Khazaeni Kamran, Rasoulian Bashir, Sadramanesh Elahe, Vazifeh Mostaan Leila, Mashhadi Leila, Gholami Golnaz
Department of Otorhinolaryngology Head and Neck Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Iran J Otorhinolaryngol. 2022 Mar;34(121):83-88. doi: 10.22038/IJORL.2022.51069.2717.
Patotidectomy is the treatment of choice for superficial parotid gland lesions. The present study aimed to assess the facial nerve status, as well as peri-and postsurgical complications, in two surgical techniques (antegrade and retrograde) for parotidectomy.
This study was conducted on 56 patients diagnosed with parotid neoplasms from 2013-2015. The patients were randomly assigned to two groups of antegrade and retrograde. In the retrograde group, the dissection was performed initially to expose the facial nerve branches, while in the antegrade approach, the facial nerve trunk was exposed initially. Different values, such as intraoperative bleeding, mass characteristics, and the time for different sections of the surgery, were noted. The facial nerve was examined after the surgery; moreover, hospital stay and drain removal time was also noted. During the six-month postoperative period, complications and squeals were also noted.
Based on the results, antegrade nerve dissection was performed in 24 patients, while retrograde nerve dissection was carried out in 25 patients. The two groups were compared for intraoperative bleeding, drain output, and drain removal time. Hospital stay was found to be statistically higher in the retrograde group (P<0.05). Other complications and morbidities, such as facial nerve trauma, sialoceles, salivary fistulas, Frey's syndrome, skin sensory changes, and surgery time, were not statistically different (P≥0.05).
As evidenced by the obtained results, retrograde dissection had higher intraoperative bleeding and longer hospital stay. It seems that skin flap dissection is more extensive in retrograde dissection, leading to more bleeding in this approach. These differences, although statistically significant, are not clinically important; consequently, surgeons' experience and knowledge about the two approaches are of utmost importance.
腮腺浅叶切除术是治疗腮腺浅叶病变的首选方法。本研究旨在评估两种腮腺切除手术技术（顺行和逆行）中面神经的状况以及手术中和手术后的并发症。
本研究对2013年至2015年诊断为腮腺肿瘤的56例患者进行。患者被随机分为顺行组和逆行组。在逆行组中，首先进行解剖以暴露面神经分支，而在顺行组中，首先暴露面神经主干。记录术中出血、肿块特征以及手术不同阶段的时间等不同数值。术后检查面神经；此外，还记录住院时间和引流管拔除时间。在术后六个月期间，也记录并发症和后遗症。
结果显示，24例患者进行了顺行神经解剖，25例患者进行了逆行神经解剖。比较两组的术中出血、引流量和引流管拔除时间。发现逆行组的住院时间在统计学上更高（P<0.05）。其他并发症和发病率，如面神经损伤、涎囊肿、涎瘘、Frey综合征、皮肤感觉改变和手术时间，在统计学上无差异（P≥0.05）。
结果表明，逆行解剖术中出血更多，住院时间更长。似乎逆行解剖中皮瓣分离更广泛，导致该方法出血更多。这些差异虽然在统计学上有显著意义，但在临床上并不重要；因此，外科医生对这两种方法的经验和知识至关重要。
