Bianchi Bernardo, Ferri Andrea, Ferrari Silvano, Copelli Chiara, Sesenna Enrico
Maxillofacial Surgery Division, Head and Neck Department, University and Hospital of Parma, Parma, Spain.
J Oral Maxillofac Surg. 2011 Apr;69(4):1235-41. doi: 10.1016/j.joms.2010.03.005. Epub 2010 Aug 12.
The purpose of this article was to analyze the efficacy of facelift incision, sternocleidomastoid muscle flap, and superficial musculoaponeurotic system flap for improving the esthetic results in patients undergoing partial parotidectomy for benign parotid tumor resection. The usefulness of partial parotidectomy is discussed, and a statistical evaluation of the esthetic results was performed.
From January 1, 1996, to January 1, 2007, 274 patients treated for benign parotid tumors were studied. Of these, 172 underwent partial parotidectomy. The 172 patients were divided into 4 groups: partial parotidectomy with classic or modified Blair incision without reconstruction (group 1), partial parotidectomy with facelift incision and without reconstruction (group 2), partial parotidectomy with facelift incision associated with sternocleidomastoid muscle flap (group 3), and partial parotidectomy with facelift incision associated with superficial musculoaponeurotic system flap (group 4). Patients were considered, after a follow-up of at least 18 months, for functional and esthetic evaluation. The functional outcome was assessed considering the facial nerve function, Frey syndrome, and recurrence. The esthetic evaluation was performed by inviting the patients and a blind panel of 1 surgeon and 2 secretaries of the department to give a score of 1 to 10 to assess the final cosmetic outcome. The statistical analysis was finally performed using the Mann-Whitney U test for nonparametric data to compare the different group results. P less than .05 was considered significant.
No recurrence developed in any of the 4 groups or in any of the 274 patients during the follow-up period. The statistical analysis, comparing group 1 and the other groups, revealed a highly significant statistical difference (P < .0001) for all groups. Also, when group 2 was compared with groups 3 and 4, the difference was highly significantly different statistically (P = .0018 for group 3 and P = .0005 for group 4). Finally, when groups 3 and 4 were compared, the difference was not statistically significant (P = .3467).
Partial parotidectomy is the real key point for improving esthetic results in benign parotid surgery. The evaluation of functional complications and the recurrence rate in this series of patients has confirmed that this technique can be safely used for parotid benign tumor resection. The use of a facelift incision alone led to a high statistically significant improvement in the esthetic outcome. When the facelift incision was used with reconstructive techniques, such as the sternocleidomastoid muscle flap or the superficial musculoaponeurotic system flap, the esthetic results improved further. Finally, no statistically significant difference resulted comparing the use of the superficial musculoaponeurotic system and the sternocleidomastoid muscle flap.
本文旨在分析腮腺良性肿瘤切除术中，改良面部提升切口、胸锁乳突肌瓣及颞浅筋膜瓣在部分腮腺切除术中改善美学效果的疗效。讨论部分腮腺切除术的实用性，并对美学效果进行统计学评估。
对1996年1月1日至2007年1月1日期间接受治疗的274例腮腺良性肿瘤患者进行研究。其中，172例行部分腮腺切除术。这172例患者分为4组：采用经典或改良布莱尔切口且未行重建的部分腮腺切除术（第1组）、采用面部提升切口且未行重建的部分腮腺切除术（第2组）、采用面部提升切口并联合胸锁乳突肌瓣的部分腮腺切除术（第3组）、采用面部提升切口并联合颞浅筋膜瓣的部分腮腺切除术（第4组）。在至少随访18个月后，对患者进行功能和美学评估。功能结果通过面神经功能、味觉出汗综合征及复发情况进行评估。美学评估由患者以及由1名外科医生和2名科室秘书组成的盲评小组对最终美容效果进行1至10分的评分。最后采用曼-惠特尼U检验对非参数数据进行统计分析，以比较不同组的结果。P值小于0.05被认为具有统计学意义。
在随访期间，4组中的任何一组以及274例患者中的任何一例均未出现复发。将第1组与其他组进行比较的统计分析显示，所有组之间均存在高度显著的统计学差异（P < 0.0001）。此外，将第2组与第3组和第4组进行比较时，差异在统计学上也具有高度显著性（第3组P = 0.0018，第4组P = 0.0005）。最后，当比较第3组和第4组时，差异无统计学意义（P = 0.3467）。
部分腮腺切除术是改善腮腺良性手术美学效果的关键。对这组患者功能并发症和复发率的评估证实，该技术可安全用于腮腺良性肿瘤切除。单独使用面部提升切口在美学效果上有高度显著的改善。当面部提升切口与胸锁乳突肌瓣或颞浅筋膜瓣等重建技术联合使用时，美学效果进一步改善。最后，比较颞浅筋膜瓣和胸锁乳突肌瓣的使用情况，差异无统计学意义。
