the patients were specifically asked about their satisfaction with the post-operative appearance and whether they would consent to the operation again. The vascularized SMAS rotation advancement flap is clinically simple to perform and provides satisfactory cosmetic and functional results in patients undergoing conservative parotidectomy. There are no drawbacks in the use of modified face-lift incision to remove tumours of the parotid gland.     

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。     

Minimally invasive endoscopic resection of benign tumours of the accessory parotid gland: an updated approach

The most common conventional approaches for the resection of benign tumours in the accessory parotid gland are a standard parotidectomy incision, a modified standard parotidectomy incision, or a face-lift incision. The resulting scars may severely affect the patient's postoperative appearance. The previously reported endoscopically assisted approach offers a less aesthetically invasive technique, but it may still leave a visible preauricular scar 4–5 cm long. We have used a modified endoscopic approach with minimal, and concealed, incisions for the resection of benign tumours in the accessory parotid gland. Five patients were diagnosed by physical examination, imaging, and preoperative fine-needle aspiration biopsy. They had endoscopically assisted resections using our modified approach, and we evaluated its feasibility. All the resections were successful. The mean operating time was 108 min (range 90–130). The postoperative scars were concealed and aesthetically satisfactory. There were no facial paralyses, salivary fistulas, or recurrences in the short term. Using endoscopically assisted resection we completely removed benign tumours from the accessory parotid gland and obtained good aesthetic results. Our updated endoscopic approach for these resections is successful with shorter, concealed incisions. It is a viable alternative to conventional approaches.     

Clinical outcomes and cost-effectiveness of superficial parotidectomy versus extracapsular dissection of the parotid gland: a single-centre retrospective study of 161 patients

Improvements in preoperative diagnostics and intraoperative techniques have made the surgical excision of benign parotid gland tumours less invasive. Extracapsular dissection (ECD) has become more popular in comparison to superficial parotidectomy (SP), the gold standard. Although clinical outcomes have been reported, reports on cost-effectiveness are limited. The aim of this retrospective study was to analyse the surgical outcomes and cost-effectiveness of ECD versus SP in benign parotid tumour surgery. A retrospective cohort of 161 patients treated between 2012 and 2020 was collected. Data concerning demographics, clinical outcomes, and cost-efficiency were recorded. Analysis of the 161 unilateral parotidectomy cases (59 SP, 102 ECD) showed a significantly longer operation time, anaesthesia time, and length of stay for SP patients (all P < 0.001). Regarding postoperative complications, transient facial nerve weakness (P < 0.001) and haematoma formation (P = 0.016) were more prevalent in the SP patients. The frequency of positive margins was lower for SP (P = 0.037). No case of recurrence was identified with either technique. ECD showed excellent clinical outcomes as well as a reduction in complications when compared to SP. ECD is a viable alternative for superficial benign parotid gland tumours after thorough preoperative clinical, pathological, and radiological examination. The reduction in operation, anaesthesia, and hospitalization times with ECD is likely to result in a gain in cost-effectiveness.     

Salivary gland tumours treated in the stomatological clinics in Bratislava.

During the period of 1951-1996 a group of 1021 patients (484 men and 537 women, mean age 53 years, range 2-87 years) with salivary gland tumours were analysed retrospectively. The mean follow-up period was 8 years (range 10 months-25 years). The frequency of benign tumours was 74% (n = 755) and malignant tumours 26% (n = 266). Lesions were sited in the parotid gland 83% (n = 847), in the submandibular gland 10.8% (n = 110), in the sublingual gland 3.2% (n = 33) and in the minor salivary glands 3% (n = 31). The most common benign tumours were pleomorphic adenoma in 53.9% (n = 550) and Warthin's tumour 9.7% (n = 99). Of the malignancies, the adenoid cystic carcinoma was most common (6.4% of cases, n = 65) and mucoepidermoid carcinoma occurred in 5.2% (n = 53). The predominant therapy was surgery alone or in combination with postoperative radiotherapy in 93.7% (957 cases), radiotherapy alone after fine needle aspiration biopsy for 4.7%, and 19 patients remained untreated.     

隐蔽切口入路内镜辅助颈部肿物切除效果初探

目的探索评价颌面部隐蔽切口入路内镜辅助下颈部良性肿瘤切除的新术式。方法选取2018年1月至2019年8月于山东大学齐鲁医院口腔颌面外科就诊的颈部良性肿瘤患者17例(颏下区3例,下颌下区2例,腮腺后下极9例,胸锁乳突肌上区1例,胸锁乳突肌中区1例,胸锁乳突肌下区1例)。术前行CT检查,评价肿瘤大小、边界、形态、性质,根据肿瘤所在区域设计不同部位隐蔽切口,颏下区及下颌下区肿物选用口内前庭沟入路,腮腺后下极及胸锁乳突肌区肿物选用耳后隐蔽小切口入路。术中采用自制的"口腔手术用造腔装置"辅助牵拉完成颈部"造腔",内镜辅助下将肿物完整摘除,术后每3个月定期随访。结果所有手术均按预期完成,术后3个月复查时,视觉模拟量表平均为9.3分,患者对切口设计及手术整体效果均表示满意,术后1~15个月随访均未见复发。结论采用隐蔽切口入路内镜辅助颈部良性肿物切除是一种切口不明显、具有良好美容效果的手术方法。     

近发际缘切口在颧骨复合体骨折中的应用

目的 探讨应用近发际缘切口治疗颧骨复合体骨折的临床疗效。方法 对我科2009年7月—2009年12月收治的7例颧骨复合体骨折患者应用近发际缘切口治疗进行回顾性分析。结果 术后均无感染,面部外形恢复满意,咬合关系正常,无面神经颧支损伤出现。结论近发际缘切口损伤较小,可避免传统冠状切口的一些不足,是治疗颧骨复合体骨折的较好术式。     

Transoral robotic surgery of parapharyngeal space tumours: a series of four cases

Tumours arising from the parapharyngeal space (PPS) represent less than 1% of all head and neck tumours. Salivary gland tumours account for 40–50% of PPS lesions and are located in the pre-styloid parapharyngeal space. Pleomorphic adenomas represent 80–90% of salivary tumours in the PPS. Recently, transoral robotic surgery (TORS) has become common in head and neck surgery as a minimally invasive procedure. Four cases of benign PPS tumour treated with TORS are presented here. Preoperative diagnosis was conducted by fine needle aspiration biopsy and magnetic resonance imaging, and the results were used to plan the correct surgical approach. One case required a change of approach to conventional transoral blunt dissection. Patients required pain control and reported dysphagia symptoms for a period of weeks, but no nasogastric tube was needed at any time. This case series indicates that TORS is a safe surgical procedure for the excision of benign tumours of the PPS in selected cases.